NEW YORK — The health care discussion in the United States increasingly has revealed evidence of how corporations and politicians hinder the provision of adequate health care to the majority of Americans. The result is that the U.S. has one of the worst health care systems among industrialized nations.
Studies carried out by the World Health Organization and the Commonwealth Fund in New York show that overall performance of the U.S. health care system ranked 37th among the countries included in their analysis.
The Commonwealth Fund study, released in 2007, titled “Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care,” found that the U.S. health care system was not only the most expensive in the world, but it also came in last in most measures of performance.
The Commonwealth study compared the health system in the U.S. with that of Australia, Canada, Germany, New Zealand and the United Kingdom. The most obvious point on which the U.S. differs from the other countries is the absence of universal coverage. The U.S. is also last in terms of access, patient safety, efficiency and equity.
Compared with the other countries studied, the U.S. lags in the adoption of information technology and other national policies that promote quality improvement. In New Zealand, Germany and the U.K., up-to-date information systems enhance physicians’ ability to monitor chronic conditions and medication use. Yet, the U.S. pays a higher percentage of health dollars for administration than any other nation.
Almost 47 million Americans lack health insurance coverage, more people than the entire population of Canada. As pointed out by Wendell Potter, a former health insurance executive, if this number were to include all those that are underinsured, it would represent more people than the population of the U.K.
According to the Children’s Health Fund, 9 million children are uninsured in the U.S., while another 23.7 million — nearly 30 percent of the nation’s children — lack regular access to health care.
How do corporations pressure politicians not to support health care plans that benefit the majority of the population?
“By running ads, commercials in your home district when you are running for re-election, not contributing to your campaigns again, or contributing to your competitor,” Potter said during an interview with Bill Moyers.
In addition, Potter described how a Republican strategist suggested the use of catchphrases such as “government takeover,” “delayed care is denied care,” “consequences of rationing,” “bureaucrats, not doctors, prescribing medicine,” which have been faithfully parroted by politicians opposed to health care for all.
Through several mechanisms, insurance companies deny coverage to people to increase profits. As Potter explained in testimony to the U.S. Senate Committee on Commerce, Science and Transportation last June, among those mechanisms are “rescission” and “dumping.”
If a sick policyholder omits a minor illness or a pre-existing condition when applying for coverage, the insurance company uses this as justification to rescind the policy. In addition, insurance companies may dump businesses whose employees’ medical claims exceed what insurance underwriters have estimated. And once a business has been dumped by an insurer, it may have no other viable options because of widespread consolidation in the industry.
Lack of coverage seriously affects the health of the uninsured because they receive less preventive care, are diagnosed with a disease at a later stage, tend to receive less quality care, and have higher mortality rates than those who are insured.
Separately, an article just published in the Journal of the American Medical Association reveals that 62.1 percent of all bankruptcies filed in the U.S. in 2007 could be attributed to medical reasons. Most of those who had accrued massive medical bills contributing to bankruptcy were well-educated, owned homes and had good jobs. Three-quarters of them had health insurance.
This is a crucial moment for resolving one of the most savage inequities conspiring against people’s health and well-being in the U.S. Both individuals and businesses, particularly small businesses, are at the mercy of powerful corporation interests. Unless those interests are curbed, people’s health will continue to be a victim of corporate predation.
Cesar Chelala, M.D., Ph.D., is a public health consultant for several international agencies.