Skolnik Evaluates U.S. Healthcare For Cost, Coverage And Fairness For LWV



Richard Skolnik, an expert on global health, spoke to the League of Women Voters at a recent Lunch with a Leader at Mesa Public Library.  His topic was “56 Countries Later – A Global Perspective on Healthcare in the United States.” Skolnik has nearly 40 years of experience at the World Bank and has lectured at George Washington and Yale Universities.  

Skolnik explained that the goal of a health system is to maximize the health of the population, in fairly distributed ways, and at the least cost.  Unfortunately, the United States spends nearly 50 percent more as a share of national income on health than any other country; we spend more in absolute amounts per person than almost any other country; yet we live shorter and less healthy lives than people in countries that spend less and we have unacceptable health care-related disparities.  

For example, in 2016 life expectancy in the United States was only slightly higher than in Thailand and Brazil, but lower than in Costa Rica, Cuba, Germany, the United Kingdom, France, Canada, and Norway.  In maternal mortality, the United States fares better than Cuba and Brazil; but women in the United States are more likely to die in childbirth than women in many other countries including Costa Rica, Thailand, the United Kingdom, Germany, France, Canada, and Norway. The United States also falls behind Norway, Cuba, and the United Kingdom in newborn and infant deaths.

In the United States, a person’s income plays a role in life expectancy.  Individuals with an annual income of $17,000 have an average life expectancy of 77 years.  An income of $47,000 increases life expectancy to 81.5 years; an income of $87,000 increases life expectancy to 85 years; and those with an annual income of $256,000 have the highest average life expectancy of 87 years.

The United States spends more of its Gross Domestic Product (GDP) on health care than other countries including Thailand, Costa Rica, Brazil, the United Kingdom, Canada, France, and Germany. These discrepancies stem from the higher cost of healthcare in the United States.  Physician compensation, total pharmaceutical spending, and administrative expenses are much higher in the United States. Further, many other countries invest more in systems that improve health such as early childhood education and universal health care.

Skolnik’s data show that the United States spends more money, achieves less, and is less effective in health care for its population.  We are the only country without a commitment to universal health care and we have the highest share of uninsured than in any other high-income country.  We also have unique causes of high mortality, such as gun violence and opioid addictions than many other countries

Skolnik recommends that the United States focus on achieving universal health care at the least cost in sustainable and fair ways.  We need to cut costs by spending more wisely, reducing administrative costs, and negotiating at every turn (currently Congress has prohibited the negotiation of drug prices). Further, social determinants of health need to be addressed fairly and at the least cost, and gun violence and the opioid epidemic should be addressed via a public health approach.  The gaps in infant and maternal mortality between us and other high-income countries should be considered inexcusable and unacceptable.

For several reasons, however, Skolnik is pessimistic that positive change is on the horizon.  The first reason is politics: the United States has privately funded elections with no limits on financing and a problem with gerrymandering. The second reason is American individualism, arrogance, and ignorance.  And the third reason Skolnik is pessimistic that our health care systems will become fairer and less expensive is that our health care system is profit-oriented with key actors fighting for the spoils at the expense of consumers.

Skolnik believes that change may come about through state-led efforts to achieve universal health care; locally led efforts to address specific gaps in health care; private sector-led efforts to selectively improve the health care system and reduce costs; and philanthropist-led efforts on creating and funding movements for universal health care and addressing key gaps and inequities.  Individually, we can vote for politicians who understand and care about the ethical and economic value of universal health care.