Thursday | September 21, 2017
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Obamacare will be an improvement

In the same way that democracy, as Churchill said, is the worst form of government except for all the others, Obamacare is the worst form of health care reform except for all the others that had no chance of passing.

There are, however, far better ways for developed nations to operate health care systems. A new report from the private Commonwealth Fund foundation, published online last week by the journal Health Affairs, shows just how poorly the U.S. health care system is operating compared with those in 10 other industrialized nations.

This is the point that’s often ignored by critics of the Patient Protection and Affordable Care Act: For all of its shortcomings, both in its design and implementation, it can only be better than what it’s replacing.

The survey found only one in four American adults think the country’s health care system works well and needs only minor changes. Forty-eight percent said the system needs “fundamental changes,” and 27 percent said it needs to be “completely rebuilt.”

Canada, where only 42 percent of the adults surveyed are happy with their nation’s health care system, is the next-most-disgruntled of the 11 nations surveyed. The health care system with the highest rate of satisfaction is the United Kingdom, where 63 percent of adults think the system works well and needs only minor tweaks.

There’s good reason for the U.S. system being so unpopular.

— It’s by far the most costly. The United States spends $3,000 more per patient than Norway, the second-highest spender. Forty percent of Americans reported spending at least $1,000 in out-of-pocket medical costs in the last year. In Sweden, the U.K., France, the Netherlands and New Zealand, fewer than 10 percent reported high out-of-pocket costs.

— It’s hard to get a timely appointment. In Germany and New Zealand, about 70 percent of adults said they got a same- or next-day appointment the last time they were sick. In the United States and Canada, fewer than half of adults said they got such prompt attention.

— It’s a hassle. Eighteen percent of those in the U.S. said they’d spent significant time dealing with medical bills and administrative issues last year. Only the Swiss, where 16 percent reported paperwork hassles, have that much of a problem.

It’s a problem for doctors, too, with 54 percent of U.S. primary care physicians saying they had to wrestle with insurance providers.

The most alarming part of the Commonwealth Fund survey is the number of people who skip getting care or drugs because of access and affordability issues. Among Americans with insurance, 21 percent said they’d put off seeing a doctor and 15 percent had skipped prescription drugs in the past year because of costs.

Among the uninsured, 58 percent skipped seeing the doctor and 36 percent skipped prescription drugs.

Even the social Darwinists among us — those who believe that Nature sorts out the undeserving — should realize people who don’t see a doctor or take drugs when they need to likely become much sicker and thus a greater burden to society. Unless we just let them die, an alternative that some of Obamacare’s critics haven’t ruled out.

The Affordable Care Act, for all of its shortcomings, will help some of these problems. It won’t fix everything; not even the U.K. and France, countries with the broadest single-payer systems, score 100 percent satisfaction.

However, costs are significantly lower and satisfaction is significantly higher in those countries. The United States will get there eventually, but it will be a very long, painful and expensive journey.

— From the St. Louis Dispatch


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