September 13, 2007

Expensive and divisive: how America is losing patience with a failing system

But in clinics such as this, just across the Anacostia river from the great white dome of the Capitol, many of the ailments have an underlying cause: none of these people have access to adequate medical care.

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Between the two extremes is where America's healthcare system has unravelled. A patchwork of employer benefits and government assistance for the very poor and elderly has produced distinct differences. Those with very good jobs and generous benefits packages enjoy extensive, often almost wasteful, health cover. Meanwhile, tens of millions regularly put their health on hold because they cannot afford basic treatment, prescriptions, or even a visit to the doctor.

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The US spends about 16% of GDP on healthcare, a proportion expected to climb to 20% by 2015, according to the National Coalition on Health Care. At present spending levels of $1.6 trillion a year, which works out at $6,700 per capita, is double what is spent in countries such as France. And yet that still leaves some 47 million Americans entirely without health coverage, and tens of millions of others under-insured, according to latest census figures.

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It also fails to guarantee a better service to those Americans with access to healthcare. The US ranks last or near the bottom on quality, access, efficiency, equity and healthy lives, according to a report in May 2007 from the Commonwealth Fund, which studies healthcare.

"The US healthcare system is considered a dysfunctional mess," writes Ezekial Emanuel, chairman of the department of clinical bioethics, in a recent issue of the Journal of the American Medical Association.


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