Many people in the United States believe that we have the best heathcare system in the world, but the World Health Organization ranks the US at 37th in the world.

Look at the number of people without health insurance in the US. It dropped significantly when we began Medicare and Medicaid in 1965, and then climbed again, reaching a peak in 2008. The Medicaid expansion by the ACA covered 11 million new people, which brought the un-insurance rate down significantly. Coverage under the ACA has leveled off.

Though the US has the highest percentage of people without health insurance among the industrialized nations, it spends the most on health care. In many cases the US spends twice what other nations spend per person each year. The US spends more in public dollars on health care than other nations spend.

Why does the US spend so much on health care? One reason is the heavily bureaucratic system. There are hundreds of insurance plans, which require administrators that work for the plans, businesses, health professionals and hospitals to communicate with each other about who is covered, where they can go for care, what care they can receive, and how much each party pays. It is a very inefficient system that is difficult for patients and providers to navigate.

This is reflected in the high insurance overhead in the US.

Some hospitals have more billing people than nurses.

And physicians have high overhead in order to interact with the many insurers.

Let’s look at how the US does compared to other industrialized nations with respect to health outcomes.

People in the US have a lower average life expectancy.

Other countries have a longer life expectancy even though they have more smokers.

More infants die in the US than in other industrialized nations. In some areas of the US where poverty is high, the infant mortality rates are similar to non-industrialized nations.

And the maternal mortality rate (the number of mothers who die from childbirth) is very high in the US.

Part of the reason for poor health outcomes is rationing. Unlike other industrialized nations, rationing in the US is based on ability to pay, which could be considered the cruelest form of rationing.

People in the US spend fewer days in the hospital.

People in the US visit the doctor less.

There are fewer nurses per capita in the US.

A significant reason why people in the US use less health care services is because they have to pay more out of pocket up front. This turns the decision to seek care into a financial decision rather than focusing on needs. People are forced to decide between health care and other necessities such as food and shelter.

As far as industrialized nations go, the US has very high rates of child poverty. It is often said that one can judge a nation by the way it treats its most vulnerable people.

What is the Affordable Care Act (aka the ACA or Obamacare)?

Here are the basics of the ACA. It does prescribe essential benefits but there is no standard benefits package so there is wide variation among the many different plans. Patients have high co-pays and deductibles (out-of-pocket) costs for everything except some preventive services. Insurers use a high percentage of patient premiums for overhead instead of care and insurers can charge high premiums and out-of-pocket costs that shift the burden onto patients.

The ACA did reduce the number of people without health insurance. This was mostly due to an expansion of Medicaid, a public system for people with low incomes.

But the ACA has driven more people who have health insurance to be under-insured. This means that they have health insurance but they still can’t get the health care they need either because the out-of-pocket costs are too high or because they can’t see the health professional they need to see because it is out of their insurance network.

The ACA has not had an impact on people who become bankrupt due to medical debt. This is the greatest cause of personal bankruptcy in the US and most people had some form of health insurance when they had their accident or illness.

The ACA included what they called called cost control provisions, but NONE of them have been proven to control healthcare costs.

And the ACA has put a tiered healthcare system into law. It has made low coverage and high out-of-pocket costs the norm. This is degrading employer plans, which used to be the best plans.

Even the lowest tiered plans are not affordable for families.

And rather than lowering administrative waste, the ACA has increased it.

Public opinion in the United States supports National Improved Medicare for all. There has been consistent majority support for decades.

Physicians also support National Improved Medicare for All. This study was conducted in 2007. It showed a 10% increase in physician support over a similar study done five years earlier in 2002. Physicians are becoming increasingly frustrated with the current system. It would be interesting to see a new study.

Among particular specialties, there is very high support.

Professional medical organizations tend to be very conservative, but some of them are shifting their positions. The American Academy of Pediatrics recently adopted a resolution to study single payer national health insurance.

So what is single payer (National Improved Medicare for All)? It is based on these beliefs:

National Improved Medicare for All will deliver what the ACA was supposed to deliver, but couldn’t.

Here is how National Improved Medicare for All works.

National Improved Medicare for All removes private insurers from the equation so that health decisions are made by patients and health professionals. Here is what it covers:

National Improved Medicare for All (called national health insurance or NHI in the slide below) will control the costs of pharmaceuticals and medical devices because it is the single purchaser of them.

Physicians can choose how they want to be reimbursed for care.

Here is a direct comparison of National Improved Medicare for All (single payer) and the ACA:

HR 676 is the Expanded and Improved Medicare for All act. It was introduced in the House of Representatives on Jan. 24, 2017. It currently has 57 co-sponsors. You can find out if your member of Congress supports it by clicking here.

We are already spending enough on health care in the United States to provide comprehensive coverage to everyone without co-pays or deductibles. The only thing stopping us from having it is the political will to do it. Our task is to educate ourselves, organize and mobilize to make National Improved Medicare for All the ONLY politically-feasible solution.