16
Virginia Policy Review
You (Don’t) Get What You Pay For: Why the United States Pays So Much for an Underperforming Health Care System & How to Fix It By Jack DiMatteo Abstract Health Care Spending in the United States and Other High-Income Countries, by Irene Papanicolas, Liana R. Woskie, and Ashish K. Jha, assesses the American health care system relative to ten other wealthy countries. They seek to identify the primary explanations for the dangerous parallel trends of high health care spending and poor health outcomes in the United States. The article offers quantitative comparisons between the American health care system and other wealthy countries selected for analysis. This article will build on those metrics and expand the conversation to focus on the elements of the American health care system that are driving up costs without improving outcomes, including (1) prices, (2) geographic and racial disparities, (3) Medicare and Medicaid, (4) waste, and (5) end-of-life care. Finally, I will provide the following suggestions to improve the health care system of the United States: (1) waste reduction, (2) negotiated prices, (3) individual mandate reintroduction, (4) Move to Opportunity, (5) investing in best practices for efficient and quality care, and (6) investing in vulnerable populations and communities. The American Health Care System in Comparison The United States spends about twice as much as other high-income countries on health care despite faring much worse on most measures of health (Papanicolas, Woskie, & Jha, 2018). In their article, Papanicolas, Woskie, and Jha evaluated the American model in comparison to ten other wealthy countries on 98 indicators across seven domains: (1) general spending, (2) population health, (3) structural capacity, (4) utilization, (5) pharmaceuticals, (6) access and quality, and (7) equity (Papanicolas, Woskie, & Jha, 2018). General spending The United States spends more than one-sixth (17.8 percent) of its GDP on health care, five percentage points more than the next highest spender and nearly double that of the United Kingdom and Australia. The U.S. spends more of its health care budget on outpatient care and administrative costs than any of the other studied countries (Papanicolas, Woskie, & Jha, 2018). Population health The United States has relatively low rates of smoking and alcohol consumption, but the highest obesity rate among wealthy nations. The U.S. also has the lowest life expectancies and highest infant mortality rates (Papanicolas, Woskie, & Jha, 2018).