Before I took my first job, as a phlebotomist, I had absolutely no understanding of how the health system in the United States worked. I always assumed that the U.S. had the best health care system and that every country should at least attempt to emulate us. We have the highest survival rates for most types of cancer in the developed world, we perform the most complex medical procedures, and we pay our doctors the most. The output of our health system seems pretty darn good. I was stumped, however, at understanding how our inputs into the health system are then translated into one of the greatest and most advanced medical systems in the world.
I was completely baffled when I looked at a chart by the WHO ranking health systems’ performances across different nations and the U.S. didn’t even rank among the top twenty-five. The ranking was based on a definition of a health system, which includes health status, responsiveness, and financial risk protection. A health system is not ranked solely by its output. The U.S. would rank very highly if the only criteria considered were survival rates of rare diseases and the amount of specialized medical personnel. The U.S. health care system, however, is the most expensive health care system in the world. U.S. per capita expenditure is nearly double that of the next highest, Switzerland. Most of these costs, however, aren’t because our health system provides that much more health care than other countries, but because the U.S. has exorbitant administrative costs due to our complex multiple payer system. Our system has left out around 50 million Americans because they cannot afford health care, but honestly they just can’t afford the high transaction costs of our health system.
Our expensive health care system is a reflection of our culture. Traditionally, Americans have considered themselves libertarians valuing the independence of individuals from massive governmental programs. Many Americans are wary to accept a public option because it is just one more way the U.S. government can control its citizens. We value the innovation inspired by completion and pride ourselves in having the most advanced health care in the world. Americans also look at the past financial managing experience of the U.S. government. The social security fund never actually existed and now the system is on the verge of collapse, and Medicaid and Medicare are horribly run and often times have huge gaps in medical coverage. I can see why many Americans fear government run programs, but our unequal distribution of health care among the poor and wealthy does need to be fixed.
There is no universal health system; there is no one right way to sustain health in a population. A health system should work to increase the health of the population, be responsive to individual needs, and protect people from financial devastation due to illness. Comparisons of health systems may not be the best way to analyze performance either. Differing factors such as population size, culture, per capita income, and societal values all effect how a health system is organized and these factors vary widely across national boundaries. In the U.S., I receive great health care for what I pay. I would be upset if the quality of my individual care is reduced because of a lack of resource allocation. I am also aware that some people cannot afford health care in the U.S. because of our health system. Should there be a trade off? Should Americans accept less innovation and less quality for equal distribution or is there a way to have our cake and eat it too?