health_care_jus - Justice Spring 2006-1 Health Care and...

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Justice, Spring 2006—1 Health Care and Justice 1. The Problem. The American health care system is, by general agreement, in pretty bad shape. Putting aside many relevant details, there are two basic facts about it that trouble observers. First, the United States spends a vast quantity of money each year on health care, much more than the amount spent in other comparably wealthy countries. The United States spends nearly two-and-a-half times the median per capita spending in the industrial world (see Gladwell, WHO report for 1998); as a percentage of GDP, the United States now spends more than 60% above the OECD median. Of course, if we are spending more and getting more, you might conclude that we simply have a cultural preference for greater health, and are prepared to spend what we need to achieve it. But, and here we come to the second basic fact, health outcomes in the United States are relatively poor by comparison with countries that spend much less. In 2000, for example, the United States ranked 23rd in the world for male and female life expectancy. And as for infant mortality: the United States now ranks 19 th in the world, and considerably higher than any OECD country: moreover, the black infant mortality rate is twice the rate for white Americans. We also have a poor score of what is called “disability-adjusted life expectancy” (the number of healthy years that we can expect on average): here, the United States was (in 1998) 24 th in the world. So it appears as if we are now getting very much for our money.
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Justice, Spring 2006—2 Something has gone wrong, and, while health is not simply a product of heath care, at least part of the story has to do with the now-45 million Americans who have no health insurance, and therefore have limited access to health care: uninsured Americans are nearly eight times more likely than Americans with private health insurance to skip health care because they cannot afford it. Not surprisingly, lack of insurance is particularly common among low-income Americans: 68% of low-income adults were insured for at least part of the time between 1996-99. Others are covered by a vastly complicated system of private insurers with very high levels of administrative overhead (20-25% of total expenditures). In discussions of health care, then, it is common to worry both about the sheer amount that we are spending, and about the distribution of health care and of health itself. These concerns about the US system are widespread, though they have resisted remedy over a very long period—there were major reform efforts during the presidencies of Roosevelt, Truman, Nixon, and Clinton—and there is considerable disagreement about how to fix the health care system.
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health_care_jus - Justice Spring 2006-1 Health Care and...

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