Is the United States’ poor showing in combating the pandemic a direct consequence of its market-based healthcare system?
The United States, among the most advanced countries in medical research and healthcare, has lost more than 80,000 people to date to Covid-19, a rate close to 6% of official cases. Many studies indicate the toll could be even higher on the ground.
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Late and insufficient testing was the primary reason why the United States lost the first round of its battle with the disease. Few expected that the country boasting the world’s largest economy would be so unprepared for a public health crisis. The size of the US economy, $21.428 trillion in 2019 in dollar terms, defies imagination; one could buy 21 companies like Apple with that money and still have enough left over to fund all the necessary cancer research in the country.
It is against this backdrop that the campaign for Medicare For All as the future of US healthcare policy assumes great significance for Americans, who spend a much larger sum out-of-pocket on healthcare than citizens of other developed economies—$1,103, according to a 2016 estimate. More Americans lack health insurance than ever before; and with both political parties active in curbing Medicare, the situation remains grim. Those who have insurance may not have comprehensive coverage, which means when the devil strikes with a life-threatening disease, their insurance isn’t big enough to fight back.
More Americans than ever are putting off treatment for serious, even life-threatening diseases.
A 2019 Gallup Survey
As a consequence, they also carry more debt related to medical expenses. Such evidence affirms that the United States health system can be rated among those with the worst outcomes, despite the government spending more than 17 percent of its GDP on healthcare.
Costly and inadequate
Hospital beds per 1000 people were 2.8 in 2016 in the US, compared to 2.6 in the United Kingdom, which has a public healthcare system, and 8.1 in Germany. Even with insurance, a weak and expensive primary care system has resulted in Americans receiving inadequate treatment, leading to costly hospitalizations later. The Covid-19 pandemic has further exposed these faultlines in American healthcare.
America’s fractured medical care system has seen healthcare costs rise much faster than inflation in recent years. According to The Center for Medicare & Medicaid Services, healthcare spending was forecast to increase by 5.3% in 2018, after a 4.6% increase in 2017; this trend is expected to continue through 2026. US policy-makers‘ inability to check rising prices of medical goods and services and higher Medicaid costs are to blame for healthcare expenses that are quickly becoming unaffordable for many. Indeed, statistics show that the financially weaker section of the population, with poor insurance coverage and limited access to primary care, has been hurt badly by the pandemic.
Watch: American healthcare system has betrayed the financially weaker communities.
The gap between R&D and cure
The big pharma companies, buoyed by tax reform in 2017, are spending more on R&D but it is well known that the sector has been slow on randomized clinical trials, because such studies, especially for critical illnesses such as heart diseases, are so large and expensive that most companies do not test their medicines. The United States has spent nearly $700 million of taxpayer money on coronavirus research since the 2003 SARS outbreak through the National Institutes of Health, which has funded 210 drugs approved by the FDA from 2010 to 2016.
$700 Million
Taxpayer money spent on coronavirus research since the 2003 SARS outbreak.
The country leads in global biomedical research. But pharma companies enjoy exclusive licenses to engage in later-stage drug development, which allows them to retain pricing and marketing rights, a practice that encourages drug R&D. Gilead Sciences and Sovaldi, developer of the Covid-19 drug Remdisivir, Regeneron Pharma, Johnson & Johnson and Sanofi are some of the big names active in this area. However, the pricing does not reflect taxpayer funding and therefore does not adequately take the welfare of citizens into account.
Healthcare policy revolution that the US needs
The current reality is that the US healthcare system, and each of its units, must be a profitable business model in order to sustain itself, which presently happens only in the expensive ‘specialty care’. The result: primary care, the first stop for a sick person, is overlooked, and pandemics can have a disproportionately adverse effect on the category. Research shows that higher investment in primary care leads to lower total healthcare costs and improved patient outcomes, yet the sector has remained underfunded and neglected.
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Unfortunately, in the race for the Democratic presidential nomination, few candidates offered any concrete and clear plan on healthcare, except for Bernie Sanders, who had a clear slogan of “single-payer, no-cost healthcare”, and Elizabeth Warren, whose campaign offered a less extreme model of Medicare For All. Both failed to sustain themselves in the race as China, President Donald Trump‘s impeachment, and Covid-19 took center stage.
Whichever way the pandemic pans out, one thing will be made clear: whatever the outcome of the 2020 elections, whenever they are held, healthcare looks set to be the policy reform issue that will make or break the new US administration.
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