U.S. Health Care--Its Strengths and Weaknesses

Oct 31, 2007

By Thomas J. Donohue, President and CEO, U.S. Chamber of Commerce
November 20, 2007

Over the past few months, I've written often about the competitive challenges facing our economy in today's global world—challenges like energy, infrastructure, legal reform, education, and immigration. But health care is a competitive challenge unlike any other.

One could write volumes of books about health care in America—and many have! But in my next three columns I'd like to: 1) recognize the strengths of our system; 2) examine its primary shortcomings; and 3) outline five core principles we can employ to make health care more affordable, efficient, and inclusive, while rejecting an expansive government-run system heavy with mandates, costs, and rationing of care.

In many respects, we're already beating the global competition hands down when it comes to health care. We are home to the finest medical facilities, technologies, innovations, treatments, and human talent. Many of the world's best medical practitioners have moved here—or want to. Patients of means who face major health challenges beat a path to our doors for treatment. Tens of billions of dollars in capital for medical and pharmaceutical R&D flows here. Health care is also generating more new job opportunities than any other sector of our economy. This is good news for Americans from every skill level and background.

Since World War II, and then with the advent of Medicare and Medicaid, the U.S. health care system has evolved into a blend of privately financed care—with employers playing a leading role—along with government support for the elderly and the poor. Under this mostly voluntary approach, we have managed to insure roughly 85% of our people, with emergency care legally required for everyone else.

It may surprise you to hear that all told, the number of people with either private or government health insurance went up in 2006—to 249.8 million. More than 201 million are covered by private insurance, the vast majority of those—177 million—with employment-based coverage under a voluntary system with no employer mandates. Many of the insured, including all the elderly, enjoy comprehensive coverage. Medicare has recently added a prescription drug benefit that most seniors are very happy with.

All these advances, along with the widespread availability of a vast range of medical services, have played a major role in enabling us to live longer and better lives. In 1900, life expectancy in the United States was about 48 years. By the end of the century, it had reached 78 years and is climbing. Now that's a remarkable achievement!

At the same time, we must clearly recognize the significant problems, and there are many—the number of uninsured, escalating costs, medical liability, and lack of consumer responsibility and health care information technology. We'll take a closer look at what's wrong with our system next week ...

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