The American Health Care [non-]system is in decline. The number of Americans covered by employer health care plans actually fell by about 5 million during the past four years, even though the number of people eligible rose by about 10 million. That’s an additional 15 million average Americans for whom the health care system is a distant mirage. Plus for those lucky enough to have coverage the cost is rising rapidly. American industry is in a pickle: how does it contain cost without antagonizing it’s employee base? A national crisis is looming, but before it can be resolved Americans need to face the truth about their system.

It is time Americans stopped thinking that they have ‘the best health care in the world’ and recognize that they are, in fact, way behind most every other industrialized nation. The facts are stark when you face up to them: America spends twice as much on health care as its industrial partners, yet ranks below them in terms of basic results. For all that vaunted money and technology, Americans have shorter life spans and higher infant death rates than anyone else in the industrialized world. That’s a rotten return on investment. Very rotten. Not only this, but Americans are much less likely to see a doctor — they say they are afraid of the cost, or to take the medicines that they are prescribed — they cost too much. Clearly, at least to an objective observer, Americans are getting a bad deal from their market driven system.

Why? Because the system is knee deep in bureaucrats all of whom cost money, and all of whom are fighting to cut or eliminate expenditure rather than to provide care: they do not add to care but they take up a lot of dollars. It is a system designed for accountants not those in need of care. This is truly ironic given that a major criticism leveled at Government run systems is that they are typically bureaucratic, but in this case the reverse is true: a Government system would have less, not more, bureaucracy. Another aspect of this is that the system is fragmented, there are too many players none of whom have the clout that the Government would in the market place. For instance, Americans pay far more for their drugs than anyone else because no one in their system has sufficient power to drive a hard bargain with the drug makers. The Government could do that, but such is the lobbying power of the drug industry that the George Bush’s pet Medicare bill explicitly forbids the Government from using its market power. So the sick and the taxpayers get the shaft while drug company profits are inflated.

America has a system where the rationing of service is by price rather than government allocation. It is market driven. In other words you can get whatever you want if you can afford it; if you can’t then you get nothing. For instance, it is correct to observe that people in Britain and elsewhere wait longer for elective surgery [what’s wrong with waiting for something that is elective?]; but wait times mask a grim reality here in the U.S.: for many people the system simply doesn’t exist because they cannot afford it. So those short wait times are irrelevant, the service isn’t there to wait for. It is a scandal that the world’s richest nation has approximately 15%, and rising, of its population uncovered for health care, and it is delusional nonsense to keep lauding the system as if it’s good. It isn’t.

The fix is obvious: America needs some form of national health care system. It’s time to press for the correct answer. Then maybe the system will deserve the credit Americans currently give it.