Flaws in the US Health System Design




Rick lives in the United States and has no health insurance. A work injury sliced off the top of two of his fingers. Not having enough money to reconstruct both fingers, he decided to save his ring finger at the cost of $12,000. Larry and Donna is a middle class American couple in their mid-50s who had good jobs and lived comfortably until they had the misfortune of both being victims of chronic illnesses. Donna was diagnosed with Cancer and Larry had several heart attacks. The deductibles from their health insurance added up and left them bankrupt. They now have to live in their daughter’s home and start from scratch. These are the stories of citizens of the most powerful and richest country in the world; the country where all dreams can come true; the country that many risk their lives to get to, seeking the American dream (Sicko, documentary by Michael Moore, 2007).

 Millions of American citizens do not have health insurance and even the ones that do, are often overwhelmed by medical costs. In a comparison study of health insurance designs of the US with several European high-income countries (UK, France, and Germany), American adults were the most skeptical about being able to afford care if they fell ill. In fact, 20% of the US adults revealed having serious problems paying medical bills as compared to a maximum of 9% in the other countries (Schoen et al, 2010). This gap was more pronounced for adults below 65 years of age and with lower-income status. In a time when the world is moving towards free primary care for all and equity in health, the US health scheme still divides the population in different insurance programs based on age and socioeconomic status. Is the health of all American citizens not valued equally? Even war veterans who have put their lives on the line for the country often times come home and struggle with medical bills. Is it pride keeping the US from seeking advice and following the path of its European counterparts?

It is true that the US takes the lead when it comes to cancer treatment. Adults over the age of 65 have a better chance of surviving when they get sick because Medicare provides access to intensive screening and treatment, even in the case of chronic diseases such as cancer. Cancer survival does not decline with increasing age in the US (Nolte et al., 2012). But one might ask, who are the most likely to survive cancer long enough to have the chance to enroll in Medicare and enjoy its benefits? The middle to higher-class individuals maybe. If a lower class working age citizen, who is barely above the threshold to qualify for Medicaid, is diagnosed with cancer, he might not live long enough to benefit from the Medicare services. This illustrates the different intricacies of the US healthcare system where every citizen cannot fit perfectly in the pre-designed categories in order to receive certain health services. Some, will inevitably be left out and remain uninsured.

When it comes to healthcare coverage for all, the US is still lagging behind compared to other high-income countries. The US might have the highest health expenditures but they still only rank 42nd in infant mortality and 46th in average life expectancy ( Schroeder, 2007). There are still strong health inequalities based on race, class, and geographical area. Even with the introduction of the Affordable Care Act, some of the insured might not escape medical financial catastrophes (Schoen et al., 2010).



Sicko (2007). Documentary by Michael Moore

Schoen C., Osborn R., Squires D., Doty M., Pierson R., and Applebaum S. (2010). How health insurance design affects access to care and costs, by income, in eleven countries. Health Affairs, 29, no.12: 2323-2334

Schroeder A. Steven (2007). We can do better- Improving the health of the American people. New England Journal of Medicine 357; 12.

Nolte E. and McKee M. (2012). In amenable mortality–Deaths avoidable through health care—progress in the US lags that of three European countries. Health Affairs 2114-2122


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