News reports of the proposed replacement for the Affordable Care Act cite huge cost estimates with comments by hard-headed fiscal types that suggest we cannot afford health care for everybody. Truth is we are already paying for universal health care; we just don’t get what we pay for.
In the U.S., combined public and private spending on health care accounts for about 17.6 percent of gross domestic product. This is the highest in the world. Of all the countries in the Organization for Economic Co-operation and Development, the next highest spending is in The Netherlands at 12 percent of GDP. For the OECD nations combined, the average health care spending is about 9.5 percent of GDP, and most of those nations already have some form of universal health care.
This enormous cost differential might be justified if it bought us better health care, but it doesn’t. The average U.S. life expectancy is 78.2 years vs. 79.5 years in other OECD countries. A more important metric is infant and childhood mortality, and by that measure the U.S. ranks no better than a dismal 18th in the world.
The driver for this cost-benefit disparity is the fragmented structure of our health care system. Physicians and hospitals are paid only for procedures, not for preventive care, and almost always by third parties (insurance companies and governments). There are no cost controls built into the system; everything is designed to be as expensive as possible. As a result, insured people are overtested, overdiagnosed, and overtreated.
People without insurance can’t afford to see a doctor until they arrive at a hospital emergency room in labor or in an advanced stage of some condition that could have been treated by a primary care physician at far less cost. The high cost of this unnecessary ER care becomes hospital overhead and is passed on to the insured patients. Because of this structural inefficiency, our annual rate of increase in health costs is higher than in any of the OECD countries. This is unsupportable and we must restructure the system.
Opponents of single-payer plans and proponents of abolishing the ACA complain that both are socialist schemes. This is true, but the employer-paid and individual insurance plans we cling to are also socialist schemes. The only difference is the size of the society and the terms of membership.
We are always just one corporate downsizing or a pre-existing condition away from being excluded from those societies and losing our socialist health care coverage. With a single-payer plan, the society is the nation and health care becomes a right of citizenship.