Almost everyone in America understands that our health-care system is broken, dysfunctional and getting worse.
We spend almost twice as much per capita on health care as any other nation, nearly $13,000, and an unsustainable 18.3 percent of our GDP.
Yet, we remain the only major country not to guarantee health care to all—leaving 85 million uninsured or underinsured. That number has gone up recently as millions have lost the Medicaid coverage that was provided to them during the pandemic.
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The day must come, sooner than later, when we join the rest of the industrialized world and guarantee health care for every man, woman, and child as a human right through a Medicare for All single payer system. That is the right thing to do, that is the humane thing, and that is the cost-effective thing to do.
Today, despite our huge health-care expenditures, our life expectancy is considerably lower than almost any other wealthy nation and, in many parts of the country, is getting lower. Incredibly, the gap in longevity between the rich and the poor in our country is now at least 10 years as tens of thousands of Americans die each year because they can’t access the health care they need.
In America today, we pay, by far, the highest prices in the world for prescription drugs. While the pharmaceutical industry reaps huge profits and pays their CEOs exorbitant compensation packages, one out of four Americans cannot afford the prescriptions their doctors write. Further, one of the major causes of the escalating cost of hospital care and insurance premiums is that many of the new drugs coming onto the market for cancer and other diseases now cost over $200,000 a treatment.
As bad as our overall health-care system is, our primary care system is even worse. Today, we have major shortages of doctors, nurses, mental health providers, dentists, and pharmacists—and those shortages will only grow as a result of the COVID burnout that many providers experienced and the aging of our health-care workforce. As a result, tens of millions of Americans, even those with decent insurance, cannot find the medical care they need on a timely basis. Some Americans have to wait months to get a medical appointment. Others have to travel long distances to find a doctor.
According to the most recent estimates, over the next decade our country faces a shortage of over 120,000 doctors—including a huge shortage of primary care doctors. The nursing shortage may even be worse. Over the next two years alone it is estimated that we will need between 200,000 and 450,000 more nurses. We also have a shortage of tens of thousands of dentists in America. And, despite the very serious mental health crisis we are facing there is a massive shortage of mental health service providers—psychiatrists, psychologists, social workers, counselors, addiction specialists and many more. Our home health-care workforce is also totally inadequate.
Most countries spend between 10 to 15 percent of their health-care budgets on primary health care. Canada spends 13 percent, Germany spends 15 percent, Spain spends 17 percent, and Australia spends 18 percent. We spend less than 7 percent.
In other words, instead of investing in disease prevention and enabling people to gain easy and timely access to the medical care they need when they need it, we spend heavily on hospital and tertiary care and force people with common illnesses into emergency rooms—the most expensive form of primary care.
Every major medical organization in the country agrees that what we are investing in primary health care is woefully inadequate. They understand that focusing on disease prevention and providing Americans with a medical home will not only save lives and ease suffering. It will save billions of dollars. Providing primary care to all is not only smart health care, it is cost-effective health care.
As chairman of the U.S. Senate Health, Education, Labor, and Pensions Committee (HELP), I am working hard on bipartisan legislation that will begin to address some of the health-care crises we face. This legislation, if passed, would be an important step forward toward a more humane and rational health-care system.
Among other provisions, this is what we are proposing:
Working with the Senate Finance Committee, we would significantly increase the number of doctors in our country by greatly expanding the Graduate Medical Education Program residency program. We would also expand the Teaching Health Center Graduate Medical Education program and the National Health Service Corps. The goal of these programs is not only to increase the number of doctors we have but to focus on primary health care and placing physicians into medically underserved areas. We would also provide incentives for medical schools to graduate more students who will work in primary care.
We would greatly increase the number of nurses by expanding programs that address the shortage of nurse educators. Unbelievably, in the midst of a massive shortage of nurses, the American Association of Colleges of Nursing tells us that U.S. nursing schools turned away over 91,000 qualified applications in 2021 because of a lack of qualified faculty and inadequate physical infrastructure.
We would expand primary care by growing the number of Federally Qualified Health Centers (FQHCs) that now provide primary health care to some 30 million Americans. They also provide low cost prescription drugs as well as dental care and mental health care. This bill would increase the number of these centers throughout the country, concentrating on rural and urban areas which are now medically underserved. The result: Millions more Americans would be able to receive the primary health care they need in a timely and cost-effective way.
For many years members of Congress have talked about our health care crises. Now is the time to act.
