COVID exposed all that is wrong with the American Dream and how our healthcare system is failing us.

Let’s settle in and discuss universal healthcare. It can be complex, controversial and often contentious in political debates. For many years, healthcare options in America have been the source of contentious debate. Throw in a pandemic and all that is wrong with our system is revealed. We are using a definition of universal healthcare defined by the World Health Organization as “ensuring that all people have access to needed health services (including prevention, promotion, treatment, rehabilitation and palliation) of sufficient quality to be effective while also ensuring that the use of these services does not expose the user the financial hardship” (1).

The complications around universal healthcare often occur when information is not presented clearly. What, why, and how changing our healthcare system to something that works better and costs less can happen. What do other options look like and how can we start to make a change today? While we might not all agree on the steps to get to the end goal, it has become painfully obvious we need to try and find a common ground to bring healthcare costs down while helping people be healthier through prevention.

Based on a brief literature review on Google Scholar, I found over 51,000 articles to date discussing the pros and cons of universal healthcare. Several key themes arose in the articles and they included cost, type of care, and systems in other countries. More than can fit into a 3000-word article, so for our purposes, we will stick to the facts regarding the cost of health care in the US, who has what kind of care in America, and what other countries are doing compared to us.

Scientific studies can help you, me, and any other interested people understand the many ways universal health care can impact our lives through COVID and beyond. Universal health care can impact our economy, life choices, and our access to health care. (Spoiler Alert!) The science and data can show us over and over again that exercise, eating well, and mental health can help prevent the onset of disease and illness and that, on a larger scale, will help us decrease healthcare costs.

Cost of Health Care

The American healthcare system is a huge part of the US economy and our annual individual budgets. U.S. healthcare spending grew 9.7 percent in 2020, reaching $4.1 trillion or $12,530 per person. As a share of the nation’s Gross Domestic Product, health spending accounted for 19.7 percent (2). These data can show us that healthcare costs have a significant part of the annual US budget without a universal healthcare plan. The cost of for-profit healthcare by 2030 is estimated to be $16 trillion which will be 32% of our GDP (3). And, without universal healthcare, over 18% of Americans have medical debt and this is up from data presented in 2018 (4). From these numbers, we know that a lot of money is being spent, and a lot of people are still in debt despite the crazy amount of spending. These costs and debt come from premium costs, prescriptions, and other procedural costs. Medical debt is almost unheard of outside of the United States (5). All of these things listed need to be assessed, more transparently reviewed, and re-priced. High expense and high debt can mean health care is too expensive for a good part of America and it will continue to increase our national debt. We are spending more than we are able to afford and at some point this will become a bigger problem. If a health crisis occurs in our already broken system, it is very likely that it will create an even larger, more impactful and lasting effect on our economy and the health of our nation. The cost of care will continue to rise as we need to pay for supplies, staff, and support for testing vaccinations, medications, and more. This will increase premiums, increase debt, and not necessarily improve anyone’s health. Canada restructured its healthcare system and in 1984 instituted a universal healthcare option and it is still being offered today. It’s goal for restructuring was: …to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers (6). We can explore rates of debt and bankruptcies in Canada to compare what might happen if we change systems in America. As reported by the Fraser Institute, there are similar bankruptcy and debt levels in Canada as in the US (7).

canada.ca

We are on a roll, so let’s look at more numbers and data to understand what else is costing so much money in America and what is making our healthcare system break. Did you know the leading cause of death in 2020 was heart disease, not COVID? As reported by the Journal of the American Medical Association (JAMA) the provisional leading cause-of-death rankings for 2020 indicate that COVID-19 was the third leading cause of death in the US behind heart disease and cancer (8). Did you also know that heart disease and cancer have been the leading causes of death for decades? (9)

[In 2020], COVID-19 was the third leading cause of death in the US behind heart disease and cancer.

Number of deaths due to heart disease and cancer: United States, 1950-2014. Source: cdc.gov

As we look at the numbers of deaths and illnesses in America, we have to ask the question: What would prevention do? Can we work on prevention as faithfully, as a nation, as we did to combat COVID and can it help decrease costs by decreasing risk factors? In theory, the answer is yes. In practice, it seems that if we can start reducing the leading causes of death in America, we might be able to start decreasing costs associated with these illnesses. A study in the UK showed just that. The study showed that any population wide reduction in any cardiovascular risk factor would significantly decrease the cost to the healthcare system (10). It seems logical to think that if we could make some small changes to shift towards prevention through decreased risk factors that, as in other countries, we might see a reduction in healthcare costs. Decreasing risk factors can be done through prevention and through medication. If we use medication, we also need to be aware of the costs associated with pharmaceuticals.

In America, we also spend a lot of money on pharmaceuticals. We spend about 348 billion on prescription medication annually and individuals spend over $1200 per person double the amount spent in the UK, Germany, and Japan (11). These numbers show us that there is a huge share of Americans invested in the pharmaceutical industry with or without any other options to diversify their investment. We need to decrease our investment into medications and focus on other tried and true methods to help decrease costs of healthcare and illnesses that require medications. As reviewed by the Commonwealth Fund, we might benefit from better price negotiations and price control on medications here in the US (12).

It is mind-blowing that the health product and the pharmaceutical industry spend about 233 million dollars a year lobbying in Washington (13). Just a small reduction in risk factors and interventions with behavior change, lifestyle habits, and decreased medication costs can severely impact our healthcare system in a very positive way and cost a fraction of the amount being spent on lobbying. These small improvements will come at a cost of time and energy to make a change, a willingness to change by pharmaceutical companies, and a lot of re-education that prevention can have an impact on the larger scale economy.

In America… we spend about 348 billion on prescription medication annually and individuals spend over $1200 per person double the amount spent in the UK, Germany, and Japan.

Types of Health Care

In almost all of the world, there is some form of subsidized healthcare or a system that promotes well-being through prevention, education, balanced costs, and transparency. In a short article written by Princeton’s Mimi Chung, she details 4 types of universal health plans that range from total government subsidy to minimal government involvement. She also explains how they can all have components that can be of benefit to our American healthcare system (14).

Typically we can think of 4 types of universal health care as described by Princeton’s Mimi Chung.

Individual Healthcare plans
Employer Healthcare plans
Government Healthcare plans
Hybrid Healthcare plans

Each system has pros and cons and no system is perfect. In America, as of 2019, there are about 10% of people who have no health insurance (15). The costs of each healthcare system would put a different burden on our government structure and on employers as well as individuals. The costs of these healthcare systems can also serve some people better than others and leave others uninsured or underinsured if something bad happens or if there is a “pre-existing” condition. As a side note, no other countries use the term “pre-existing” conditions. It is used in the United States to deny coverage or as a rationale for increasing someone’s premium. COVID helped us realize that there are a lot of costs associated with prevention but these problems existed well before COVID.

What Other Countries Are Doing

As seen in the chart below, a common denominator across all countries is that healthcare is an expensive line item on a national budget. We stand alone, in America, with the highest prescription costs, costs for disease, and costs for healthcare insurance. We need to stand up, look around us, and see what changes we can make based on the successes in other countries. Clearly our system is broken if it is putting us more in debt and making Americans less healthy in the process.

Source: OECD

While there is not one system that is clearly better than others and they all have pros and cons, in my humble opinion and based on the data I reviewed, I think we need to review and create a hybrid approach with the thought that nothing will be perfect, free, or agreed upon by everyone. We can, however, work to create something marginally better than what we have now to help more people live a healthier lifestyle while decreasing illness and cost associated with it. In America, as of 2019, there are about 10% of people who have no health insurance (16). We, as a country, can do better to redistribute access to health insurance and create better options to build prevention and affordable care into people’s lifestyles. Most other countries include prevention in their universal healthcare options and we can too.

Let’s put on our thinking caps and figure out ways to decrease costs while stopping the thought process that a pill is always the answer. Sometimes good old hard work, behavior change, and sweat is the answer. Sometimes sweat equity might cost more than just throwing money at a problem.

Through the healthy debate, always remain respectful of other people’s health choices and keep in mind that our Constitution Preamble states that our government should “promote the general Welfare” and “secure liberty” ”to ourselves and our Posterity”. Pause to understand that every individual in America has a right to both welfare and liberty for themselves and their generations to come. Let’s ask a question here: Is healthcare a human right as a citizen in a country or is it a luxury based on income level, location, access, or other factors?

Is healthcare a human right as a citizen in a country or is it a luxury based on income level, location, access, or other factors?

In summary, cost can be drastically reduced in our broken healthcare system. We can simply start by exploring more of what other countries are doing in the way of prevention, insurance cost sharing, and universal health care options. Whether we start now because of COVID or another disease, the key is to start now for saving money in the long run. The costs associated with heart disease, cancer, COVID, and other killers can severely be reduced if more emphasis was placed on prevention as opposed to care just when the disease occurs. Every individual is able to work towards a healthier lifestyle in some way and with the support of others if they want to. In today’s age there are millions of free resources with social media, internet, nonprofits, and volunteers. People have to want to make a choice to make a healthy change to start making the world a better more cost-effective living space. When COVID hit, we realized how important hand-washing is and how important masks are for prevention and we opened our eyes to what needs to be done to be healthier today for tomorrow. Let’s apply the same principles to other killers in America like heart disease, cancer, and our healthcare systems impact on our larger economy. As Dr. Paul Reed, Director of the Office of Disease Prevention and Health Promotion says: “Although not a cure-all, increasing physical activity directly contributes to improved mental health and better overall health and well-being” (17). We can do better.

Gary Gianetti has an M.S. in Allied Health and holds certifications in health, fitness, and exercise sciences. When he’s not coaching, he enjoys outdoor adventures on foot, rock, wheels, and in the air with his little ones and his wife. He is the founder of Healthy Altitudes…For Your Life™.