"The Best Health Care System in the World"?

When President Obama signed Patient Protection and Affordable Care Act (P.L. 111-148) (referred to as Affordable Care Act [ACA]) in 2010, advocates for uninsured and health care reform experienced some sense of accomplishment and satisfaction. A battle that started decades before had seemingly come to a close. However, this was indeed only a battle, or maybe even just a small skirmish, and war continues. Many conservative politicians have begun chants for repeal of so-called Obamacare health plan. Republicans continue to maintain that ACA will destroy the health care system in world, a favorite phrase of Speaker of House John Boehner. Does United States have health care system in world? Social workers engage in many discussions, debates, and arguments with friends, family members, and even strangers about health care, need for health care reform, and direction of American health care system. Although social workers are adept in discussing values and moral principles related to health care, discussions on this level can often remain philosophical and likely do little to change minds. As we know but sometimes forget, compelling facts and information must be mixed in with discussion of values and principles in order for advocacy of any type to be successful. As such, social workers need to know and understand key facts and information to better discuss and debate current American health care system and needs for reform. This is purpose of this commentary. Health care and health care systems are typically evaluated along three interrelated dimensions: cost, access, and quality. In our Western culture, cost of goods and their quality are often perceived to be positively related. So according to this principle, we indeed have best health care. The United States spends more on health care than any other country in world. In 2008, U.S. health care costs were $2.3 trillion which works out to $7,681 per capita (Kaiser Family Foundation, n.d.). The U.S. per capita cost is 45 percent greater than our northern neighbor, Canada, and 33 percent greater than Norway, which ranks a distant second in per capita costs (Organisation for Economic Co-operation and Development [OECD], 2011). With high cost, debt is leading reason for personal bankruptcy in United States (Himmelstein, Thorne, Warren, & Woolhandler, 2009). In 2010, 28 percent of Americans surveyed reported that they had not seen a physician when sick in past year because of costs, compared with 4 percent of residents of Netherlands and 5 percent of British (Schoen et al., 2010). Sadly, only 58 percent of Americans surveyed stated they were confident or very confident they would be able to afford care they needed if they became seriously ill. This was lowest percentage among citizens of 11 OECD countries surveyed (Schoen et al., 2010). Speaker Boehner, is this one of your indicators of health care system in world? Because of costs, a significant number of Americans now travel to other countries, such as India and Thailand, to receive care. Turner (2007) cited case of an uninsured, 53-year-old North Carolina man who needed cardiac surgery to replace a mitral valve. A local hospital estimated cost for procedure at $200,000 and demanded a $50,000 deposit. After much investigation, man and his wife traveled to New Delhi and had procedure performed successfully. The couple returned home a month later. Their total cost (including travel and lodging) was $10,000. It is not surprising that insurers, state governments, corporations, and small businesses alike are moving in direction to encourage their enrollees or employees to travel to other countries for care (Einhom, 2008; Turner, 2007). The Centers for Disease Control and Prevention reports that estimated number of American medical tourists is between 60,000 and 750,000 (Lee & Balaban, 2010). …

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