In the United States we spend twice as much per capita on healthcare as do other countries. That’s an average of $12,530 per person per year, totaling $4 trillion or roughly 20% of our GDP. Yet despite these cost disparities, America ranks near the bottom among major industrialized nations in medical outcomes, including longevity, childbirth mortality, equity, and fullness of coverage. America’s private healthcare, to put it bluntly, is a grossly inefficient money pit. That shouldn’t surprise anyone considering healthcare in the U.S., save for single-payer Medicare and Medicaid, is a disjointed collection of thousands of competing providers linked more by financial enrichment than humane prolonging of lives. In his latest book It’s OK to Be Angry About Capitalism, Senator Bernie Sanders, our sole visionary in elected office today, aptly describes America’s current for-profit healthcare system as “working exactly the way it was designed…for the people who own it.” Healthcare industry profits, soaring over $100 billion in 2021, attest to the need for complete overhaul to repair flaws and make it more serviceable to the rest of us. Until then, it will remain inaccessible to many in need of medical attention because the current system, dominated by private insurers and equally greedy pharmaceutical companies, is much too expensive, accounting for half of all U.S. personal bankruptcies (about 500,000 each year). More importantly, $60 billion in profits raked-in by the six largest health insurance companies in 2021 coincided with 85 million Americans either uninsured or underinsured that year. Another consequence of our misplaced priorities is that inadequate medical coverage contributes to an estimated 60,000 preventable deaths each year. Not only do patients and untreated suffer, but physicians are burdened by bureaucracy as well. Because a third of healthcare costs are spent on administration, physician costs for interactions with myriad insurers average about $80,000 per year.
Maintaining a status quo which guarantees unconscionable wealth for insurance and drug companies (and aspiring billionaires controlling them) denies universal provision of medical service as a human right. That failure makes us the only major country not to guarantee healthcare for everyone. It also focuses medical attention, physiologically and psychologically, on retroactive treatment of illnesses much more than preventive medicine, proactive disease control and societal wellbeing as a whole. Countries with single-payer healthcare generally have populations which are healthier and happier than U.S. congeners. If we were to adopt a single-payer system here, fiscal analyses suggest Medicare-for-All, the most tenable option, could save our healthcare system $650 billion a year beginning in 2030 and provide much needed equity in medical coverage.
Single-payer systems may contract for medical services from private organizations (as happens in Canada) or own and employ resources and personnel (as in the UK, India and Spain). The “Beveridge” (or “Nordic”) Model found in Scandinavian countries features both public health providers and public health insurance, differentiating it from Canada’s Medicare and similar universal systems, including Taiwan’s. Because “single-payer healthcare” refers to health insurance provided to citizens and legal residents as a public service, either managed by government or regulated agencies, U.S. Medicare expanded to cover everyone would be our best and easiest mode of transition. Of course, that would dig into excessive profits of private insurers, pharmaceutical companies and compensation packages awarded CEOs, the latter totaling hundreds of millions of dollars. Medicare-for-All, as envisioned by Bernie Sanders, the Green Party and overwhelming majorities of doctors and nurses supporting that conversion, should also be expanded to include dental care, treatment of mental illnesses, eyeglasses, hearing aids, and provision of services to millions of elderly and disabled Americans in their homes. Delaying that process in America has been a persistent moral failure. Oscar Wilde was spot-on when he said, “The truth is rarely pure and never simple.” While no healthcare system is perfect and tweaking Medicare-for-All won’t be a panacea, implementing that single-payer conversion will get us much closer. Clearly, until we make that switch, private for-profit healthcare in America will continually get costlier, fatally trailing the global pack.
Unlike many countries, the United States also has been reticent to provide inexpensive education for students choosing career paths in medical professions, including dental, nursing, and mental health curricula. As a result, fewer students pursue those degrees and those that do can be tethered to student loans amounting to hundreds of thousands of dollars, steering them into specialized medicine and high-income locales. Few flock to rural, economically depressed, medically underserved regions of the country. The twofold result: “treatment deserts,” forcing patients to travel long distances for diagnoses and care, and overcrowded hospital emergency wards for lack of primary care physicians to treat nonemergency conditions. That problem is only worsening because so many medical professionals, nurses especially, are either reaching retirement age or suffering burnout, especially with COVID variants persistently endemic. Those worsening staff shortages are exacerbated by fewer and fewer med school graduates replacing lost personnel. Adding to America’s medical crisis, primary care in emergency rooms can cost ten times more than treatment in community health facilities.
Unlike single-payer systems, adopted by most other industrialized nations and greatly appreciated by their citizenry (just ask any Canadian, Frenchman, Brit or Swede), America’s privately-operated healthcare landscape is unnecessarily complicated by gaps in coverage caused by excessive fragmentation and networks. Medicaid, while reasonably comprehensive, is only available to people below a certain income. As a major source of funding for long-term care, either at home or in nursing/convalescent facilities, eligibility necessitates patients depleting life savings. If patients have any savings at all, they must “spend-down” assets they hoped to leave children and grandchildren. Even their homes are taken as equity. Medicare with co-payments at least provides strong and comprehensive medical and hospital coverage, but currently doesn’t include glasses, hearing aids, extended long-term care or dental coverage. The Affordable Care Act, which expanded Medicaid, is a labyrinthine convolution of federal subsidies and private insurance coverage with variable co-pays, deductibles and premiums, and unlike other countries with universal healthcare support, most Americans have private healthcare insurance tied to their employment. The fragility and ineffectiveness of employer-based health insurance became clear during the pandemic when lost jobs meant lost healthcare. Consequently, in order to stay insured, workers are often trapped in jobs they want to leave. Additionally, low-income workers can’t afford premiums, medical records aren’t centralized, and hundreds of plans with variable coverage impact quality and availability of treatment. Out-of-pocket expenses (premiums, co-pays, deductibles) keep escalating as well, especially for non-union hires at the mercy of employers.
Life expectancy in the U.S. dropped from 78.86 years in 2019 to 76.6 years in 2021, the second year of the pandemic. In fact, in the wake of SARS-CoV-2, American longevity has dropped more than any other wealthy industrialized nation. COVID-19, however, which has killed 1,125,000 Americans to date, including 186,702 confirmed “underlying-cause” deaths in 2022, isn’t the sole reason for that decline. Decades in advance of the biggest drop in U.S. life expectancy since 1943 (WWII’s deadliest year) developed countries around the globe have been surpassing us in lifetimes. Norwegians and South Koreans live a full six years longer than the average citizen here, whereas people in New Zealand, France, Germany and other EU countries beat us by four to five years. Of course, people in those countries work 32 to 35 hours a week, make living wages, have sick and personal leave, and take long vacations. They also know basic necessities for existence (i.e., healthcare, education; medicines) are government-guaranteed rights, services provided at low to zero cost. Stress reduction resulting from those assurances also contributes to longevity. Not surprisingly, the aforementioned nations, especially Scandinavia, are perennially ranked happier than we are.
These disparities in happiness and life expectancy, the latter in its worst decline in a century, aren’t limited to international standings among global peers alone. At home, we’re experiencing our biggest regional life expectancy divide in 40 years. Americans in Florida and Mississippi, for instance, tend to die 20 years younger on average than counterparts in California and Colorado. Income assistance, Medicaid expansion, prevention of gun- and drug-related deaths, and access to safe abortions are some of the ways state policies affect our time above the ground. Each year, guns kill far more people than automobile accidents, deaths attributable to air pollution number around 107,000, and drug overdose fatalities take another 100,000. As Bernie Sanders understates it, “rich people live, poor people die.” American Inequality’s research, recently summarized in a Time Magazine article by Jeremy Ney, suggests a strong correlation between household wealth and prospects for survival. While richer communities in California and Colorado nurture 87 years on average, poorer communities in Kentucky and Florida, where median income is $35,000, have an average life expectancy of 67, lowest in the U.S.
Incomes tie into many other factors which either delay or hasten our curtain calls. Low-income communities, regardless of geography, are generally less able to access healthcare and live not only in food deserts but close proximity to toxic industrial waste. Those segments of the population also die younger because higher frequencies and sociologic propensities for gun violence, drug overdoses, obesity and chronic diseases, such as cancer, diabetes and heart conditions, form hotspots in impoverished areas. The racial divide is likewise pronounced. African Americans tend to live about 5-years (on average) less than White counterparts for whom prenatal, maternal and preventive health outcomes are better. Arkansas, for example, has a maternal mortality rate 50% higher than the national average, and it’s 75 times more dangerous to carry a pregnancy to term in Mississippi than to abort it. Yet, some of the poorest states with lowest life expectancies refuse to expand Medicaid, despite generous federal funding. Meaningful gun control measures also remain nil, even though firearms are the No. 1 killer of America’s children, and in poorer communities, firearms prevent 1 in 25 younger adults from reaching age 40.
People in lower income U.S. communities certainly shouldn’t die in their 60s, while folks in wealthier counties live into their 80s. But that’s exactly the contrast existing today between states in the Deep South and those above the Mason-Dixon Line, largely because of state and local politics. Unaware of these differences, most Americans are clueless to the benefits major countries around the world guarantee their citizens to prevent, or at least minimize, inequities. Norway’s government ensures that every citizen, not just the well-off, gets access to high-quality healthcare and education from pre-K through college. We don’t. Canada and other major countries negotiate prescription drug prices with pharmaceutical makers. We don’t. So, Canadians, Asians and Europeans pay a fraction of what Americans do for the same meds. Our ignorance of what other countries provide citizens is engineered, of course, because media outlets make money selling timeslots and print space from which private health insurers and drug companies launch advertising salvos. Manufacturing consent for dysfunctional systems, it’s a constant barrage that only gets worse. Because Medicare-for-All threatens those revenues, media moguls obscure facts about single-payer healthcare successes and guaranteed rights in other countries, suppressing informed debate on those topics and limiting American reforms. Meanwhile, as if fascism were in vogue, propaganda mills keep cranking out “anti-socialist” non sequiturs, attacking healthcare, environmental and educational advances.
Close to 90 percent of all U.S. media is controlled by eight gargantuan conglomerates, including Comcast, Warner Bros., Facebook, CBS and Fox. Other large media companies are owned by individual billionaires such as Jeff Bezos, who purchased The Washington Post 10 years ago. Too often, when facts don’t support narratives that financially benefit owners, media giants are inclined to ignore the facts. Class issues ranging from income and health inequalities to corporate power and influences of money in politics fall by the wayside despite thousands of television and radio stations, newspapers, magazines and websites. We need to learn from other countries and emulate their successes, especially when it comes to education and healthcare. And until we learn to greatly enhance funding for public, non-partisan, nonprofit media, America’s well being will continue to decline, sinking in the wake of unfettered Uber-capitalism that puts profits ahead of lives.
Scott Deshefy is a biologist, ecologist and two-time Green Party congressional candidate.