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Maybe Now Americans Will Finally Get Affordable Care!

The views expressed are those of the author and are not necessarily those of Scientific American.

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I’m immensely relieved by the U.S. Supreme Court’s decision to uphold key provisions of the Affordable Care Act, as reported here. The ruling represents a crucial step toward fixing my country’s dysfunctional health care system. Anyone who denies or doubts that our system is broken should be aware of two profoundly important facts.

First fact: The U.S. spends much more on health care per capita than any other nation on earth. We spent $7,164 per person in 2008, according to the World Health Organization (via Wikipedia). That is over $1,000 more per person than the number two and three-ranked countries, the super-wealthy kingdoms Monaco and Luxembourg, and almost $2,000 more than the fourth highest-spending nation, Norway, which enjoys enormous oil revenues.

We spend almost twice as much per capita as Germany, Canada, France, Sweden and Australia, and more than twice as much as England, Greece, Spain, Italy, Japan and New Zealand. So what are we getting for all our money? Are we getting better health care than all these other countries?

This question brings me to my second profoundly important fact: The U.S. does not rank first in the most basic measure of health, life expectancy. It ranks 38th, behind every other country I’ve mentioned above, according to the United Nations (again via Wikipedia). We rank in life expectancy just below Cuba, which spends $495 per capita on health care, well under 10 percent of what we spend. In other words, Michael Moore’s 2007 documentary film Sicko, which unfavorably compared U.S. medicine to that of Cuba (and Canada, England and France) was not just lefty agitprop; it was based on hard, cold facts.

The Affordable Care Act should help us get better care for less money, first of all by providing lower-cost care to tens of million of uninsured Americans who often ended up getting costly emergency treatment. I’m hoping that the act will also help promote several other health-care reforms, which I wrote about last November.

One would be to move American medicine away from the so-called “fee for service” model, under which doctors are compensated for the quantity rather than quality of their care. An alternative, which has demonstrated its ability to deliver better care at lower cost, gives doctors a flat salary with bonuses for improved patient outcomes.

We also need to reform malpractice laws so that doctors don’t prescribe tests and treatments simply to avoid lawsuits. Finally, the government should provide better evaluations of the efficacy of all medical tests and treatments, so doctors don’t prescribe—and, equally important, patients don’t demand—unnecessary and even harmful procedures, such as the PSA test for prostate cancer. With all these changes, perhaps the U.S. will start getting truly affordable care.

Photo courtesy Wikimedia Commons.

Addendum: A commenter, Postman1, has repeated the tired old canard that Brits and Canadians, who have socialized medicine, envy U.S. medicine. I responded with a comment, but I thought I’d add a comment on this important issue here. Recent surveys suggest that people in Canada, UK and other nations with socialized medicine are more satisfied with their health care than Americans. If you don’t believe a lefty like me, check out the piece from Fox News.,2933,136990,00.html

John Horgan About the Author: Every week, hockey-playing science writer John Horgan takes a puckish, provocative look at breaking science. A teacher at Stevens Institute of Technology, Horgan is the author of four books, including The End of Science (Addison Wesley, 1996) and The End of War (McSweeney's, 2012). Follow on Twitter @Horganism.

The views expressed are those of the author and are not necessarily those of Scientific American.

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  1. 1. jtdwyer 4:01 pm 06/28/2012

    Those of us that have been paying for heath insurance already get health care of reasonable quality. It remains to be seen whether we will get affordable, quality health care. Whatever we get, we may have little choice in the matter…

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  2. 2. MarkNic 8:16 pm 06/28/2012

    Anytime the government calls something Affordable, you can know for certain it is not. Anytime the government tells you that millions more people will receive good health care, while reducing costs, without adding more doctors to treat them, you know for certain it will not be. Anytime the government tells you in the most strenuous terms that this Act is not a tax, you can be most certain that it is.

    For those who believe this government takeover is good thing, dream on.

    Government will never be able to do anything, except those things elucidated in our founding documents, as well as individuals and private enterprise.

    Only the fool believes otherwise. Just saying’.

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  3. 3. arynix 2:31 am 06/29/2012

    Moving away from payment-for-procedure, tort reform, and opening health insurance to interstate commerce are precisely the kinds of reforms we need and which will improve our very broken health care delivery system. And, surprise, these don’t cost anything. And, surprise again, they are not in the ACA.

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  4. 4. 11:45 am 06/29/2012

    Those of us who have been around long enough know any program the government is a part of usually runs many times over budget by the time its fully implemented. Almost every federal program today is in the red and yet the left thought it was a good idea to run our health care the same way. Truly amazing. We older Americans are also smart enough to know when they use the word “affordable”, its usually far from it. This administration has lied to us about everything and now the middle class is facing the highest tax increase in our history. This is without a doubt the most clueless, the most divisive, the most anti American administration in our nations history. Congratulations my fellow Americas, we are now one step closer to becoming a 3rd world nation with no middle class The only people this benefits are the incredibly poor and the elites who think they know whats good for the rest of us. My tax rate is 52%, just how much more do you people want? Oh’ and for the record, I will have to close one of my businesses if the taxes go up as mentioned which means 4 more people will soon be out of work. Thanks liberals. November cant come soon enough.

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  5. 5. Jayhawk 3:14 pm 06/29/2012

    “The Affordable Care Act should help us get better care for less money, first of all by providing lower-cost care to tens of million of uninsured Americans who often ended up getting costly emergency treatment”

    Obamacare will cost less by adding more people?

    DRD4 Gene people are genetically handicapped. They cannot, through no fault of their own, understand the basics of survival.

    The constitution was written by people and for people that did not have this DRD4 genetic malady.

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  6. 6. nooch190 3:44 pm 06/29/2012

    I am in agreement with MarkNic above. Nearly everything the government touches it screws up. SS, medicare, Postal service. Need I say more. A great man once said “Government is not the solution to our problem; government is the problem.” — Ronald Reagan

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  7. 7. plswinford 4:32 pm 06/29/2012

    I would like to know the location of this fortuitous forrest of money trees from which we are to come up with the means to pay for this.

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  8. 8. voyager 5:09 pm 06/29/2012

    Mr. Horgan, I’m with you in your steadfast stand in other columns on the free will issue, but doesn’t it tell you something when every reader’s response to your Obamacare piece so far is negative? Let me add my two cents to the reasons why costs in total are going to go up, and this bunch of amateurs in Congress and White House are doggedly out of step with reality: when you force insurance companies to cover existing conditions, conditions that are definitely going to require treatment and so are in the highest actuarial category, insurors HAVE TO charge their entire insured pool more money, or run in the red. The first answer contradicts the ‘saving’ proposition, and the second is unsustainable.
    Your arguments that our present system is lousy are right-on. But Obamacare is not national Affordable Care, it’s a pandering for votes, and for other political reasons does not even address several major issues, as your other respondents point out.
    You might give a thought to free will here, not coercion.

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  9. 9. tucanofulano 5:19 pm 06/29/2012

    Who is this non-scientist political rabble-rouser, and why are his bias and prejudice in a “scientific” journal? The guy ought to be in Politico, Pravda, or the DNC yellow propaganda sheets, NOT in “Scientific” American. Get rid of him!

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  10. 10. MARCHER 6:36 pm 06/29/2012


    If you hate it here so much, please head over to the nearest Faux News blog, your rabble rousing will go over better there.

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  11. 11. validata 6:52 pm 06/29/2012

    So many assumptions underlying Obamacare are erroneous. The World Health Organization and United Nations reports to which Mr. Horgan refers are even worse. They are inauthentic. For but one refutation, please see “The Worst Study Ever” by Dr. Scott W. Atlas in the April 2011 issue of Commentary Magazine. It is searchable in the archive at

    On page 28 of the article, Dr. Atlas says, “[The WHO] World Health Report 2000 was an intellectual fraud of historic consequence…[its] true achievement was to rank countries according to their alignment with a specific political and economic ideal – socialized medicine – and then claim it as an objective measure of ‘quality’.”

    For a comprehensive view, please refer to Reforming America’s Health Care System: The Flawed Vision of ObamaCare (Hoover Institution Press, 2010), Scott W. Atlas (Editor).

    Please also check Dr. Atlas’ credentials at the Hoover Institution and at the Stanford University Medical Center. Note that he is a an established authority on health care systems. He is also a member of the Nominating Committee for the Nobel Prize in Medicine and Physiology.

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  12. 12. MARCHER 7:04 pm 06/29/2012


    It’s not just the WHO; pretty much every other major institution agrees with these findings.

    You can find dissent on almost any issue, but it’s rather absurd to claim one researcher’s disagreement as proof of much.

    You could find scientists with decent credentials advocating creationism.

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  13. 13. validata 9:10 pm 06/29/2012

    Point taken. What specific reports or individual experts do you recommend?

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  14. 14. MARCHER 12:14 am 06/30/2012


    Good question.

    I recommends the numerous reports from the Commonwealth Fund; their work strikes me as unbiased, and their findings have been used by individuals advocating a wide variety of healthcare reforms. If they have a bias, it is one in favor of examining healthcare in terms of accessibility and affordability for all citizens of a country.

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  15. 15. Crasher 7:43 pm 07/1/2012

    Good Luck USA. I can only hope you get a system like the one here in Australia. I have no idea why so many people in the US are against a fair, low cost health system. From the cost per capita in the US of the current system that leaves its people so far behind the rest of the developed world in terms of health outcomes it is a no brainer….your current system is BROKEN.

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  16. 16. Postman1 8:15 pm 07/1/2012

    Crasher- Just one question: If the US system is so ‘broken’, why do so many Brits and Canadians come here to get quality care in a timely manner? Perhaps the Aussie system is better, but I have read comments from down under on other sites which paint a different picture on your system too. The main question I have though, why is this political nonsense on a ‘science’ site?

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  17. 17. jhorgan 9:01 am 07/2/2012

    Postman1, this familiar claim that Brits and Canadians are clamoring for American-style health care is, in your words, “political nonsense.” My brother, an investment banker who’s lived in London with his family for more than 10 years and can afford any doctors he chooses, raves about the superiority of the British health service to American medicine. Surveys show that people in Canada, UK and other nations with socialized medicine are more satisfied with their health care than Americans. Please educate yourself before you spout your opinions here.

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  18. 18. MARCHER 3:27 pm 07/2/2012


    If you are expecting an educated response from Postman1 you clearly have no experience with his previous comments.

    In fact, the number of Canadians who come to the US for healthcare is less than 1% of the population. This idea that many people from any country come here for healthcare is just a sad, tired myth.

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  19. 19. villeville 4:54 am 07/14/2012

    I moved to the US from Finland in 2008. I am self-employed and so have to buy my own health insurance. I am appalled by the poor level of health care and the astronomical costs of health care. Obamacare doesn’t really change anything for myself or my family. What really truly bothers me is that even after forking out hundreds of dollars a month, I am stuck with an immense deductible when something major happens. Sure, $4,000 is less than $25,000 for two nights in a hospital – but it’s very rough and I don’t understand why people are so willing to let insurance companies treat them this way. I’ve never had insurance that is this bad – any insurance. The purpose of insurance is to pool money, so when one person in that insurance “community” has a stroke of bad luck they can pick themselves up. I don’t think health insurance in America does that – it’s very exploitative and draconian – as are the phone companies here, who in my opinion are a direct oxymoron to the American “Free Market” philosophy but that is another topic for another day…

    I look at all the things that Obamacare addresses (the unethical business practices of insurance companies that lead to death or financial destitution) and really do not understand why people would oppose it? It seems like the ethical thing to do and isn’t patriotism about taking care of your own people? Or is it just about your own backyards and bumper stickers? Frankly, the tax rates here are ludicrously low when you’re through working on the numbers in your tax returns. I’m not saying taxes are the cure-all but I do think that productive members of society shouldn’t have to die because they put off their health because of financial difficulties.

    Another thing (sorry for the novel): why are people being such cry babies about this anyway? People who can afford it will continue buying expensive health care insurance and get the same care they are used to. Nothing will change. This is a rational/practical policy and people should stop thinking with the ideological side of their brains for just a moment.

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