The presidential campaign has sparked a rigorous and much-needed national debate over health system reform, with polls consistently pointing to healthcare as the publics top domestic concern. Ensuring that everyone in the U.S. has health insurance is essential to establish a truly high-performance health system, but it must be pursued simultaneously with comprehensive reforms to control costs and improve quality and access.
Universal coverage should not be held hostage until we have a more efficient healthcare delivery system. But we need to start now to initiate the reforms necessary to achieve both high performance and real value in healthcare.
There is ample evidence that the U.S. health system falls short of achieving what it is possible to achieve in health status, quality, cost and coverage. As highlighted by the Commonwealth Funds Commission on a High Performance Health Systems national score card released last year, the U.S. does not stack up terribly well against other countries in mortality amenable to medical care, ranking 15th out of 19 countries. That statistic is a powerful measure of the impact of the health system itself (rather than poverty and other factors) on conditions that we are able to treat with good care.
We also know from the commissions state score card that there is enormous variation among the states on a number of measures of healthcare quality. For example, if all states reached the levels achieved among the top-performing states, almost 9 million more older adults would receive recommended preventive care, and almost 4 million more diabetics would receive care to help prevent disease complications.
The problem is not a lack of spending on healthcare. The U.S. spends far more on healthcare than any other nation. Furthermore, costs have been rising particularly rapidly in the past seven years. Since 2000, insurance premiums have increased 91% and medical outlays have increased 65%, while wages have increased only 24%. The growing burden of paying for healthcare undermines families economic security, and makes it harder for employers to provide health insurance for their employees.
Were headed in the wrong direction in the U.S. with costs rising and the ranks of the uninsured growing, up 8 million just in the past seven years. Today, 47 million Americans are uninsured, and even working middle-class insured families are feeling the squeeze of rising out-of-pocket costs and premiums.