How U.S. health care measures up

With the debate over the future of Obamacare now underground — Senate Republicans having decided that the monstrous American Health Care Act approved by the House two weeks ago is best discussed in secret, and they may be at it for months yet — it's a good time to review the state of health care in the United States. It's not just a question about the fact of ACA beneficiaries (or those who might lose insurance under the AHCA). How has the U.S. health care system performed for all of us, rich and poor, insured or uninsured over the last quarter-century?

The short answer: Not great.

The latest study on the quality of health care internationally between 1990 and 2015 published this week in The Lancet, a leading medical journal based in the United Kingdom, examined what researchers call "amenable mortality" in 195 countries. It's a clever way of looking at health care outcomes and not just spending or sickness. Instead of merely considering mortality rates, researchers investigated death rates for medical conditions that "should not be fatal in the presence of effective medical care."

In other words, the quality of, or access to, medical care probably isn't at fault when someone suffers horrific injuries in a serious car crash, but perhaps it was an issue for those who died young of treatable diseases like diabetes or measles. The good news is that researchers found nearly all countries saw improvements over time with the worst results often recorded in — and there's certainly no surprise here — undeveloped countries, which tend to have fewer medical resources of any kind.

The United States tied for 34th under what's called the "Healthcare Access and Quality Index" with Estonia and Montenegro, countries with gross domestic products that rank a piddling 104th and 155th in the world. That a nation with the wealth and technology of a super power like the U.S. has a health care performance behind that of Slovenia, Cyprus and Malta — and not even within hailing distance of leaders like Iceland, Switzerland or Sweden — is nothing short of a national disgrace.

Yet one wonders if the American public even appreciates how bad things are, or are they, like many members of Congress, caught up in the minutia of Medicaid expansions or the operation of insurance exchanges? The crisis is that the nation pays too much and receives too little in the health care system, and it's literally killing us — the number of preventable deaths by neonatal disorder, heart disease, non-melanoma skin cancer, diabetes and kidney disease is simply not in line with our spending of $9,000 per man, woman and child each year, the highest of any country.

Earlier this month, a congressman from Idaho drew national attention for making a particularly asinine statement about the situation, which was captured on video and seen around the world. "Nobody dies because they don't have access to health care," Rep. Raul R. Labrador told constituents attending a town hall in Lewiston, Idaho. He couldn't be more wrong, as the Lancet study documents. People with health emergencies may not be refused treatment at the local emergency room, but without health insurance, many can't afford the regular checkups and screenings that can prevent a health crisis from developing in the first place.

And that's another frustration in the health care debate. Why doesn't Congress focus as much on the cost of sickness to this country as it does on the cost of taxpayer-subsidized insurance? The Centers for Disease Control and Prevention has estimated that the cost of illness to employers alone (in lost productivity and sick days) runs about $225.8 billion annually. Even with Obamacare, there are still an estimated 28.5 million Americans without health insurance coverage — many of whom simply can't afford it.

Conservatives object strongly to the notion that health care should be regarded as a "right," yet they ignore the country's chronic underperformance dating to well before the Affordable Care Act was ever on the books. Shortly after the House passage of the Obamacare repeal and replace measure, President Donald Trump congratulated Australia's prime minister for having a better health care system than the U.S. And he was right. They have universal health care with publicly-financed free access to doctors and public hospitals. When will Americans get wise and demand similar access and similar results?

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