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Straight, No Chaser: The Affordable Care Act and The Math of the US Healthcare System

By Jeffrey Sterling, MD September 22, 2018

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As we begin 2014 with the implementation of the Affordable Care Act and states’ implementation of Medicaid expansion (well in most of the country), it bears reviewing why this was necessary. Joining me in this conversation is Dr. Bill Vostinak, a prominent orthopedist.
Prior to approval of the Affordable Care Act, and in spite of the loud and incorrect proclamations that we have the “best healthcare system in the world,” the U.S. would have been easily challenged on its purported effectiveness of our healthcare system based on a simple review of the following objective data points. (Our apologies in advance to those who value opinions over facts—or math.)

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Let’s start by appreciating just how much the U.S. has been spending on our healthcare system and what type of access Americans have had to it.
The U.S., by a large margin, has the highest healthcare expenditures in the world. We spend approximately 17% ($1 in every $6) of our gross domestic product (GDP) on healthcare. The next closest nation spends 11%. (For clarification, that’s an incremental increase from the above chart of 2000.)
Despite our exorbitant national costs, only 84.9% of U.S. citizens have healthcare insurance. That translates to 50 million Americans who were uninsured prior to today. We rank 33rd in the world.
Have you ever heard the quote that “85% of Americans are happy with their healthcare?”  (Congratulations if that statement applies to you.) Do you realize that in a nation of over 320 million, that leaves 48 million Americans unhappy? Even if you got past the “48,000,000″ number, which is a massive number of citizens, consider the 85% number.
This is America. 85% is barely a B-grade in school. Is that the standard we seek? And … do the math. Notice the nearly exact match, likely not coincidental, between the number of individuals dissatisfied with their healthcare and the number of uninsured Americans. Basically, you’re satisfied if you have insurance, and if you don’t … not so much. Alternatively, 85% satisfaction may be based on the perception of insurance carrying the individual’s burden of medical costs.
Now let’s move to quality.
In an infamous ranking of healthcare systems around the world, the World Health Organization (WHO) ranked the U.S. system 38th based on routine outcomes-based metrics such as disability-adjusted life expectancy, speed of service, protection of privacy, quality of amenities, and fairness of financial contribution. WHO Ranking
Amid predictable criticism of the U.S. regarding the WHO study, Bloomberg performed its own analysis  and discovered that among advanced economies, the U.S. spends the most on healthcare (on a relative cost basis) with the worst outcome. Bloomberg ranked the U.S. 46th among all nations in efficiency given the average expenditure of $8,608 per year per individual. Bloomberg Report
In terms of infant mortality, about 11,300 newborns die each year within 24 hours of their birth in the U.S., with 50 percent more first-day deaths than all other industrialized countries combined. Infant Mortality
Save the Children’s 14th annual “State of the World’s Mothers” report ranked the U.S. 30th out of 168 countries in terms of best places to be a mother. Criteria included child mortality, maternal mortality, economic status of women, educational achievement and political representation of women. SaveTheChildren.org
An important distinguishing factor in comparing U.S. healthcare with other systems is tying it to employment rather than citizenship. Labor and other costs of American goods and services make it difficult for American corporation to compete in world markets. Add the large fixed cost of healthcare, and competing is nearly impossible.
It is reprehensible to suggest that the effort to cover 50 million uninsured Americans is some socialist plot or anything other than the humane thing to do. Let’s just stop with the selfishness and nonsense about there being no value to the efforts being made to improve access to/quality of healthcare (which reintroduces preventive and mental healthcare considerations) than we had previously. If you don’t believe us, just do the math. Even after a full implementation of the ACA, estimates suggest than some 20 million Americans will still be uninsured.
America is alone among the major industrial nations of the world in not having universal healthcare. That’s the collective decision of the country. Hopefully, these most recent steps through the ACA will represent significant steps toward efficiency, effectiveness and full inclusion. So, how do other countries deliver quality care for less? We’ll save that for another discussion.
Feel free to ask your SMA expert consultant if you have any questions on this topic.
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0 thoughts on “Straight, No Chaser: The Affordable Care Act and The Math of the US Healthcare System

  1. Timely discussion Dr.Sterling…looking forward to hopefully more dialogue on our unhealthy lifestyle choices, such as obesity,Violence etc…Other developed countries simply have a better handle on these and other issues that’s making our current U.S. system unsustainable. Great work!

    1. Jonas, if you type either obesity or violence into the search engine, you will find many blog posts that have already covered these topics. Of course much more information is available at sterlingmedicaladvice.com. Thanks for the compliment and for following Straight, No Chaser.

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