Skipping the Cycle: Why more investment makes health care accessible, affordable and more just for all

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This article is part of a series in which OECD experts and thought leaders — from around the world and all parts of society — address the COVID-19 crisis, discussing and developing solutions now and for the future. Aiming to foster the fruitful exchange of expertise and perspectives across fields to help us rise to this critical challenge, opinions expressed do not necessarily represent the views of the OECD.

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COVID-19 has ravaged health systems around the world, but American health care has been laid particularly low. The pandemic, it seems, has exposed every flaw and weakness in the world’s most expensive health system, and its deep, systemic inequities.

Of course, long before COVID-19, Americans struggled to get and afford health care— in the first half of 2020, nearly half (43.5%) of Americans were uninsured or underinsured, meaning they have insurance but their costs are so high they still struggle to afford health care. Similarly, pre-pandemic the nation’s disjointed health care system resulted in substantially different experiences and health outcomes depending on one’s race and ethnicity, income or which state they lived in. The Affordable Care Act did help narrow both income and racial and ethnic inequalities in health coverage but those improvements have stalled, and the uninsured rate for Black and Latino adults in 17 states was at least five percentage points higher than it was for white adults.

Read more on this topic: Working Together to Create Greater Equity in Healthcare by John Damonti, President, Bristol Myers Squibb Foundation; BMS Patient Assistance Foundation

The Commonwealth Fund’s most recent international health policy survey showed us just how much of an outlier the United States is when it comes to health disparities, especially income-related inequality, compared to the rest of the world. It is stunning.

The value of cross-national comparisons, which we have spent our careers studying, is that we can learn who is doing well, how they are doing it and how we can replicate it. Clearly, the United States has some learning to do, and as a new administration is poised to take charge this is an opportune time for us to do so.

To start, we have an opportunity to make sure every American has health insurance and access to health care they can afford regardless of their income, race or ethnicity. Expanding Medicaid, one of our public health insurance programmes, in every state would be a tremendous step in that direction and would immediately provide affordable coverage to millions more Americans.

Primary care, the backbone of any strong health care system, is woefully underfunded here. At a moment when people will be relying on primary care doctors for COVID-19 care and vaccinations, it is critical to invest in making our primary care system work better. Our European counterparts in the Netherlands and the United Kingdom have shown that when you invest heavily in primary care, you get better access to care, better health outcomes and lower costs overall. It is clearly a lesson worth learning for the United States.

Also on the Forum Network: Resilience of Health Systems to the COVID-19 Pandemic in Europe: Learning from the first wave by Francesca Colombo, Head of the Health Division, Directorate for Employment, Labour and Social Affairs, OECD

Protecting people from hunger, homelessness and other social stressors is another area where the United States falls far short of our peer nations. Recognising that keeping health and social services separate does not meet patients’ needs, several countries are implementing policies to combine them. Since 2016, the United Kingdom has prioritised social prescribing, where health care providers help patients get needed nonmedical services. In Norway, local budgets for primary care and social care have been combined to better meet patients’ needs.

These kinds of improvements and investments would be game changing for American health care. And our economy needs the boost that a stronger, more inclusive health care system can provide. Just as the Affordable Care Act provided an economic stimulus as we clawed our way out of the 2008 global recession, investing in better health care can support broader economic recovery from the COVID-19 downturn.

As countries around the world recover from COVID-19, each will have to find its unique way forward. In the United States, we must recognise that a system where nearly a third of people skip doctor visits, medications and medical tests because they can’t afford them is woefully insufficient. We will need to commit to taking serious steps to improve coverage, access, affordability and equity. If we don’t, we will only be perpetuating this cycle where we spend the most on health care and get the least for it. And, when the next crisis hits, we will find ourselves even worse off. We can do better. Studying how other nations grapple with meeting the health needs of their people gives us hope that with modest steps—we can do the same here in the United States.

Read the OECD policy response Building a coherent response for a sustainable post-COVID-19 recovery

                                  Photo: Kieran Jones

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Tackling COVID-19 Health Income Inequality

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Reggie Williams

Vice President, International Health Policy and Practice Innovations Program, Commonwealth Fund

Reginald D. Williams II (Reggie) joined the Commonwealth Fund in 2020 as the Vice President of the International Health Policy and Practice Innovations program. In this role, he is responsible for fostering international dialogue, exchange, and education that enables U.S. policy makers and healthcare leaders to learn from cross-national experiences, including The Commonwealth Fund's Harkness Fellowships in Health Care Policy and Practice. Prior to joining the Fund, Mr. Williams was at Avalere Health, a consulting firm dedicated to improving healthcare, where he served as Managing Director focusing on health care delivery innovation and digital health. Reggie earned an AB in Biomedical Ethics from Brown University.