Two facts about US health care are beyond dispute. First, US health care is the most expensive in the world; it is twice as expensive as the average industrial nation.1, 2
Second, US health care is not the best health care system in the world. Four different studies have compared US health care to other industrialized nations. As shown in Table 1, the United States has not fared well in these reports.3, 4, 5
In the United States, life expectancy is shorter, immunization rates are lower, and infant and maternal mortality are much higher than in other Organisation for Economic Co-operation and Development (OECD) nations.1
Our poor health outcomes reflect the fact that unlike other industrialized nations, many Americans lack access to ongoing medical care because they do not have health insurance. Prior to the passage of the Affordable Care Act (ACA) in 2014, there were 47 million uninsured Americans. In 2018, 4 years after the ACA was enacted, 27 million were uninsured.6
Americans without health insurance receive suboptimal health care. They are less likely to have a usual source of health care, less likely to fill prescriptions, and more likely to postpone or go without care due to cost.6 In addition, those who are uninsured are less likely to have preventive screening tests for cancer, including mammograms, pap smears, and colonoscopies.7
Patients with chronic conditions such as heart disease, diabetes, and asthma who lack a regular source of health care are at a greater risk of premature mortality than those who are insured.8
The impact of not having health insurance is illustrated by Table 2, which compares Canadians (all of whom have access to health care) to Americans who do or do not have health insurance.9
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-James E. Dalen, MD, Jennifer L. Plitt, MD, Neha Jaswal, MD, Joseph S. Alpert, MD
This article originally appeared in the June 2019 issue of The American Journal of Medicine.
