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Health care in the U.S. compared to other high income countries

Guest Commentary

Today, with over 900,000 COVID-19 deaths (Feb. 4) we remain the tragic outlier in COVID public health effectiveness. We have the highest per capita death rate among the world’s 10 richest countries. Ezra Klein (NYT Feb. 6) maintains that our vast unvaccinated millions lack trust. “Public health is rooted in the soil of trust. That soil has thinned in America.”

Excuse me? What public health is Klein referring to, I ask, as must all those individuals who think government should stay out of their health business. What Americans know of health care as a full range of consumer health options among industries: doctors, hospitals, insurance or pharmaceuticals. For them, health is about their individual choices.

There is essentially nothing else. The U.S. simply does not have the national health authority, the health infrastructure or the public health social awareness to manage an epidemic, no matter who is in office. Governmental response to infection is a state responsibility. Public health authority is vetted only in the states. The Centers for Disease Control and Prevention (CDC) has no statutory role for intervention nor does the Department of Health and Human Services. (The Institute of Medicine’s The Future of the Public’s Health in the 21st called for such authority in 2002 in response to the Anthrax scare but to no avail.)

Elizabeth Rosenthal (WP, Dec. 27, 2021) has pointed out that public health is about future. It is about readiness. It is about prevention.

Like national defense readiness, effective public health is embedded in infrastructure and national authority proactively developed with a coordinated capacity for responding with distribution channels, and staffing.

Alternatively, economic markets are about the present. They are demand-driven. When a need occurs, it is monetized and as many deliverers as wish to be in the market enter to provide it. Some, like hospital needs, are over extended with tragic results.

The 1918-19 flu epidemic infected more than 500 million people with 675,000 deaths in the U.S. The lesson learned was that it was not reasonable to blame individuals for catching an infectious disease, nor to treat them in isolation.

Many countries quickly went for socialized medicine. First Russia, then Germany, France, the Scandinavian countries. Only in the 1950s did the U.S. finally offer health care and only in the form of health insurance for the employed (first as a “perk” and ultimately as a purchased add on). The first U.S. government health care services program was Medicare and Medicaid in 1965 — still controversial.

The U.S. remains the only one of 10 comparable nations (Austria/Canada/France/Germany/Netherlands/New Zealand/Norway/Sweden/Switzerland) without a unified health care system and one available to all. We rank last in health care availability, and first in personal expense ($11,000 a year). Each of the other countries has a national system integrating prevention and medical treatment within their blended economies (“socialist” programs with “free market services”).

Isn’t it time that we begin to face the fact that our lack of a health care system is the source of our excess death rates?

 

Nancy McKenzie is a retired professor from the CUNY School of Public Health. She and her partner moved to Amenia in 2016 from Brooklyn.

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