The coronavirus pandemic (COVID-19) reveals how important a health care system is for the welfare of society. Everyone is endangered if people do not get adequate health care. What does the coronavirus reveal about the United States health care system?
We start with the positive. The United States is the world leader in medical innovations. An effective vaccine for COVID-19 is likely to emerge from U.S. medical research. However, patent laws often restrict the diffusion of our medical innovations and limit the benefits they could bestow upon humanity at large. Indeed, this could happen regarding a future COVID-19 vaccine.
Unfortunately medical innovation is about the only health-care measure at which the United States excels. We spend 17.7% of our GDP on health care, and we have the world’s highest per capita health-care expenditures. Other wealthy countries only spend about 10% of GDP on health care, but they get substantially better health care results. The United States has the lowest life expectancy of any wealthy country (almost six years less than that of Japan), as well as the highest maternal mortality rate (nine times higher than that of Sweden).
A comprehensive study initiated by the Commonwealth Fund compared the United States health care system to that of 10 other advanced capitalist countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United Kingdom). The study used five broad measures of health care: equity (how does the health care of rich people compare to that of poor people); access (how affordable is health care); health care outcomes (e.g. age-specific mortality rates); care process (four different scales of patient experience); and administrative efficiency (e.g. cost of delivering comparable medical treatment).
The United States health care system ranked dead last on equity, access, and health care outcomes. It ranked second last on administrative efficiency. Overall, the U.S. health care system proved far inferior to the health care systems of the other 10 advanced capitalist countries, despite spending much more money on health. So extreme was this inferiority that the study’s authors considered the U.S. health care system to be a statistical outlier.
Capitalist economic systems always generate inequality, and they usually organize production for the purpose of making profit. But not all capitalist systems are the same. What explains the inferiority of the U.S. health care system to that of other advanced capitalist countries? Health care in the United States is largely organized as a profit-making system. We are the only wealthy country without universal health care benefits.
Hence insurance companies acquire huge profits, health care delivery is severely income-graded, and millions of U.S. citizens lack medical coverage. The absence of universal care benefits is the most important source of our flawed health-care system, but certainly not the only one. Both health-care providers and patients waste a lot of time on billing and insurance claims. The fee for service compensation of health care of providers invites a plethora of irrationality and corruption.
The performance of our health-care system in the face of the coronavirus pandemic has been dangerously inadequate. Some of the system’s failings are attributable to incompetent leadership, but many are truly structural. A crisis sometimes enables deep social change, and perhaps the coronavirus pandemic will do exactly this. Transforming our flawed system into egalitarian socialist health care is probably not feasible, but at least we should catch up with other rich capitalist countries.