Thomas P. McGrath

Healthcare

Overview: The U.S. has poorer health outcomes & higher costs than all peers with universal coverage

Healthcare costs in the U.S. are a primary driver of projected Federal Debt growth and consume almost one in five dollars of Gross Domestic Product (GDP). This level of spending is much greater than all other, and about twice the average of, wealthy peer countries. Further, the U.S. generally has much poorer health outcomes (e.g., lowest life expectancy).

A more efficient and cost-effective U.S. healthcare system would allow greater investment in other areas of the U.S. economy and provide long-term economic benefits and fiscal stability as well as a healthier population. Healthcare system reforms that emphasize preventive care and eliminate waste (an estimated 25 – 30% of healthcare spending) are needed.

All the peer countries, with better health outcomes and much lower healthcare costs, have universal government/compulsory healthcare coverage for its citizens. The U.S. should transition from the current fragmented public/private healthcare insurance system to a universal coverage system and achieve similar benefits.

The U.S. healthcare system has poorer health outcomes than wealthy peer countries

The U.S. has poorer health outcomes than wealthy peer countries including the lowest life expectancy at birth and the highest rates of infant and maternal mortality, obesity, avoidable deaths, and multiple chronic conditions.

Life expectancy at birth in the U.S. is 77 years, which is lower than the life expectancy in 13 wealthy peer countries and three years less than the average for 38 high-income Organisation for Economic Co-operation and Development (OECD) countries [1]. The U.S. maternal mortality and avoidable death rates are almost two times greater than the next highest peer country. Based on body-mass index data, 42.8% of the U.S. population is considered obese.

The U.S. has very low rates of practicing physicians and physician consultations per capita

Amongst peer countries, the U.S. is essentially tied for the lowest number of practicing physicians per 1,000 population and is lower than the OCED average. Physicians would prefer to spend less time on insurance and administrative tasks and more time practicing medicine, and waning job satisfaction in the medical community could be contributing to the low rate of practicing physicians in the U.S. A 2020 article in The Lancet [2] notes

“overwhelming paperwork is a primary factor in physician burnout.”

There are inefficiencies in the U.S. healthcare system and opportunities for improvement

The combination of high costs and poor health outcomes makes clear that there are inefficiencies in the U.S. healthcare system and opportunities for improvement.

“While the United States spends more on health care than any other high-income country, the nation often performs worse on measures of health and health care. For the U.S., a first step to improvement is ensuring that everyone has access to affordable care. Not only is the U.S. the only country we studied that does not have universal health coverage, but its health system can seem designed to discourage people from using services.” [1]

Excessive waste, complexity, tax subsidies, and perverse pay structures drive high healthcare costs

Causes of high U.S. healthcare costs include excessive healthcare system waste, a complex and fractured public/private healthcare system, tax code subsidies for employer-based health insurance, and fee for service payment structures that disincentivize lowering costs and improving quality of care [1 2 3 4 5]

An estimated 25 – 30% of U.S. healthcare system spending is on services that are “unnecessary, ineffective, overpriced, and wasteful”. [3 4] Pricing failure (unreasonably high prices), administrative complexity, and failure of care delivery account for about 75% of the wasteful expenditures.

Poor health causes include inadequate preventative care, sedentary lifestyle, poor diet, & obesity

Causes of poor health outcomes include missed and deferred preventative or other necessary care by the uninsured and under-insured and other factors including sedentary lifestyle, poor diet, chronic stress, smoking, excessive alcohol use, and obesity. [1 6]

High calorie, low nutrition ultra-processed foods have been linked to weight gain and greater risk of other health issues such as cardiovascular disease, heart attacks, and strokes. [7 8 9]

"Blue zones" lifestyle characteristics contribute to longer healthier lives

Factors that contribute to longer healthier lives were identified by studying the lifestyles of people living in “blue zones”, five areas in the world where people live to be over 100 years old at a rate 10 times greater than in the U.S. [10]

The common lifestyle characteristics of the blue zones are: Move Naturally (keep moving throughout the day); Down Shift (have daily rituals that reduce stress); Purpose (have a sense of); Wine at 5 (1 – 2 glasses per day); Plant Slant (primarily plant-based diets); 80% Rule (stop eating at 80% full); Loved Ones First (prioritize family relationships); Belong (to a faith-based community); and Right Tribe (associate with people with healthy lifestyles).

The U.S. should transition to universal health coverage and benefit from better health at lower cost

All of the U.S. peer countries included in the above analysis have universal healthcare systems and better health outcomes and much lower healthcare costs than the U.S. This indicates the U.S. should transition to a universal coverage system and achieve similar benefits. Politics and vested interests, such as the pharmaceutical industry and health insurance companies, are potential roadblocks.

The 2020 article in The Lancet [2] analyzed the anticipated impact of the proposed Medicare for All Act (MAA) “a single-payer system of universal health care for every American.” The article points to Medicare as a “real-world test for the viability of single-payer, government-funded health care” that “has significantly and cost effectively improved the health of older people.” Key findings of the analysis were:

37 million people in the U.S. did not have health insurance and 41 million were underinsured;

An estimated 13% reduction in U.S. healthcare spending from the implementation of universal healthcare covering all Americans. Primary savings were from reductions in avoidable emergency room visits and hospital stays, fraud, administrative costs, and reimbursement rates for healthcare service and pharmaceuticals. Lower compensation for healthcare services would be offset by eliminating unpaid hospitalization bills and reduced administration expenses.

A universal healthcare system would save about 68,000 lives per year, improve health/quality of life from better primary and preventative care, provide more efficient life-long uninterrupted healthcare, and increase patient choice of healthcare providers.

Financing options included a payroll tax offset by employers no longer paying insurance premiums and an income tax for households to replace insurance premiums paid by households.

The paper also notes that reduced administrative tasks/paperwork with a single-payer system would reduce burnout of physicians, nurses, and other medical professionals and increase career satisfaction.

“As providers reduce their administrative workload, they free time for patient care, which will bolster career satisfaction”

Interim improvements to the existing public/private healthcare coverage system should be implemented

Until a single-payer universal healthcare coverage system can be implemented in the U.S., improvements to the existing public/private healthcare coverage system should be pursued.

Federal actions to reduce healthcare costs and improve healthcare service could include. [3 5]

Change incentives to encourage healthcare providers to deliver better care at a lower cost. For example, transition from a fee-for-service model to a pay-for-performance model.

Improve healthcare system information and data transparency for patients to encourage greater participation in healthcare decisions.

Reduce subsidies for federal healthcare to limit government costs.

Redesign the federal programs for healthcare. For example, change Medicare to a program that supplements beneficiary payments for private insurance.

References

1. “U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes”, M.Z. Gunja et al, The Commonwealth Fund Issue Brief, January 31, 2023. www.commonwealthfund.org/publications/issue-briefs/2023/jan/us-health-care-global-perspective-2022

2. “Improving the prognosis of health care in the USA” A.P. Galvani et al, The Lancet 2020, Volume 395, February 15, 2020. www.thelancet.com/article/S0140-6736(19)33019-3/fulltext

3. Peter G. Peterson Foundation / Finding Solutions / Healthcare Reform www.pgpf.org/finding-solutions/healthcare

4. “Waste in the US Health Care System, Estimated Costs and Potential for Savings,” W.H. Shrank et al, Journal of the American Medical Association, October 7, 2019. https://jamanetwork.com/journals/jama/article-abstract/2752664

5. “Containing the Growth of Health Care Costs,” B. Ritz, Bipartisan Policy Center, October 3, 2016. https://bipartisanpolicy.org/blog/containing-the-growth-of-health-care-costs/

6. “Your Heart is in Your Hands,” M. Lee, MD, RHG Media Productions, 2020.

7. “What are ultra-processed foods?”, H. Alexander, The University of Texas MD Anderson Cancer Center, March 16, 2022. www.mdanderson.org/cancerwise/what-are-ultra-processed-foods.h00-159538167.html

8. Harvard Health Blog – What are ultra-processed foods and are they bad for our health?” www.health.harvard.edu/blog/what-are-ultra-processed-foods-and-are-they-bad-for-our-health-2020010918605

9. “Ultra-processed foods: how bad are they for your health?” British Heart Foundation. www.bhf.org.uk/informationsupport/heart-matters-magazine/news/behind-the-headlines/ultra-processed-foods

10. “Business Engagement in Building Healthy Communities: Workshop Summary, Lessons from the Blue Zones®” National Library of Medicine, National Center for Biotechnology Information. www.ncbi.nlm.nih.gov/books/NBK298903/

Tom McGrath
Independent Candidate
U.S. House of Representatives

California's 47th Congressional District

Healthcare

Overview: The U.S. has poorer health outcomes & higher costs than all peers with universal coverage

The U.S. healthcare system has poorer health outcomes than wealthy peer countries

The U.S. spends a much greater share of its economy on healthcare than peer countries

The U.S. has very low rates of practicing physicians and physician consultations per capita

The U.S. is the only peer country without universal government/compulsory healthcare coverage

There are inefficiencies in the U.S. healthcare system and opportunities for improvement

Excessive waste, complexity, tax subsidies, and perverse pay structures drive high healthcare costs

Poor health causes include inadequate preventative care, sedentary lifestyle, poor diet, & obesity

"Blue zones" lifestyle characteristics contribute to longer healthier lives

Policies and incentives for better health and lower costs for the U.S. should be implemented

The U.S. should transition to universal health coverage and benefit from better health at lower cost

Interim improvements to the existing public/private healthcare coverage system should be implemented

References

DOWNLOADS

Tom McGrath Independent CandidateU.S. House of Representatives

California's 47th Congressional District

Healthcare

Overview: The U.S. has poorer health outcomes & higher costs than all peers with universal coverage

The U.S. healthcare system has poorer health outcomes than wealthy peer countries

The U.S. spends a much greater share of its economy on healthcare than peer countries

The U.S. has very low rates of practicing physicians and physician consultations per capita

The U.S. is the only peer country without universal government/compulsory healthcare coverage

There are inefficiencies in the U.S. healthcare system and opportunities for improvement

Excessive waste, complexity, tax subsidies, and perverse pay structures drive high healthcare costs

Poor health causes include inadequate preventative care, sedentary lifestyle, poor diet, & obesity

"Blue zones" lifestyle characteristics contribute to longer healthier lives

Policies and incentives for better health and lower costs for the U.S. should be implemented

The U.S. should transition to universal health coverage and benefit from better health at lower cost

Interim improvements to the existing public/private healthcare coverage system should be implemented

References

DOWNLOADS

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Tom McGrath
Independent Candidate
U.S. House of Representatives