Looking Overseas Gives Us Reasons to Be Thankful for Obamacare

U.S. Adults Are More Likely to Skip Care and Struggle with Medical Bills Than Adults in Peer Countries

This Thanksgiving, a lot of Americans will be giving thanks for Obamacare.

By the end of this month, HealthCare.gov will be able to handle 800,000 users per day, enough to enroll everyone who needs coverage by the end of the year. Meanwhile, the state-run exchanges are reporting “a November enrollment surge,” precisely as the Obama administration predicted. (Massachusetts also experienced a late enrollment surge when they adopted an individual mandate in 2006.) Everyday, we hear new stories about Americans who are saving thousands of dollars on their insurance costs, including House Speaker John Boehner, whose new Obamacare insurance will cost pennies on the dollar of his six-figure income.

And not a moment too soon. Earlier this month, the nonpartisan Commonwealth Fund published the results of their latest survey of eleven industrialized countries, including the United States, where they asked people about their experiences with the health care system in the past year. Their findings are a sad reminder of just how bad the status quo is — and why we demanded health reform in the first place.

Many Americans don’t go to the doctor when they’re sick because they can’t afford it. Many don’t go to the pharmacy or take their medicine. Add it all up, and 37 percent of Americans had some sort of “cost-related access problem” in the past year.

That kind of problem isn’t nearly as common in the Netherlands, where it only affects 22 percent of the population. Or France, where the number drops to 18 percent. Or Canada, where it’s 13 percent. Or the UK, where it’s 4 percent.

Fair enough, you might say. More people have more access, but they also have to wait in line longer, right? Not necessarily.

In fact, in most countries, the majority of the population could see a doctor within a day of their request. The United States placed second-to-last in this category. A quarter of our population had to wait six days or more — a little better than Canada, but far worse than Australia, France, Germany, the Netherlands, New Zealand, and the UK.

But that’s primary care. The United States is known for its specialists, where 76 percent of the population got an appointment in less than four weeks and only 6 percent had to wait two months or more. That’s a heck of a lot better than Australia, where only 51 percent got an appointment in less than four weeks and 18 percent had to wait two months or more. Or Canada, where the numbers are 39 percent and 29 percent, respectively.

But it’s about the same as the Netherlands, where the numbers are 75 percent and 3 percent. And the UK, where they’re 80 percent and 7 percent. And even Germany isn’t far behind, at 72 percent and 10 percent.

So it’s a mixed bag, but we’re certainly not in the lead.

In most countries, it’s a lot easier to get after-hours care than in the United States. Only 35 percent of American doctors have an arrangement to take care of their patients after the office is closed — by far the lowest percentage of all the countries surveyed. In Canada, it’s 46 percent. In France, it’s 76 percent. In Germany, the Netherlands, and the UK, it’s 90 percent or higher.

And the doctors have a lot more problems in the United States, where the paperwork piles up. One in three — 32 percent — reported significant paperwork or payment problems in 2013, compared to 23 percent in France, 17 percent in Germany, 15 percent in Canada, and 4 percent in the UK.

No wonder everyone else is happier with their health care than we are.

Only 25 percent of Americans think their health system works well. In the other countries, that approval rating ranges from 40 percent in France to 63 percent in the UK.

Whereas 27 percent of Americans think the health system needs to be completely rebuilt, that disapproval rating ranges from 12 percent in Norway to 4 percent in the UK.

That’s a lot of numbers, but they all tell the same story: The United States has the most complicated, most expensive, and most frustrating health care system in the industrialized world — and none of that is due to Obamacare, most of which took effect after the survey.

In fact, Obamacare is moving our system closer to our international counterparts. Based on these numbers, I’d say that’s definitely something to be thankful for.

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An abbreviated version of this op-ed was published in Friday’s South Florida Sun-Sentinel. This version was published in the Huffington Post.

We Don’t Have a Government Spending Problem. We Have a Health Care Problem.

Nobody’s happy about the sequester, the government spending cuts that took effect a few days ago, but most people think it was a necessary evil.

Evil? Maybe. Necessary? Absolutely not.

In June 2011, before Congress passed the Budget Control Act, the Congressional Budget Office released its annual “Long-Term Budget Outlook.” This is the best nonpartisan projection we have of what the federal budget would look like without the sequester.

The CBO considered two possibilities.

First, what would the budget look like if Congress did absolutely nothing? The Bush tax cuts would expire as scheduled, Obamacare would take effect, and Medicare payments to doctors would remain at current rates. They called this the “Extended-Baseline Scenario.”

Second, what if Congress stopped all those things from happening? They extended the Bush tax cuts permanently, repealed Obamacare, and raised Medicare’s payment rates for doctors every year. They called this the “Alternative Fiscal Scenario.”

The difference is stunning. In the Extended-Baseline Scenario, the government’s debt never increases. Relative to the size of the economy, it’s the same in 2033 as it was in 2013. Meanwhile, in the Alternative Fiscal Scenario, it skyrockets. By 2033, it’s double what it was in 2013.

The Alternative Fiscal Scenario is what scared legislators into passing the Budget Control Act. They decided to slash government spending across-the-board by over $2 trillion over the next decade in order to avoid a massive increase in debt.

But why were they looking at the Alternative Fiscal Scenario? After all, the Extended-Baseline Scenario showed that the debt problem disappeared if Congress simply did nothing. Why didn’t they just…do nothing?

Well, if they did nothing, taxes would go up, and doctors’ payments wouldn’t. The politics speaks for itself.

Instead of doing nothing, Congress made 84 percent of the Bush tax cuts permanent at the beginning of this year, and of course, doctors’ payments continue to rise.

And that’s why they needed the sequester to rein in rising debt.

But that doesn’t explain why the sequester was an across-the-board cut in government spending when, according to the CBO, we don’t have an across-the-board spending problem.

Let’s look at the 2011 Budget Outlook one more time.

In the Alternative Fiscal Scenario, it’s true that spending increases dramatically — from 24.1 percent of our nation’s income in 2011 to 33.9 percent in 2035. But it’s not across-the-board. In fact, if you exclude health care programs and interest payments, federal spending actually decreases from 17.1 percent in 2011 to 14.6 percent in 2035!

In other words, we don’t have a spending problem. We have a health care problem!

If we had the health care costs of the average industrialized country – which has a higher life expectancy than us, by the way – we’d save over $2.5 trillion over the next decade, far more than the sequester.

And yet, looking at these numbers, our legislators decided to slash government programs across-the-board, the vast majority of which nothing to do with the problem. They chose to kick 70,000 kids out of Head Start; eliminate funding for 1.2 million disadvantaged students; serve 4 million fewer Meals on Wheels; eliminate nutrition assistance for 600,000 women and children; kick 120,000 families out of low-income housing; kick 100,000 homeless people out of shelters; conduct 2,100 fewer food inspections; conduct 1,200 fewer workplace safety inspections; treat 373,000 fewer mentally ill Americans; employ 1,000 fewer federal law enforcement agents; prosecute 1,000 fewer criminal cases; issue 1,000 fewer science research grants; guarantee $540 million less in loans to small businesses; conduct 424,000 fewer HIV tests; and treat 7,400 fewer AIDS patients. And that’s only this year, when less than 10 percent of the sequester will kick in.

All because they didn’t want to deal with the real problem.

Last month, the CBO published a new Budget Outlook. Including the effects of the sequester, it shows debt declining for the next few years, and then in 2019 it starts to rise again. That’s the dirty little secret that Congress won’t tell you: Even $2 trillion in spending cuts can’t stop the rise in debt…because spending simply isn’t the problem.

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This op-ed was published in today’s South Florida Sun-Sentinel.