The past year has given me a chance to travel internationally several times – once to the Caribbean and multiple times to England and France. This travel, while validating my belief that the United States is the greatest country in the world, did provide quite a few opportunities for me to see where our preconceptions that everything here is better are somewhat misplaced.

The simple act of traveling was an eye opener. Even in small island countries, the Customs and Border processes in the countries I visited were more efficient, logical and less irritating. Comparing standing in a seemingly endless line at Dulles International Airport (as a US citizen) so that an agent can look at you and ask silly rote questions, to the experience in London, where (also as a US citizen) an automated process gets you through the perfunctory requirements in less than half the time is mind blowing.

And the differences don’t stop there. As someone who has been involved tangentially in the delivery of health care in this country for the past 35 years, I have become ingrained in the health care system. Being involved in program integrity has allowed me to see and come to understand (as far as possible) the complexities involved in delivering affordable high quality health care to a huge diverse population. To my detriment, being ingrained led me to believe that the system here was the best in the world in meeting those challenges. In visiting other places, however, I have seen vast fundamental differences in their approach to those same challenges. I am sure that universal single-payer health care systems have their issues but, from what I observed, they do work. People I spoke to in England and France spoke highly of their own system and were very confused as to how the United States’ system works.

I am starting to see their point of view. Why is it that health care cost per capita in the United States is the highest in the world but the quality of the care is so lowly ranked? Why is it that the elderly must spend down their entire life’s savings to be cared for in their waning years? Why is it that the infant mortality rate in the wealthiest country in the world is higher than many other developed countries? The mortality rate in the United States was 5.44 in 2020. This rate was 50th among the 195 countries and territories measured, and significantly higher than in dozens of other developed countries as Sweden (2.15), Japan (1.82), and Australia(3.14). Some of this difference can be explained by different definitions, but the differences are still there and they are stark.

The kneejerk reaction is always that the single payer system will not work here because it smacks of socialism or that people lose the chance to have their own doctors. Well, the last time I looked, Canada, Great Britain, and France were not socialist countries. And further, the era of the small town doctor caring for generations of families is being relaced by urgent care centers and emergency rooms becoming the de facto primary care physicians for higher and higher percentages of the American population.

While overseas, I also did not see advertisements for prescription drugs or medical equipment. The direct marketing to the American populace has turned the device manufacturers and pharmaceutical companies into health care decision-makers – telling patients what drugs they need or what equipment they should obtain. And the strategy works – some of the highest grossing pharmaceuticals on the market today are those that advertise (the TV drugs). Is that how we want our health care decisions made? The anti-kickback statute was enacted to eliminate profit-making from health care decisions. This type of direct advertising brings it squarely back into the equation. Doctors are put in the position of prescribing the medications or else angering their patients (or simply pushing them off to another source of the prescription).

I have no idea if the single payer system will work in this country but it is time to put aside the out of date rationales used by insurers to argue that it can’t. Our system is breaking – the business of health care has become business and not health care and the results are – higher costs, higher profits and poorer quality of care. From both a health care and business perspective, that is a model that is not sustainable.

by Matt Kochanski
Former HHS-OIG Program Director
Sr. Manager FWA at Advize