In 2010 the American healthcare system received its most dramatic overhaul since the introduction of Medicare and Medicaid in the 1960s.
The introduction of the Affordable Care Act – popularized in the media as “Obamacare” – mandated that applicable, large employers provide health insurance, while also requiring all Americans carry health insurance. It helped establish an open Marketplace whereby insurance companies could not deny coverage based on pre-existing conditions, and citizens earning less than 400% of the poverty line would qualify for subsidies.
It is the closest the USA has been to a universal healthcare system. Yet despite evidence showing it has reduced healthcare disparities for minorities, America is still spending more money per capita on healthcare than any comparable wealthy nation while continuing to have a lower life expectancy and worsening health outcomes compared to its peers.
How does the US healthcare system compare?
The cost and quality of the US healthcare system are two prominent issues facing everyday Americans. The comparison of healthcare between the US and other nations, however, goes far beyond simplistic questions like, ‘what does a nurse practitioner do in America that’s so different to other countries?’ Instead, we need to examine the system as a whole.
From the late 19th to the mid-20th centuries, many nations worked towards creating health insurance systems that made health care accessible and affordable to all residents. Some countries relied on publicly funded systems, while others had a compulsory private insurance system in place. Many countries utilized a mix of both, resulting in universal or near-universal coverage for all their citizens.
The USA however, took a different approach during this period. Primarily relying on a voluntary private insurance system, it resulted in a large number of the population being uninsured. Strides were taken in 1965 with the introduction of Medicare for adults over 65 and Medicaid for low-income earners, and the Affordable Care Act in 2010 which overhauled the system to create near-universal eligibility for healthcare, however, the health system is still largely voluntary, and millions of people continue to go without insurance citing cost as the primary barrier.
Despite strides forward, the United States still does not have a universal healthcare system. Photo by Online Marketing on Unsplash.
United States healthcare spending
The USA spends more on healthcare per person than any other wealthy country. Comparatively, in 2022 the United States spent an estimated $12,742 per person on healthcare, Switzerland was the second highest at $9,044, while the average across wealthy OECD countries was just $6,850 per person.
Healthcare spending is driven by utilization and price, meaning an increase in either of these will result in higher healthcare costs. The interesting part of all this? Despite the significantly higher spend per person, the US utilization rates does not differ significantly from other wealthy countries – meaning United States pricing is the main driver of this cost.
The reasons behind this higher cost are varied. A combination of inefficiencies, the consolidation of hospitals leading to a lack of competition, and administrative costs that relate to the complex healthcare system that must be navigated all likely play a part. The United States tops the list of administration costs, spending over $1,000 per person – nearly $600 more than the next country, almost five times more than the overall average across all countries, and more than it spends on long-term care.
United States healthcare outcomes
With the significantly higher spending and cost to patients, better health outcomes would be expected in the US – and yet, they are not. The United States’ health outcomes are no better than other wealthy countries, and are in fact, worse in some factors.
In the 1980s the life expectancy of a US resident was similar to other wealthy countries (73.7 years to 74.5), however, this gap has grown substantially. In 2021, the life expectancy of a US resident is now six years shorter than those in peer countries.
All-cause mortality rates (the number of deaths per 100,000 people) also plateaued in the United States in the 2010s, while in other nations they continued to fall. From 1980 to 2020, the mortality rate from all causes of death fell by around 19% in the US, compared to a 43% decline in other peer countries. During the COVID-19 pandemic, all countries saw an increase in mortality rate, but the US showed a significantly higher increase than all peer countries.
The United States also performs worse in many common health concerns, such as infant mortality rate, unmanaged diabetes, and safety during childbirth.
Overall the United States healthcare system does not compare favorably with other peer countries. A system that perpetrates high costs and poorer outcomes poses a long-term threat to the financial and economic well-being of the country, and so focus should be placed on the areas of concern; health outcomes, healthcare spending, and access to healthcare for all residents.
