Most Republicans in the 112th Congress pledged to repeal the Affordable Care Act of 2010. When Speaker of the House John Boehner was asked why the Republicans want to repeal the Affordable Care Act, he replied: “because ‘Obamacare’ would destroy the best health care delivery system in the world” (NBC News, January 6, 2011).(1)
Does the US Have the Best Health Care Delivery System in the World? Do All Americans Have Access to It?
There are many reasons why one would expect the US to have the best health care delivery system in the world. We have a well-educated population with a high standard of living. We have well-trained health professionals and well-equipped hospitals and clinics. And most of all, we spend far more on health care than any country in the world!(2)
If we have the world’s best health care system, it follows that we would have the world’s best health care outcomes. We don’t! We lag behind other industrial nations in life expectancy, infant mortality, maternal mortality, and immunization rates.2 In 2000, the World Health Organization ranked our health care system as the 37th best among 119 nations. We ranked #17 of 17 industrial nations.(3)
Why We Don’t Have the World’s Best Health Care System: The Uninsured
The reason that we do not fare well in these health outcomes is that many of our citizens do not have access to ongoing primary and preventive care. To have access to ongoing preventive care, one must have adequate health insurance. In our country, up to 22% of our citizens were uninsured or had inadequate health insurance in 2007.(4) Those without adequate insurance can seek help for emergencies in our hospitals’ overcrowded emergency rooms—but where do they go for ongoing preventive care?
The uninsured at greatest risk are those with chronic conditions. Nearly 40% of our population have a chronic condition such as diabetes, hypertension, asthma, or heart disease.5 These conditions require ongoing physician care and nearly always require prescription drugs.
Multiple studies document that patients with chronic conditions who are uninsured are less likely to have a usual source of health care, do not see a physician at least once a year, and have an unmet need for prescription drugs for their condition.(5)
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— James E. Dalen, MD, MPH
This article originally appeared in the July 2011 issue of The American Journal of Medicine.
