What's wrong with the US healthcare system

"All health systems in Europe are better than the US"

There are millions of people in the United States without health insurance. “In the United States, medical costs are perceived as a private matter,” criticized Professor Reinhard Busse, Professor of Management in Health Care at TU Berlin, in an interview with the “Ärzte Zeitung”.

Doctors Zeitung: What do you think is the core problem in the US healthcare system?

Professor Reinhard Busse: There is no political consensus in the United States that everyone should have a right to health insurance. Millions of people are without insurance, many are underinsured.

When the newly elected President Joe Biden says that he wants health insurance coverage for all people, his opponents criticize that it is socialism. What nonsense!

This insurance coverage is a human right, and it applies to the whole world. In the United States, medical expenses are perceived as a private matter. That is a poor foundation for socially equitable health care.

After all, Obamacare was a positive sign ...

That's true. Obama has put a lot of effort into his law and there is certainly progress, for example, that millions of people are covered by health insurance that were not before.

But now the Supreme Court is deciding the future of Obamacare, and there is a risk that what has been achieved will be reversed. You have to keep in mind that Obama's law still has many loopholes.

It would be a success in the end if the law were not abolished. Against the background of this whole development, I am skeptical that there will be an improvement in the near future.

Professor Reinhard Busse

  • Actual position: Professor for Management in Health Care at the TU Berlin
  • Career: scientific activities in Madrid and London, among others
  • Training: Medical studies in Marburg, Boston and London

Where do you see the US pension system in an international comparison?

To be honest: very far back. It is about the question of how the quality of a health system is measured. An important parameter becomes relevant here: How many deaths are there in a country that could have been avoided in a well-functioning health system with appropriate disease prevention or therapy?

If you compare the development of all OECD countries over the past 20 years, it becomes clear that the USA has fallen further and further behind. And when you add the cost of care, you can see that the US system is not only expensive, it is both expensive and bad.

When Americans ask which health systems in Europe are better than those in the United States, one has to be honest: all of them!

So we can't find anything in the US pension system that we could take on?

I wouldn't see it that way. With this negative assessment, of course, we always look at the mean value for the entire country. There are extreme differences within the US as well. That means, for example, that we find initiatives that have very good programs. It is not for nothing that Helmut Hildebrandt, for example, took role models for himself with his project Healthy Kinzigtal in the USA.

We find quite innovative ideas there, but they have not yet been rolled out across the country. This includes, for example, concepts for quality assurance or population-related management, we can definitely learn something there. But there is also another part of the truth: the Americans themselves unfortunately do not learn anything broadly.