Christopher Flavelle: Website mess doesn’t change need for reform

10/31/2013 12:00 AM

10/30/2013 5:33 PM

The HealthCare.gov debacle and the blame game that followed it have reinvigorated Obamacare’s critics, who argue anew that the law represents expensive government overreach. So it’s worth stepping back from the website mess to remember the deeper problems that made this law necessary in the first place.

The first problem with the status quo can’t be mentioned often enough: The United States spent 17.7 percent of its gross domestic product on health care in 2011 – 50 percent more than the next highest among countries in the Organization for Economic Cooperation and Development. The average for developed countries is less than 10 percent.

Yet unlike every other developed country, a big chunk of Americans didn’t have insurance – almost 1 in 6 Americans last year.

Of course, for those with access to care, the United States is a good place to be sick. Americans received 103 MRI exams per 1,000 people in 2011, more than any other rich country, including Belgium (77), Spain (66) and Canada (50). And deaths from cancer are lower in any given year than for many rich countries – 194 for every 100,000 people in 2010, which was better than Britain, Italy, Germany, the Netherlands and Denmark.

Yet Americans on average get less care and die younger, despite spending more as a country. The U.S. has an alarmingly high infant-mortality rate – higher than other OECD nations with the exception of Mexico and Turkey. And not just a little bit higher. In 2011, 6.1 infants died for every 1,000 live births. The corresponding figures were 2.3 in Japan, 2.1 in Sweden and 0.9 in Iceland.

The U.S. is also lagging at the opposite end of life. An American born in 2011 can expect to live 78.7 years – less than somebody born in almost any European country, and 26th out of 36 in the OECD.

What’s made U.S. outcomes so bad? Partly it’s that Americans have built a system that makes them less likely on average to see doctors than their rich-world counterparts. Fewer doctor’s visits mean fewer chances to diagnose problems, manage treatments or even take simple preventive measures – such as talking about the importance of diet and exercise.

Another consequence of less access is lower immunization levels. Ninety-five percent of U.S. children were immunized against diphtheria, tetanus and pertussis last year. If that sounds high, the rate was 99 percent in Belgium, France and Greece, as well as the Czech Republic, Poland and even Mexico.

You could also measure the inadequacy of American health care through the amount of health care resources that are available to the population as a whole. The U.S. has fewer hospital beds per person than most developed nations, a fraction as many psychiatric care beds and trails every European nation in medical graduates, at 6.6 per 100,000 people. (Germany and Britain have almost twice as many.)

Obamacare won’t fix all of this. The U.S. will probably keep spending more than its peer countries on health care.

But expanding government-subsidized insurance and standardizing what it means to be covered, along with removing co-pays for preventive care, should start to close the gap in health outcomes between the U.S. and other countries.

That doesn’t mean we should stop talking about HealthCare.gov’s problems. It just means we should keep reminding ourselves why it’s so important they get fixed.

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