U.S. Health System Fails the Chronically Ill

Americans who have such chronic illnesses as heart disease, diabetes and depression are less likely to get the care and treatment they need than people in seven other advanced countries. And when Americans do get medical care, they pay substantially more for it.

A new survey from the nonpartisan Commonwealth Fund provides the latest evidence of the dysfunctionality of the United States health care system. It was published this month in the journal Health Affairs. High costs, wasteful treatment and lack of access are signs of a system in urgent need of reform.

The study surveyed people with chronic illnesses including heart disease, high blood pressure, depression, diabetes and cancer. It compared the health care experiences of American patients to those of residents of Australia, Canada, France, Germany, the Netherlands, New Zealand and the United Kingdom.

The most glaring difference, of course, is the percentage of uninsured people. Other developed countries cover all of their citizens and spend considerably less doing it. In contrast, about 30 percent of the Americans surveyed were uninsured for at least part of the prior year. That's about double the rate for all Americans. But it makes sense. Many people with serious chronic illnesses can't afford to buy health insurance that covers their condition. In many cases, their health conditions prevent them from working full time, which means they probably don't qualify for health insurance through their job.

But even Americans who are insured skipped recommended tests or treatments because of costs, the study found.

One likely reason is that Americans with insurance still pay higher out-of-pocket fees for health care than residents of the other countries.

Germany, which has the highest deductibles and co-payments, limits patient costs to 1 percent of income for someone with a chronic illness and 2 percent for everyone else.

Compare that to the United States, in which the average per-person deductible is $1,001, according to a study released this week by Mercer, a New York-based benefits consulting firm. And that's just the point at which coverage starts. Total out-of-pocket spending tends to be much higher, often many thousands of dollars for someone with a serious illness.

None of the health systems examined in the Commonwealth Fund study was perfect. The authors found what they called "opportunities for improvements" everywhere. Nor did the United States perform poorly by every measure.

For example, Americans reported shorter waits to see a specialist than residents of other countries. Americans also were less likely to be discharged from a hospital without getting clear instructions on what symptoms to watch for and when to seek additional treatment.

But given how much we spend as a nation for health care and how often Americans struggle to receive even the basic recommended tests and treatments, the overall picture is that of a system that desperately needs to change.

Politicians may say that we have the world's best health system. The mountain of accumulating evidence suggests a very different reality.

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