This assessment, made April 2020, looks at various measures for healthcare quality, access, coverage and capacity.
Hospital beds are an important gauge of quality healthcare. Here’s a table showing hospital beds per 1,000 people with useful extra data on hospital occupancy (what percentage of beds are occupied), ICU beds per 100,000 people, number of ventilators and ventilators per 100,000 people.
|Germany||8.28||8.00||79.8||29.2||40,000 (+25000 March2020)||49.3 (80.2)|
|United States||2.89||2.71||64.0||34.7||82755 (hospital inventory)||25.6|
|United Kingdom||2.76||2.54||84.3||6.6||8,175 (+25000 inbound Apr2020)||10.1 (30.6 after inbound Apr2020)|
These figures are largely pre-coronavirus. Many countries have responded to the COVID-19 crisis by increasing numbers of critical care beds and making large orders for ventilators. This time next year the picture may be very different.
DENSITY OF DOCTOR – PRIMARY CARE – GENERAL PRACTISE
… GPs per 100,000 people, access to primary care, etc.
… life expectancy by country, by gender and quality of life (by health only) measures.
HEALTHCARE COSTS AND PROLIFERATION
… costs, out of pocket and to government, and how many insured and how many not.
PROFIT, INNOVATION and PUBLIC HEALTHCARE OPTIONS
Healthcare in the United States, leaving aside issues like insurance companies refusing cover (many patients get treated anyway), is objectively higher cost per capita than any other developed country. Part of that is big pharma and other providers of medical goods/service charging high, for maximum profit. Partly it’s because gov’t provision needs to level the elderly playing field so they get the same quality of care as younger Americans using regular insurance; and this is expensive, for the reason prior.
American doctor and hospital standards are mostly very good, on a par or better equipped than other developed countries with nationalized healthcare.
America’s enormous healthcare system and the billions of dollars annually passing from taxpayer to IRS to public spending (social security, Medicare, Medicaid) generate vast, largely stable profits for companies doing business in the industry. This is incentive for competitive high standards as well as pharmaceutical research, biotech startups, drug development (expensive trials, patient safety testing, winning FDA approval).
Profit attracts innovation. Demand and liquidity is underwritten by gov’t money. The end results is a dynamic, creative healthcare service. For most Americans.
“For most Americans” is the key point of ideological divergence, if you boil away all the white noise of political rhetoric. “For most Americans” means the healthcare system doesn’t cover everyone. It means the excellent median quality of care deteriorates closer to the bottom (poor) demographics. It means ‘can we profit?’ is part of the decisions process on provision of care, made by insurance companies trying to do the best possible job for their shareholders. Insurance has a systemic resistance to paying out; and this is entirely legitimate given their business model.
Most of the cost of healthcare across a country’s population comes from providing medical treatment for chronic conditions, terminal (or major life-threatening) illness, the working poor and the growing elderly demographic. Millions slip through gaps in the system and live uninsured, praying for good health rather than visiting a doctor when sick.
In a nationalized healthcare system, the government foots the bill for these unprofitable sections of society, spreading the burden across the entire population.
American government picks up much of this slack, Medicare and Medicaid covering most of the old and much of the poor patient demand. It pays hundreds of billions of dollars a year, of taxpayer money, to maintain these programs.
By having government – or nobody – bearing the cost of the unprofitable sections of society, insurance and medical providers exist in the majority space of “most Americans” from whom it’s possible to make their profit. The American healthcare system’s hard edged government-corporate partnership is an effective way to manage a nation’s medical system while also allowing profit and removing risk to business by public spending to cover the unprofitable demographics. It’s a complex picture.
Whether or not this big capital cabal is better – in America – than a more socialized healthcare system, is open to debate. What is objectively true, however, is the United States has an excellent doctor, hospital, research and medical services network, for the top half of society. Quality drops but remains good for much of the lower half. The rest – some 20-30 million Americans – have little or no coverage and bad healthcare.
To date the corporate-government model has been the choice of the American establishment and, for the most part, it’s a choice supported by the majority of its citizens. The ethical question of universal healthcare – to each according to need – is quite rightly an ongoing debate. It won’t help Democratic Party progressive ambitions to simply dismiss the current pro-capitalist big capital system. Evidence of the latter’s effectiveness, for most Americans, is as plain as a Bulgarian centerfold.