Obamacare Will Survive Its Botched Rollout
The HealthCare.gov debacle, and the cover-up and blame game that followed it, have reinvigorated Obamacare's critics, who argue anew that the law represents expensive government overreach. So it's worth stepping back from the website mess to remember the deeper problems that made this law necessary in the first place -- and, by extension, why the issues with HealthCare.gov, which seem so important today, pale in comparison.
The first problem with the status quo can't be repeated often enough: The U.S. spent 17.7 percent of its gross domestic product on health care in 2011, 50 percent more than the next highest among countries in the Organization for Economic Co-Operation and Development. The average for developed countries is less than 10 percent. Yet unlike every other developed country, a big chunk of Americans didn't have insurance -- almost one in six Americans last year.
And that money is spent badly. U.S. government health-care spending alone reached $4,066 per person last year -- more than any other OECD country save for Norway. But it mostly went to Medicare and Medicaid. In other words, it costs the federal and state governments more money to cover the elderly and the poor than foreign governments spend to cover their entire populations. It's hard to think of a better signal that the system before Obamacare didn't work.
Of course, for those with access to care, the U.S. is a good place to be sick. Americans received 103 MRI exams per 1,000 people in 2011, more than any other rich country, including Belgium (77), Spain (66) and Canada (50). The discrepancy was even higher for CT scans. And deaths from cancer are lower in any given year than for many rich countries -- 194 for every 100,000 people in 2010, which was better than the U.K., Italy, Germany, the Netherlands and Denmark.
Yet Americans on average get less care and die younger, despite spending more as a country. As Eduardo Porter noted in the New York Times last week, the U.S. has an alarmingly high infant mortality rate -- higher than any OECD nation, with the exception of Mexico and Turkey. And not just a little bit higher. In 2011, 6.1 infants died for every 1,000 live births. The corresponding figures were 2.3 in Japan; in Sweden, 2.1; and in Iceland, 0.9.
The U.S. is also lagging at the opposite end of life. An American born in 2011 can expect to live 78.7 years -- less than somebody born in almost any European country, and 26th out of 36 in the OECD. Put another way, American men lose almost twice as many potential years of life as the Swiss, Dutch, Swedes or Italians, and U.S. women aren't far behind.
The part in between isn't great either. Fully 70 percent of American men and 56 percent of American women reported being overweight or obese in 2011. That's 15 to 20 percentage points higher than their counterparts in Canada or Europe. You could look at that as the product of lifestyle, or you could look at it as the sign of a country that's failing to protect its citizens' health.
What's made U.S. outcomes so bad? Partly it's that Americans have built a system that makes them less likely on average to see doctors than their rich-world counterparts. In 2009, the latest year for which the OECD has published data, there were 4.1 doctor consultations for each American; only Sweden was lower, while the numbers in Germany, Spain and Canada were about twice as high. Fewer doctor's visits mean fewer chances to diagnose problems, manage treatments, or even take simple preventive measures -- such as talking about the importance of diet and exercise.
Another consequence of less access is lower immunization levels. Ninety-five percent of U.S. children were immunized against diphtheria, tetanus and pertussis last year. If that sounds high, the rate was 99 percent in Belgium, France and Greece, as well as the Czech Republic, Poland and even Mexico. The U.S. does even worse on immunizations for measles -- 92 percent in 2012, compared with 99 percent in Hungary, Slovakia and Korea.
You could also measure the inadequacy of American health care through the amount of health-care resources that are available to the population as a whole. The U.S. has fewer hospital beds per person than most developed nations; a fraction as many psychiatric care beds; and trails every European nation in medical graduates, at 6.6 per 100,000 people. (Germany and the UK have almost twice as many.)
Obamacare won't fix all of this. The U.S. will probably keep spending more than its peer countries on health care. But expanding government-subsidized insurance and standardizing what it means to be covered, along with removing co-pays for preventive care, should start to close the gap in health outcomes between the U.S. and other countries.
And while the mayhem around HealthCare.gov might slow that process, it's unlikely to prove fatal to the law. That doesn't mean we should stop talking about the website's problems. It just means we should keep reminding ourselves why it's so important they get fixed.
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To contact the author on this story:
Christopher Flavelle at firstname.lastname@example.org