The Supreme Court has released its decision on the Healthcare Reform Act, and while there will be much debate through November and well beyond as the various programs within the law are enacted, one thing is clear. While we claim to have the best healthcare in the world, the fact is that as a nation, some have the best healthcare money can buy, but for others, our present system can be considered mediocre at best.
This harsh reality is supported by many international studies and reports. According to the WHO 2010 study on healthcare quality, the US is ranked 37th amongst nations with France ranked as number 1 and the US listed between Costa Rica (36th place) and Slovenia (38th place). However, when we look at healthcare costs, what matters perhaps even more is the fact that we are simply not getting good value for our money. Japan, ranked 10th in healthcare quality on the 2010 WHO survey, spends 8.1% of their GDP on healthcare, whereas the US spends 15.3%. However, a better barometer for the quality of healthcare would be to look at outcomes. Again, Japan is the winner with infant mortality at 3 per 1,000 and the average life expectancy is 83 years. In contrast, infant mortality in the US is 7 per 1000 (more than double) and the average life expectancy for an American is 78 years.
Let’s not, however, be naïve and assume that the Supreme Court decision will have any impact on the immediate future on how well our healthcare system performs. What it will do, however, is allow the process of improving our care to begin and hold us accountable as a society for the overall well-being of our nation. What we should also expect to see is that over time, components within the law will evolve, and we will look to modify them to take on the best elements of other proven systems that best match our needs. For example, the Netherlands mandates that all their citizens have health insurance, but the Dutch have to obtain coverage through private insurers. These providers can be either for-profit or not, but in any case, the government has strictly defined operating standards that all insurers must follow, and perhaps the most important fact is that coverage cannot be denied for pre-existing conditions. Enrollees can opt for different levels of coverage, and government subsidized tax credits are available for low-income individuals and families. This can be one approach that would find support on both sides of the Congressional aisle.
While we should expect that the debate in Washington will continue, we cannot ignore that over 16% of Americans are without healthcare coverage. An even more alarming number to consider is the subset of Americans who are working but without insurance. In Texas, for example, it is estimated that 70% of the uninsured population are, in fact, employed but their employers are not providing coverage. Because they are without insurance, they are not involved in preventive or ongoing care. Instead, when they require medical attention, they use the hospital emergency room as their de facto primary care provider. The problem is further compounded when follow up is lacking and cost-effective ongoing primary care is replaced by repeat visits to emergency services. Multiply this to reflect the entire nation and the inappropriate use of services is simply unacceptable.
The Supreme Court decision is a major first step in addressing this problem. Now is the time to put the political debates aside and move ahead on implementing programs that address high-quality and cost effective healthcare for all Americans. Let us not forget it has been nearly 50 years since Medicare was introduced to address the fact that over half of Americans over the age of 65 did not have healthcare coverage. As a society, we need to recognize that healthcare is a right rather than a privilege, but it does come at a cost. The intent of the bill is to share this cost across society so that every American rather than just some can have equal access to the right care at the right time.