According to a new report from The Commonwealth Fund entitled, Mirror, Mirror 2021: Reflecting Poorly, the U.S. health system trails far behind its counterparts in 10 high-income peer countries when it comes to affordability, administrative efficiency, equity, and health care outcomes. Unique in measuring and comparing patient and clinician experiences across nations, the report shows that in the U.S., an individual’s chance of obtaining good health care depends to a large extent on income, more so than in any other wealthy country. The U.S., which spends the most per individual on health care, has ranked last in every edition of the report since 2004. Also, this nation has fallen even further behind on certain measures, especially health outcomes linked to primary care access and equity in care delivery.
Readers of this issue of ASAHP’s newsletter who have grown long in the tooth over the decades may recall a popular tune performed by Creedence Clearwater Revival in 1969 called Bad Moon Rising. Some of its lyrics are:
I see the bad moon a-rising
I see trouble on the way
I see earthquakes and lightnin'
I see bad times today
Oddly enough, despite the negative appraisal of health care in the U.S., this nation is distinguished by having world class centers that attract patients from all over the globe who seek the best in what these facilities have to offer. A major problem is that not all U.S. inhabitants are in a position to have equal access to such high quality care due to a factor, such as lack of adequate health insurance. Another relevant circumstance is what has been labeled “deaths of despair.” Angus Deaton and Anne Case at Princeton University have been successful highlighting a rise in mortality rates caused by inappropriate drug use, suicide, and alcoholic liver disease. They have noted that expected years lived between ages 25 and 75 declined for most of a decade for men and women without a four-year degree, even prior to the arrival of COVID-19. An article they wrote in the March 16, 2021 issue of the Proceedings of the National Academy of the Sciences in the USA discusses the link between possessing a college degree and the opportunity to obtain jobs that provide sufficient income. Ensuring the attainment of suitable levels of education, adequate employment prospects, decent housing, impact of discrimination, lack of necessary health resources in rural areas, and low crime neighborhoods are some multifactorial examples of the complex nature underlying efforts to improve individual and community health status.
State Initiatives To Improve Health Care
Because of its involvement in research funded by the National Institutes of Health, the financing of health services through Medicare, and the direct provision of such services through various government entities that include the Veterans Administration, the federal government rightly attracts significant attention when discussing health policy issues. Nonetheless, states around the nation also play key fundamental roles in attempts to foster a healthy population. Since taking office, the Biden administration has tried to enhance the Affordable Care Act (ACA) by reversing policies implemented when Donald Trump was President, such as the latter’s decision to eliminate a policy encouraging standardized health plan designs for marketplace coverage. Researchers at the Georgetown University Health Policy Institute believe that the federal government can learn from examining how states are using plan standardization to improve access to care. For example, cost barriers could be lowered by exempting critical primary care or mental health services from deductibles.
In a separate related arena, the Pew Charitable Trusts in its Legislative Review 2021, points out that local and state public health officials wield extraordinary powers in emergency situations, such as the present coronavirus outbreak. They can close schools and private businesses. They can restrict or shut down mass transit systems. They can cancel concerts, sporting events and political rallies. They can call up the National Guard when necessary. They can suspend medical licensing laws and protect physicians from liability claims. Not only can they quarantine or isolate some individuals who might infect others, they have the authority to implement policies that involve social distancing and the wearing of masks.