image

health as it happens

Opinion: North Carolina, U.S. health care are not the worst but certainly not the best - The Fayetteville Observer

Jack Bernard  |  The Fayetteville Observer

“America's health care system is neither healthy, caring, nor a system.” ― Walter Cronkite 

North Carolina is not ranked highly regarding health care versus other states. One report has it ranked 47th based on cost, access and outcomes. Another study of access, quality and public health has it ranked 30th overall. A third report has it ranked 45th using the criteria of cost, quality and access for the elderly.

Based on these reports, North Carolina’s health care needs improvement to just be average for the U.S.

However, another study has come out illustrating that U.S. health care is very far from the best in the world. A March 2021 report in the Journal of the American Medical Association contains some startling information showing that even better-off white citizens of the U.S. (those living in the 5% richest counties) have worse health care outcomes versus the average citizen in the 12 other developed nations studied. The conclusion was “even if all U.S. citizens experienced the same health outcomes enjoyed by privileged White U.S. citizens, U.S. health indicators would still lag behind those in many other countries.” 

Jack Bernard: In NC and the U.S., thoughts and prayers not enough to stop gun violence

Jack Bernard: How the conservative minority imposes its will on the rest of us

At the same time, our expenditures per capita were much higher than any other nation. The United States spent $10,948 per capita in 2019. The average OECD nation spent $4,224. France, with what many say is the best health care system, only spent $5,274 per capita. Italy spends $3,819, about the average for an EU nation, every one of which has health insurance coverage for all of their citizens. 

Other reports show the same problems with our health care. I suppose being 37th is OK for a few Americans, but not for the overwhelming majority of us.

As is true with some other studies, France is ranked first. We are ranked below less-prosperous nations like Greece, Chile and Columbia. But slightly above Slovenia, Cuba and Croatia. 

We were ranked not quite as bad on other reports, but still not good. On the 2021 US News analysis, we rank 22nd. And on another 2021 survey, we rank 30th. We are only slightly better than Malaysia and Columbia. 

There have been a number of similar reports with the same sort of findings over the years. The most relevant question is why we are ranked so low. A United Health Foundation report offers some clues.  

First, there is the rate of uninsured, which is still at over 9% nationally even after the Affordable Care Act, aka Obamacare. And for many states and subgroups, it is much higher than that.  

For example, about a third of Latinos in Georgia are uninsured as opposed to a state rate of over 13%, one of the worst in the nation. The national insurance rate is lower for other groups — 14% of those not completing high school are uninsured as well as 19% of Latinos, and 21% of Native Americans nationally. 

Infant mortality is especially high among African Americans, 1% of all Black births. So is the maternal mortality rate, which more than doubles the rate for white mothers. Further, chronic diseases (asthma, cancer, heart disease and diabetes) are much more prevalent in the Native American and Black communities.  

Life expectancy of Black men is only 68 years, compared with an overall U.S. life expectancy of 79 years. And some particular regions, like Appalachia, have higher death rates. Some of this discrepancy can be traced to mental health, drugs and alcohol illnesses. 

What’s the bottom line?

As two national experts, Drs. David Himmelstein and Steph Woolhandler, stated: “U.S. society and medical care are bad for almost everyone’s health.”

We must leave ideology behind us, ignoring the politicians who incorrectly say that “our health care system is the envy of the world” (per former President George W. Bush). It’s very clear that both the North Carolina health care system and the U.S. health care system need major reform. The underlying question is how we go about it.  

In industry, the principle of copying “best practices” is well-accepted. We must push for systemic health care reform based on the best practices of other nations like France. When that will actually happen is based on the people we elect to state and national office. 

Jack Bernard is the former director of Health Planning for Georgia and a retired high-level executive with a health care corporation. He was one of the founders of Premier, Inc. in Charlotte. He is a widely published health reform columnist.