Like more than 1 million Americans, I live with a chronic illness, a neurologic disorder called Parkinson’s disease. Diagnosed at 48 years old and now 51, I continue to work and have medical insurance that covers most of my medical care costs, including medications. But with each visit to my neurologist comes a reminder that a progressive illness does not get better. Nor does it get less expensive to manage.
As we head into the 2020 presidential election, health care will be a leading issue. In a recent conversation with an acquaintance, he said to me, “We need to keep the government out of health care.”
His statement reflects an assumption that health care services paid through private insurance, which is typically linked to employment, is better than health care services paid through public health insurance. His assumptions about health insurance underlie another claim, “the U.S. is doing just fine. We have the best health care system in the world.”
If only this were true.
Last year, the Legatum Institute released a report ranking the world’s best health care systems utilizing its Prosperity Index. It measures personal well-being and quality of life, and includes the quality of physical and mental health care, health care infrastructure and preventative care. It found that the best health care is in Luxembourg, Singapore, Switzerland, Japan, Austria, Sweden, Norway, Netherlands, Hong Kong and Australia — the health care top 10. The United States ranked 30th. That is hardly the best health care in the world.
Another survey, conducted by U.S. News & World Report, asked people in 80 countries to assess their health care using 75 different metrics. The top 10 were the United Kingdom, Australia, Netherlands, Germany, Denmark, Canada, Switzerland, Sweden, Norway and Finland. The United States ranked 19th.
In both reports, each country that ranked in the top 10 provides universal health coverage to its people. And it doesn’t end there. Treatment is the most expensive in the U.S., both in absolute terms and relative to average incomes, but U.S. life expectancy (79 years) is lower than that of 25 countries.
The World Health Organization believes health care should be universal, that is, a basic human right. Of the world’s 33 industrialized countries, 32 have universal health care. As the world’s wealthiest nation, the U.S. does not.
What does all this mean for the staggering number of people who live with progressive or chronic diseases? It means our nation can and must do better. In addition to Parkinson’s disease, chronic conditions include multiple sclerosis, muscular dystrophy, rheumatic conditions (e.g. rheumatoid arthritis, lupus, fibromyalgia) and diabetes.
In fact, 87 million Americans live with these diseases. If you add to these figures certain cancers and pulmonary diseases, approximately 112 million Americans, or one-third of our population, live with a chronic medical condition. These conditions also threaten employability, and thus, a loss of medical insurance to pay for care. And with the Affordable Care Act constantly facing court challenges, Americans with preexisting health conditions soon may, once again, be unable to find coverage through private insurance.
Of course, the government is already in health care with Medicare, a popular and successful program that provides universal coverage to seniors. The administrative cost of delivering this program is about $132 per person, as compared with over $700 for private plans. Even though some argue health care is not a basic human right, costs alone argue for us taking a Medicare-for-all approach and providing universal coverage.
Those of us with chronic or progressive illnesses are a sizable voting block. We want a stake in deciding who provides our health care. We also want a stake in ensuring the best health care outcomes possible for us and our fellow Americans. We need coverage for everyone at a lower cost. Relying solely on private, employer-based health insurance does not meet this need and thus is not in any of our best interests. Following the rest of the industrialized world by adopting universal health care is.
Allan Hugh Cole Jr. is a professor and senior associate dean for academic affairs in the Steve Hicks School of Social Work at The University of Texas at Austin.
A version of this op-ed appeared in The Hill.