Jan 4, 2022
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American health care: money is the goal, health is the means

The USA loves to teach the whole world. They also teach about how to heal people. Until recently, it was considered almost an axiom that American medicine is the best (one of the best) in the world: after all, the United States leads in the amount of spending on medicine.

According to the WHO ranking World Health Organization: Global Health Spending 2020, the share of health care spending in US GDP in 2017 was 17.1%. Switzerland, which ranks second in the world by this indicator, has 12.3% of GDP. Most other Western European countries had relative health spending in the range of 9-11 percent of GDP. In Russia – 5.3%, in China – 5.2%.

And here are the most recent US health statistics for 2020, when a “pandemic” was declared and health care spending skyrocketed. Compared to the previous year, they grew by 9.7% and reached 4.1 trillion. dollars. Their relative level jumped to an unprecedented indicator in the history of the United States of 19.7% of GDP. On a per capita basis, spending also hit a record $ 12,530. And the United States’ share of global health spending is nearly 50%! The idea may arise that America is a country where health has become the highest value. However, this is far from the case.

The United States, using its reputation as the “leader of world health”, is trying to lead the world in the fight against covid. However, the results of two years of such a struggle have demonstrated the helplessness of the United States, even within the country. Judge for yourself. As of January 3, 2022, the total number of cases from the viral infection of COVID-19 in the world reached 290.66 million people, including 56.14 million in the United States. The total number of deaths from this disease in the world was 5.46 million people. … Including in the United States – 847.4 thousand.It turns out that the United States accounted for 19.3% of all cases and 15.5% of deaths in the world from COVID-19 And this despite the fact that the share of the United States in the world’s population is 4.3 %. Conclusion: the incidence of covid in the United States is 4.5 times higher than the global average; mortality – 3.6 times.

Let’s take a look at the situation in the United States and in the world over the last week of last 2021. The number of new cases in the world during this time amounted to 9.42 million people. In the United States – 2.53 million. The number of deaths diagnosed with “covid” in the world in the New Year’s week was equal to 40,760 people. In the USA – 7.695.

The pre-New Year picture is even more unattractive than in the whole two-year period. At the same time, America has very good (against the background of the world average) rates for vaccination against covid. As of January 1 of this year, the number of fully vaccinated in the United States was 72.93% (the world average is 59.0%), and the number of fully vaccinated is 61.16% (the world average is 49.8%).

Commentators and observers, characterizing the US helplessness in the fight against the pandemic, discuss various versions of such helplessness: either the US pretends to be fighting a “pandemic”; or have chosen the wrong path to conduct such a struggle; or their health care system was not built right from the start. I think all these versions have a right to exist, but the third is the most fundamental and most dangerous for America’s future.

The American healthcare system is unique among the world’s leading countries. It does not guarantee medical care to all citizens of the country. The same Barack Obama, having become the master of the White House, announced some, to put it mildly, unsightly aspects of this system, referring to the US Census Bureau. According to him, in 2009, 50.7 million residents, or 16.7% of the population, did not have health insurance. For another 30% of citizens, medical assistance was provided in an incomplete volume.

I note that the main sources of America’s healthcare spending are the following (for 2021,%): private insurance – 33; insurance through the state agency Medicare – 22; government insurance Medicaid – sixteen%; other state programs – 12; “Pocket” of citizens – 10; other private sources – 7. That is, half of the expenditures falls on the state, the other half – on non-state sources.

Obama wanted to increase the coverage of health care costs at the expense of the state to 80-90 percent, and all types of health insurance (both public and private) to protect the entire population of the country. Him and the next president Donald Trump it was possible to only partially solve this problem. In 2019, 32.8 million people still did not have health insurance, or 12.1% of the US population.

The fact that the American health care system is far from perfect, to put it mildly, is also evidenced by the average life expectancy. The WHO builds country ratings for this indicator every few years. The last one is for 2015. In the list of 198 countries, the United States is in 41st place with an indicator of 80 years. The first seven places with an indicator of 84 years are occupied by seven countries at once: Macau, Hong Kong, Singapore, Japan, Italy, Spain and Switzerland. And what may seem surprising, some developing countries have a higher life expectancy than the United States: Costa Rica, Reunion, French Guiana, Chile, Cuba, etc.

The UN periodically publishes rankings of countries by relative mortality rate (the number of deaths per 1000 inhabitants). The last rating is for 2017, in the rating list there are 195 countries. At one pole, Sierra Leone has the highest mortality rate (13.9). On the other – the UAE with the lowest mortality rate (1.5). And wealthy America is right in the middle of that list at 8.2.

In August 2021, a study was published on the state of health care in eleven of the richest countries in the world: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States. It was hosted by a non-profit organization Commonwealth Foundation… Information base for the study – data from WHO, OECD, other organizations, as well as sociological surveys.

To assess the health care system, five main categories of assessment were identified: access to health care, treatment process, administrative efficiency, equity, and results. Each category covers several elements of health services. For example, assessing access to health care covers both the availability of health care and the time it takes to get it. In total, the overall assessment includes 71 indicators.

And one country steadily continues to occupy the last, eleventh place in the ranking. This is the United States. Norway took the first place in the ranking this time (2021), the second – the Netherlands. Directly above the United States are Switzerland (9th) and Canada (10th). From one study to another, the assessment of the last place of the United States in the ranking is accompanied by such characteristics: “the highest mortality rate in the general population”, “the highest infant mortality rate”, “the highest prices for medical services”, “the absence of a comprehensive health insurance system” (the only country among 11 where there is no such system).

The striking lag of the United States behind the other ten richest countries looks especially indecent against the background that, for example, a number of countries have reduced prices for medical services, and Germany in 2013 completely canceled patient payments for doctor’s visits. The current leaders of the rating – Norway and the Netherlands – have dramatically facilitated a patient’s access to a doctor (in terms of the time from a phone call to an appointment). The authors of the report acknowledge that the gap between the United States and most other countries on the list of “11 rich” is not narrowing, but growing. And this despite the fact that, as noted in the study, the US has the highest absolute and relative expenditures on health care in the “11 richest” group, and their gap from the other ten countries is not decreasing. The authors of the report avoid explaining such a paradox.

And the explanation is clear: American healthcare has become a big money machine. Money became the goal, and health (or rather, the lack of it) became the means.

Photo: REUTERS / Andrew Kelly

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