The Best Health Care System in the World

When President Obama signed the Patient Protection and Affordable Care Act (P.L. 111-148) (referred to as the Affordable Care Act [ACA]) in 2010, advocates for the uninsured and health care reform experienced some sense of accomplishment and satisfaction. A battle that started decades before had seemingly come to a close. However, this was indeed only a battle, or maybe even just a small skirmish, and the war continues. Many conservative politicians have begun the chants for the repeal of the so-called Obamacare health plan. Republicans continue to maintain that the ACA will destroy "the best health care system in the world," a favorite phrase of Speaker of the House John Boehner. Does the United States have the best health care system in the world? Social workers engage in many discussions, debates, and arguments with friends, family members, and even strangers about health care, the need for health care reform, and the direction of the American health care system. Although social workers are adept in discussing values and moral principles related to health care, discussions on this level can often remain philosophical and likely do little to change minds. As we know but sometimes forget, compelling facts and information must be mixed in with discussion of values and principles in order for advocacy of any type to be successful. As such, social workers need to know and understand key facts and information to better discuss and debate the current American health care system and needs for reform. This is the purpose of this commentary. Health care and health care systems are typically evaluated along three interrelated dimensions: cost, access, and quality. In our Western culture, the cost of goods and their quality are often perceived to be positively related. So according to this principle, we indeed have the "best" health care. The United States spends more on health care than any other country in the world. In 2008, U.S. health care costs were $2.3 trillion which works out to $7,681 per capita (Kaiser Family Foundation, n.d.). The U.S. per capita cost is 45 percent greater than our northern neighbor, Canada, and 33 percent greater than Norway, which ranks a distant second in per capita costs (Organisation for Economic Co-operation and Development [OECD], 2011). With the high cost, medical debt is the leading reason for personal bankruptcy in the United States (Himmelstein, Thorne, Warren, & Woolhandler, 2009). In 2010, 28 percent of Americans surveyed reported that they had not seen a physician when sick in the past year because of costs, compared with 4 percent of the residents of the Netherlands and 5 percent of the British (Schoen et al., 2010). Sadly, only 58 percent of Americans surveyed stated they were confident or very confident they would be able to afford the care they needed if they became seriously ill. This was the lowest percentage among citizens of 11 OECD countries surveyed (Schoen et al., 2010). Speaker Boehner, is this one of your indicators of the best health care system in the world? Because of costs, a significant number of Americans now travel to other countries, such as India and Thailand, to receive medical care. Turner (2007) cited the case of an uninsured, 53-year-old North Carolina man who needed cardiac surgery to replace a mitral valve. A local hospital estimated the cost for the procedure at $200,000 and demanded a $50,000 deposit. After much investigation, the man and his wife traveled to New Delhi and had the procedure performed successfully. The couple returned home a month later. Their total cost (including travel and lodging) was $10,000. It is not surprising that insurers, state governments, corporations, and small businesses alike are moving in the direction to encourage their enrollees or employees to travel to other countries for medical care (Einhom, 2008; Turner, 2007). The Centers for Disease Control and Prevention reports that the estimated number of American "medical tourists" is between 60,000 and 750,000 (Lee & Balaban, 2010). …