Steven Barkan, University of Maine
Originally published in the Bangor Daily News on November 8, 2016.
The United States is often said to be an exceptional nation, but one way in which it is exceptional is not very flattering: Americans have much worse health overall than the people of any other wealthy democracy. Our life expectancy at birth is the lowest of all wealthy democracies, with Americans expected to live at least two fewer years on average than our counterparts elsewhere. Our infant mortality rate is the highest of all our peer nations, and we have the highest rates of adult diabetes and obesity. We also rank worse than the average of our peer nations in heart disease, chronic lung disease and other health problems. The U.S. has such poor health even though it far outspends its peer nations on health care per capita.
What accounts for this dire situation? Research by health scholars and government agencies points to several factors, among them the following:
First, the U.S. is the only wealthy democracy to lack universal health insurance for basic health care. Peer nations have many ways of achieving universal coverage, but America’s reliance on private, for-profit health insurance has left many people without insurance or with insufficient insurance. Obamacare has improved this situation, but lack of adequate coverage is still a problem in the U.S. but not in its peer nations. This fact forces many Americans to forgo needed medical care and/or to incur huge medical bills that are often financially crippling. In international survey evidence, more than one-third of Americans say they cannot afford needed medical care, a figure that is three times higher than the average for peer nations.
Second, the U.S. has the lowest rate among western democracies of primary-care physicians such as family doctors and general practitioners. Public health scholars emphasize that primary care is essential for helping individuals and families to remain in good health and to recover from any health problems. Peer nations have better health in part because more of their physicians provide primary care.
Fourth, poverty is much higher and social supports for the poor are much weaker in the U.S. than in peer nations. Because poverty and low income contribute mightily to poor health, the low quality of U.S. health partly reflects its high rate of poverty and near-poverty. But even wealthy Americans are less healthy than wealthy people in peer nations, underscoring the importance of other factors for the poor state of American health.
What can be done to improve America’s health? An important step would be to move toward what many scholars call Medicare for All. Medicare for people 65 and older is not perfect but does provide good care for older Americans at a lower cost than what younger Americans obtain with private insurance. A Medicare for All system could be modeled on the various systems found in every other wealthy democracy. A possible model is Canada’s health care system, also called Medicare, which covers all Canadians at birth and entitles them to basic health care wherever they live, regardless of income. Because Canada emphasizes primary care over specialist care, Canadians do wait longer on average than Americans for non-urgent surgeries and other procedures, but Canada ranks better than the U.S. on many other indicators of health and health care, and Canadians in national surveys report greater satisfaction with their health care system than Americans do with theirs. As Ralph Nader once commented, “In Canada, when you go to the doctor or hospital the first thing they ask you is: ‘What’s wrong?’ In the United States, the first thing they ask you is: ‘What kind of insurance do you have?’”
Obamacare was a worthy attempt, grounded in politically conservative proposals that emphasized individual responsibility, to expand health insurance coverage within a private insurance model. Many more Americans are insured now than five years ago, but Americans remain much more likely to be uninsured or underinsured than the residents of every other wealthy democracy. A public option for Obamacare coverage will be helpful, but ultimately this great nation needs to become even greater by joining other wealthy democracies with Medicare for All to ensure that all Americans can afford adequate health care regardless of their ability to pay for it.
Steven E. Barkan is professor and interim chair of the Department of Sociology at the University of Maine. He is the author of “Health, Illness, and Society: An Introduction to Medical Sociology,” published in August 2016. He is a member of the Maine chapter of the national Scholars Strategy Network, which brings together scholars across the country to address public challenges and their policy implications. Members’ columns appear in the BDN every other week.