Years ago I attended a conference in which Robert Kane, MD, of the United States Public Health Service made the following statement: “There are only two countries in the world that do not, at least philosophically, believe health care is a right of citizenship: The Union of South Africa and the United States of America.” Both countries continue to have a two-tiered system with a mix of private, for-profit health care, and public health care. However, the Union of South Africa does have a plan to fast-track a public system of health care in which all South Africans would be covered.
The United States continues to struggle with the problem of inaccessible health care. The vast majority of what is considered public health care is actually public payment for private health care through insurance programs such as Medicare, Medicaid, and more recently, the Affordable Health Care Act. While the Affordable Health Care Act extended coverage to millions of people who had no health care insurance, there are still millions of people with no coverage. There have been multiple efforts in the political arena to dismantle the Affordable Health Care Act, and those efforts continue. At this juncture, there is little likelihood that the Affordable Health Care Act will be extended to cover all Americans, and there is a danger that efforts to dismantle the Act might succeed, resulting in loss of health care coverage for millions.
With our fractured system, we spend more on health care than any nation in the world. Most U.S. citizens continue to believe that the United States has the best health care system in the world. That belief appears to be used to justify the expense of the current system. There are health care quality indicators that debunk the belief that the U.S. health care system is the best in the world. Two of the most telling are that the United States is 49th in life expectancy and 178th in infant mortality. In terms of infant mortality, the United States of America looks like a third-world country. All nations ahead of the United States in those two measures of health care have universal publicly funded systems that cover all their citizens. Although there are no data I could find on the results of quality of health care for the very rich in the United States, it is possible that the United States leads the world in the quality of health care for the very rich.
Where is the United States documented as first in terms of health care? As already stated, the United States leads the world in health care expenditures. We also lead the world in the number of citizens, primarily seniors and disproportionately women, institutionalized in long-term care facilities, mostly nursing homes. The United States institutionalizes its citizens in nursing homes at three times the rate of the country nearest to the United States in nursing home institutionalization and six times the rate of most nations. We also lead the world in the percentage of gun deaths and gun-related injuries not related to war. It stands to reason that the essentially unrestricted availability of guns in the United States is, in fact, a health issue.
Given the realities of the exorbitant expense and lack of quality and equality for all in the current U.S. health care system, isn’t a change to universal availability of quality health care long overdue?