America’s Broken Health Care: Diagnosis and Prescription

An easy way to gauge the health of a country, and to compare the health of a country with that of other countries, is to look at average life expectancy. And if you look at a chart comparing average life expectancy in the U.S. with the average life expectancy of eleven other wealthy countries from 1980 to 2021, you will find that in 1980, the U.S. was just about equal with those other countries. But as the years have progressed since then, life expectancy in the U.S. has fallen further and further behind. Until 2014, our life expectancy was going up, but we were losing ground to the populations of other advanced countries.

By 2019, prior to COVID, life expectancy in the U.S. had fallen relative to that in the other countries so much that 500,000 Americans were dying each year in excess of the death rates of the citizens of those other countries. To exclude poverty as a factor in these numbers, a study looked at the health of privileged Americans - specifically, white citizens living in counties that are in the top one percent and the top five percent in terms of income. This high-income population had better health outcomes than other U.S. citizens, but it still had worse outcomes than average citizens of the other developed countries in such areas as infant and maternal mortality, colon cancer, childhood acute lymphocytic leukemia, and acute myocardial infarction.

Now combine this with the fact that we in the U.S. are paying an enormous excess over those other countries on health care. In the U.S., we spend on average $12,914 per person per year on health care, whereas that figure in the other comparable countries is $6,125. That comes to $6,800 more per person—and if you multiply that by 334 million Americans, we are spending an excess $2.3 trillion a year on health care - and getting poorer results.

Which means that our health care system is broken and needs fixing.

The drug companies that own the patents are monopolies. How high are these brand name drugs being priced? In comparative terms, they cost three-and-a-half times more in the U.S. than in other wealthy developed countries. But the most shocking numbers have to do with the rate of increase in prices. In 2008, the average annual price of a new drug in the U.S. was $2,115; by 2021, this annual average price of a new drug had risen to $180,000. Think about that. In 2022, the average annual price was up to $257,000.

Big Pharma is comprised of for-profit companies. The job of for-profit companies is to maximize returns to their investors. Accusing drug companies of being greedy is like accusing zebras of having stripes. They are doing their job, and we’re not going to change them. So it is our job - not only doctors, but the American people as a whole - to insist on guardrails to ensure that the pharmaceutical industry serves, rather than harms, public health.

What is needed is very clear. First, we need to ensure that the evidence base of medicine is accurate and complete, which requires independent, transparent peer review. Second, we need to implement health technology assessment, so that we and our doctors know which drugs and devices are the most effective. Third, we need to control the price of brand name drugs.

This is not rocket science - so why doesn’t it happen? Largely because the greatest bipartisan agreement among our political leaders is that it is fine for them to accept large contributions from drug companies. Huge amounts of money flow about equally to Democrats and Republicans. This is why any meaningful reform will require the formation of a coalition of Americans to demand action. And a plea I would make is that people on the conservative side who have an aversion to government and people on the progressive side who have an aversion to free markets come together with open minds to find a middle way to solve the problem of declining health and spiraling costs.

We need to transcend our ideologies - to think of the good for our country and its people on this issue. Neither the people who tend to the Republican side alone nor the people who tend to the Democratic side alone will be able to break up the medical-industrial complex that has a stranglehold on American health care. Instead of focusing on our disagreements, we need to focus on what we agree about - namely, that it would be better if Americans were healthier and didn’t spend over twice as much money (much of it to little or no benefit) on health care as citizens of other wealthy countries.

Oliver Wendell Holmes said in 1869, “The state of medicine is an index of the civilization of an age and country - one of the best, perhaps, by which it can be judged.” Medical science is a wonderful gift, but we have to use that gift wisely so that it serves the American people by providing the best and most efficient care. We can’t allow it to be held hostage by the medical-industrial complex.

by John Abramson, adapted from a talk delivered at Hillsdale College on March 5, 2023 and published in Imprimis Newsletter, Volume 52, Number 2, February 2023