Edward Davies: Obamacare—it’s time to stop rooting for failure

Edward Davies“Obamacare” is much in the headlines right now and not for the right reasons. Having been the bargaining chip of choice for Republicans during this month’s shutdown, the “health exchanges,” through which patients can purchase insurance, are suffering some fairly major glitches.

The consequence is that it is now open season on the Affordable Care Act. You would expect an organ such as Fox News to relish the problems with headlines such as “Obamacare Meltdown” and “Obamacare Damage Control.” Less expected are the headlines from traditionally more sympathetic media—the Huffington Post talks about the Obamacare train-wreck, and a New York Times op-ed headline reads “Obamacare: Failing Ahead of Schedule.

And so today Obama addressed the nation and implored them: “It’s time to stop rooting for failure.”

The American health system has two major problems which Obamacare seeks to address. The first is spending—America simply spends twice as much on health per capita as almost any other developed nation on earth for little extra return on morbidity and mortality. The second is the number of people that simply don’t have healthcare insurance. While the first is a big problem, the second is a giant moral carbuncle on the face of a great nation.

The very nature of the situation makes good data hard to come by but, however you measure it, tens of thousands of Americans die every year because they don’t have enough or any  insurance. Predictions in the last few years include, at the bottom end of the scale, advocacy group Families USA, who estimated last year that more than 26,000 working-age adults die prematurely in the United States each year because they lack health insurance. In 2009 research published in the American Journal of Public Health came up with the figure that 45,000 annual deaths were associated with a lack of health insurance.  Last year, Public Citizen used that research to arrive at the conclusion that the figure would now be over 50,000.

To put this insurance coverage position in a global context, the USA sits just below Mexico (32nd) in terms of the population coverage according to OECD health data, and just above Chile (34th). It can only aspire to the universal coverage achieved in countries like Italy, Ireland, and Israel.

But it is the individual, personal cost that is far more striking. Colorectal cancer is one of the leading causes of cancer death in the USA and the American cancer society predicts it will cause over 50,000 deaths in 2013—the same as Public Citizen expects will die through lack of insurance. The figures for deaths in which diabetes was the underlying cause are not much higher at around 70,000 and this is with America’s obesity epidemic.

Put in a wider social context, almost twice as many Americans will die due to a lack of insurance this year as will die in motor accidents—the single biggest cause of non health related deaths in the US. On the Public Citizen estimate, as many Americans will die this year due to a lack of insurance as died in the entire Vietnam War. Indeed even at the lowest estimate of 26,000 deaths per year due to the lack of insurance, that is still more than 10 times as many Americans as have died in all military operations in Afghanistan since 2001.

The insurance gap is death on the scale of 9/11 every month. It is your very literal neighbour dying of something you won’t. It is tens of thousands of real people dying, hidden by the lack of health data that will simultaneously cause their death.

And in a country with the ethos, charity, and beneficence that the USA truly has at its core, it should not be allowed to stand unchecked. Americans are consistently among the world’s greatest donors and doers of charity. Indeed, the country is founded on a declaration that all men are created equal—something said to be self-evident. So why is it so spectacularly not evident in healthcare? Why does this great nation allow such mass inequity to continue unabated, to the tune of 50,000+ deaths?

Which brings us back to Obamacare—because at long last something is trying to abate this tragedy. And for all its doubtless manifest failings, for the trials it may cause small businesses, the difficulty of the websites, the government infringement on liberty, it is a fundamental attempt to rectify a massive moral failing at the heart of the nation.

So I’m with Obama on this one. Nobody said change would be easy, but it’s time to stop rooting for failure.

Edward Davies is US news and features editor, BMJ.