As Democrats debate “Medicare for All,” a new roundup of public opinion on health reform published this week by the American Enterprise Institute provides some useful background. For decades now, an overwhelming majority of Americans has felt that the U.S. system needs either fundamental changes or a complete overhaul.
In a new piece titled “The unique problem with U.S. health care,” Axios’ Sam Baker points out how unusual the mostly employer-based American system is. “If you look at other rich countries comparable to the U.S., you’ll find plenty of roles for private insurance,” he writes. “But you won’t find such a close tie between work and health care very often.”
In addition to that employer-based system, the United States also has a number of public health care programs. “It’s not unique to have a public and private system, but to have so many public and private programs co-existing — I can’t think of any other county that has that,” Irene Papanicolas, a health economist at the London School of Economics, tells Baker.
The result is costly bureaucratic bloat. “That fragmentation — one system for workers, another for the unemployed or self-employed, plus Medicare for seniors, Medicaid for low-income families, one for the military, another for Native Americans — contributes to our wasteful spending by driving up administrative costs,” Baker writes. “Almost nowhere in that convoluted process does the U.S. do much to control health care prices — another big difference from similar countries, and obviously a big reason our system is so expensive.”