The American Healthcare System

The American Healthcare System


To use the vernacular in a droll way, discussions on America’s healthcare have “gone viral.”

Let’s add to that.

The primary object of “healthcare” is, and always has been, to keep us alive and in good physical and mental shape longer.  Objectively everything else is subordinate.  With that as the premise, it is logical to look at how long we are expected to live, hence the term average life expectancy.

The Real Cost of American Healthcare | Medicare | Preventative Care

Average Life Expectancy, Worldwide

Data from World Health Organization published this year but relating to 2013 statistics indicates the United States has a life expectancy of 79, apportioned as 76 for men and 81 for women.  Those numbers rank the US in a tie for 34th place along with our neighbors just off the Florida coast, Cuba as well as Costa Rica, Nauru and Qatar.  There is a UN study but it has not been updated since 2010.  In it we rank 40th.

Canada, our northern cousins are ranked in a ten nation tie at 8th place.  Personal question: why do we keep then hearing how the Canadians hate their healthcare system?  Seems to work pretty well.

Significantly, Japan tops the table at 84 years and most of our Western European ancestral lands are 80+.

We can pretentiously debate that one year or maybe even two years does not make a real difference.  Aside from the fact that few of us would willingly give up two years of life, the line of argument is that we are ranked where we are despite having the highest healthcare expenditures in the world and by any calculation method.

American Healthcare:  Are We Living Better?

The Real Cost of American Healthcare | Medicare | Preventative CareIn understandable terms, the U.S. spends about 90% more on health care than other developed countries.  Comparatively we pay a much higher percent of GDP and per capita spending and for that achieve an unimpressive 34th place, much lower than the majority of those nations we categorize as comparable.

In simple terms:  We are paying much more and for much less of a return.

Putting aside the political rancor, the basic conclusion must be drawn that our system does not work as well as it should.  Most people accept this so the next question is the ubiquitous “why?”

What is the difference between us and, say, the European Countries?  One element goes to the core of the issue.  We do not recognize healthcare as a right (think life, liberty and pursuit of happiness).  Expanding on that thought, the United States is the only wealthy industrialized nation that does not have a universal health care system whereas every nation ranked ahead of us, resultant from that philosophy, does.

Conversely, we continue to see healthcare services as a benefit, some HR issue that trade unions demand.

Covering all the people is good but it’s also crucial to look at the desired outcome i.e. increased years of comfortable life, and approaching the “how to” from a singularly different angle.

Health + Care = Prevention

Fundamental note:  the operative word is not universal; it is health and that is an overall slant that we seem to have missed.

Trickle down might not work in economics but it does in healthcare.  It is called prevention.  It is something we do with our cars and appliances but not to ourselves and it is that which separates us from those ranked over us.

The Real Cost of American Healthcare | Medicare | Preventative Care

Adding fuel to the fire, it also that approach that causes our delivery system to be so expensive.

Irrespective of what we hear, our system is primarily geared to treating occurrences and not to preventing them.  It can be a vicious cycle: physician offices and walk-in clinics do not provide credit services; so without healthcare insurance the only source of care is the hospital emergency room.  Amazing places but they are the most expensive health environs to be seen especially for what are often not life-threatening but routine situations and thus a poor use of these expensive resources.

American Healthcare:  Looking at Medicare

Even within our so-called entitlement programs there is basic lip service to prevention and virtually no provision for what other nations see as mandated.  Medicare—which turned 50 in July 2015— is a good benefit, yes, but it comes with a price: deductibles and co-pays (20%), both of which can be expensive to insure and impossible for many living on fixed incomes.

Further, and very important, it does not cover long-term care for the elderly and the memory challenged (dementia and Alzheimer’s); or dental care including dentures; or eye examinations related to prescribing glasses; or hearing aids and the exams for fitting them.

Other nations do and because they do are not faced with what we are.  As Forbes reported, 30% of all Medicare expenditures are attributed to the 5% of beneficiaries that die each year, with one-third of that cost occurring in the last month of life.  Those figures are real.  Saying they are not does not change it.

When someone does not maintain their automobile, their asset will not last as long as it could.  When a nation does not understand its responsibility to maintain the health of its people, the results are the same.  The adage about saying something often enough makes it true might work occasionally, but continuing to say we have the best healthcare does not make it so even if we like or hope it does.

by Thomas Ignatius Hayes


Dr. Tom Hayes is an international public health specialist who writes on health topics for ACT TWO Magazine.  He served as Director of Professional Relations for Hospital Affiliates International and as Founder and Chief Executive Officer of GreatNorthern Health Management (UK).  He is a Fellow of the Royal Society of Medicine and has worked in Lebanon, Saudi Arabia, Zimbabwe, South Africa, Francophone West Africa, Gulf States, France, and the UK (where he raised his children).  He has managed major hospitals including the American Hospital of Paris and the Cromwell Hospital in London and has directed developmental projects in Egypt, Indonesia, Jordan, Swaziland, and Tanzania for organizations such as AfDB, World Bank, USAID and the European Commission.  He served as a medical volunteer during the Ethiopia famine and in Kosovo during the ‘99 crisis.  He spent the summer of ‘03 in Iraq with the UN as Team Leader for their Refugee Project.  Dr. Hayes lives in St Petersburg, Florida and chairs a private consulting group in International Healthcare.

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