Healthcare
Current figures estimate that spending on health care in the U.S. is about 16% of its GDP.[20][21] In 2007, an estimated $2.26 trillion was spent on health care in the United States, or $7,439 per capita.[22] Health care costs are rising faster than wages or inflation, and the health share of GDP is expected to continue its upward trend, reaching 19.5% of GDP by 2017.[20]In fact, government health care spending in the United States is consistently greater, as a portion of GDP, than in Canada, Italy, the United Kingdom and Japan (countries that have predominantly public health care).[23] And an even larger portion is paid by private insurance and individuals themselves. A recent study found that medical expenditure was a significant contributing factor in 62% of personal bankruptcies in the United States during 2007.[24]
The U.S. spends more on health care per capita than any other UN member nation.[6] It also spends a greater fraction of its national budget on health care than Canada, Japan, Germany or France. In 2004, the U.S. spent $6,102 per capita on health care, 92.7% more than any other G7 country, and 19.9% more than Luxembourg, which, after the U.S., had the highest spending in the Organisation for Economic Co-operation and Development (OECD).[25]
Although the U.S. Medicare coverage of prescription drugs began in 2006, most patented prescription drugs are more costly in the U.S. than in most other countries. Factors involved are the absence of government price controls, enforcement of intellectual property rights limiting the availability of generic drugs until after patent expiration, and the monopsony purchasing power seen in national single-payer systems.[26] Some U.S. citizens obtain their medications, directly or indirectly, from foreign sources, to take advantage of lower prices.
A study of international health care spending levels in the year 2000, published in the health policy journal Health Affairs, found that while the U.S. spends more on health care than other countries in the Organisation for Economic Co-operation and Development (OECD), the use of health care services in the U.S. is below the OECD median. The authors of the study concluded that the prices paid for health care services are much higher in the U.S.[7]
The Government Accountability Office reported that the unfunded liability facing Medicare as of January 2007 was $32.1 trillion, which is the present value of the program deficits expected for the next 75 years in the absence of reform.[28] According to the Centers for Medicare and Medicaid Services, spending on Medicare will grow from approximately $500 billion during 2009 to $930 billion by 2018. Without changes, the system is guaranteed “to basically break the federal budget,” Obama said at a White House news conference July 22.[29]
A new study (published December 15, 2009 in Proceedings of the National Academy of Sciences) from authors at Duke University, National Council of Spinal Cord Injury Association, Brigham Young University, and North Carolina State University shows that it might be more accurate to think of health care spending as an investment that can spur economic growth. The study also shows that government projections of health care costs and financing may be unduly pessimistic.[30]
[edit] Prescription drug prices
Main article: Prescription drug prices in the United States
During the 1990s, the price of prescription drugs became a major issue in American politics as the prices of many new patented drugs increased sharply, and many citizens discovered that neither the government nor their insurer would pay the monopoly price of such drugs. In absolute currency, the U.S. spends the most on pharmaceuticals per capita in the world. However, national expenditures on pharmaceuticals accounted for only 12.9% of total health care costs, compared to an OECD average of 17.7% (2003 figures).[31] Some 23% of out-of-pocket health spending by individuals is for prescription drugs.[32][edit] Impact on U.S. economic productivity
On March 1, 2010, billionaire Warren Buffett (who is considered one of the world’s most savvy investors[33]) said that the high costs paid by U.S. companies for their employees’ health care put them at a competitive disadvantage. He compared the roughly 17% of GDP spent by the U.S. on health care with the 9% of GDP spent by much of the rest of the world, noted that the U.S. has fewer doctors and nurses per person, and said, “that kind of a cost, compared with the rest of the world, is like a tapeworm eating at our economic body.”[34][edit] Quality of care
Average Life expectancy in the United States is 78.11 years, lower than in some other countries.[35] For 2006-2010, the U.S. life expectancy will lag 38th in the world, after most developed nations, lagging last of the G7 (Canada, France, Germany, Italy, Japan, U.K., U.S.) and just after Chile (35th) and Cuba (37th).[36]The U.S. also has a worse infant mortality rate, 6.26 per 1000 live births compared to 5.72 for the European Union.[37] The Center for Disease Control and Prevention (CDC) suggests that higher rates of infant mortality in the U.S. are "due in large part to disparities which continue to exist among various racial and ethnic groups in this country, particularly African Americans".[38] Some studies claim the data collected regarding infant mortality and life expectancy do not lend themselves to fair comparison, as there may be differences in whether patients seek help, their ethnic background, diet, lifestyle, and the specific legal definition of a live birth.[39]
In 2000, the World Health Organization (WHO) ranked the U.S. health care system 37th in overall performance, right next to Slovenia, and 72nd by overall level of health (among 191 member nations included in the study).[40][41] The WHO study has been criticized by the free market advocate David Gratzer because "fairness in financial contribution" was used as an assessment factor, marking down countries with high per-capita private or fee-paying health treatment.[42] One study found that there was little correlation between the WHO rankings for health systems and the satisfaction of citizens using those systems.[43]
Some countries, such as Italy and Spain, which were given the highest ratings by WHO were ranked poorly by their citizens while other countries, such as Denmark and Finland, were given low scores by WHO but had the highest percentages of citizens reporting satisfaction with their health care systems.[43] WHO staff, however, say that the WHO analysis does reflect system "responsiveness" and argue that this is a superior measure to consumer satisfaction, which is influenced by expectations.[44]
Another metric used to compare the quality of health care across countries is Years of potential life lost (YPLL). By this measure, the United States comes third to last in the OECD for women (ahead of only Mexico and Hungary) and fifth to last for men (ahead of Poland and Slovakia additionally), according to OECD data. Yet another measure is Disability-adjusted life year (DALY). According to Jonathan Cohn, health care scholars prefer these more "finely tuned" statistical measures for international comparisons in place of the relatively "crude" infant mortality and life expectancy.[45]
The U.S. system is often compared with that of its northern neighbor, Canada. Canada's system is largely publicly funded. In 2006, Americans spent an estimated $6,714 per capita on health care, while Canadians spent US$3,678.[46] This amounted to 15.3% of U.S. GDP in that year, while Canada spent 10.0% of GDP on health care. The Canadian system has been criticized regarding long wait times — 5.5 weeks for oncology and 40 weeks for orthopedic surgery — and provincial health ministers announced a plan to reduce these to four weeks for radiation therapy for cancer and 26 weeks for hip replacement surgery.[47] A 2007 review of all studies comparing health outcomes in Canada and the U.S. found that the quality of care in Canada is at least as good as that in the U.S.[48]
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