May 26, 2018
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Woman’s death epitome of health system’s failure

By Edwin Dean

Nikki White, a young Tennessee woman, had lupus, a serious but treatable disease. If she had lived in Japan, France, or one of many other countries, she would have received treatment and could have lived a normal life span.

But Nikki was trapped: She had too much money to qualify for Medicaid and too little to pay for the medical care she needed to stay alive. And once she was sick, she couldn’t get health insurance. So she died at age 32 — not really of lupus, according to a local Tennessee doctor, but of the failing U.S. health care system.

Nikki’s history, related by veteran journalist T.R. Reid in his new book “The Healing of America,” reflects a tragedy: In the U.S. we allow people to die because they cannot afford the doctors’ bills.

And Nikki’s case is not unusual. Each year, somewhere between 18,000 and 45,000 Americans die because they don’t have medical insurance, according to varying estimates by different research groups.

But the failings of the U.S. health care system go beyond allowing citizens to die from treatable diseases. Reid notes that our system is the most costly in the world and, compared to other industrialized countries’ systems, it performs poorly.

Health care spending in the U.S. is more than $6,000 annually per person, while Japan spends $2,500 and Germany and the Netherlands about $3,000. We spend 15 percent of our GDP on health care, more than any other country in the world.

Since U.S. health care costs are the world’s highest, shouldn’t we have one of the best health care systems? Yes, but we do not. Our peer countries — other wealthy, industrialized, democratic countries — have systems that produce much better results. For starters, the average life span of U.S. citizens is 78 years. This puts us 47th in the world, in the same league as Cyprus and Bosnia.

The U.S. is dead last in a ranking of infant mortality in developed countries; we are 23rd out of 23 countries.

We also do miserably in ratings of overall performance. The Commonwealth Fund, a New York research group, ranked us 15th out of 19 developed countries. Other studies also have ranked the U.S. system far from the top.

Even as our health care costs have risen more rapidly, our performance has slipped compared to other countries. In 1970, we spent 40 percent more per person than six other advanced countries, according to two university-based economists, Alan Garber and Jonathan Skinner. But now we spend 90 percent more. Meanwhile, U.S. life spans have risen most slowly: for example, life expectancy for people over age 65 has risen faster in all six of the other countries than in the U.S.

These simple figures, admittedly, do not fully reflect a complex reality. For example, the U.S. has a very high five-year survival rate for breast cancer patients; and our research labs and medical schools lead the world. Still, despite a few exceptions, we lag our peers on most health care performance indicators.

While these measures of cost and performance are vital for assessing health care systems, they do not address the key moral question raised by Nikki White’s death: whether a nation should guarantee a right to health care. All other industrialized countries make this guarantee; we alone allow people to die because they cannot afford the doctors’ bills.

Clearly the U.S. could learn something from other countries. And other countries’ systems offer plenty of choice, because they differ greatly from one another.

We could start by looking at Germany. As in the U.S., most German doctors are in private practice. All health insurance companies are private, and they are required to accept all applicants. All Germans have a wide choice of insurance plans — they select from among 200 companies. The system is financed by payroll deduc-tions, paid partly by workers and partly by employers. And waiting times for medical services are shorter than ours.

The French system, ranked as the world’s best, shares many features with the German system. We also could learn from Britain, Japan and Canada, countries with widely differing systems.

Will someone tell me why some Americans argue for the status quo?

Edwin Dean, an economist and seasonal resident of Vinalhaven, writes monthly about economic issues.

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