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What the U.S. gets right about healthcare

Preventive care is better in America — but plenty of work remains.

Laurent Vandebrouck

The Democratic primary race has been marked by soul-searching over U.S. healthcare — the problems with the current system, the best way to fix it, and especially the costs and benefits of single-payer systems. As a French health tech executive, I’m here to tell you that while it’s undoubtedly flawed, the existing U.S. healthcare system isn’t all bad. In fact, when it comes to preventive care, the United States currently outshines many European health systems.

Globally, according to the Organisation for Economic Co-operation and Development (OECD), developed economies devote just 2.8% of their healthcare spending to preventive care. The United States spends a little more than that, but because the U.S. spends more on healthcare than the rest of the world, it ultimately invests far more per capita on preventive care. Annually, the United States now spends more than $250 per person on preventive services — about two and a half times the OECD average. In total, the United States spends $207 billion on preventive and general care services, second only to cardiac and circulatory care. (Treating cancer, by contrast, costs Americans just $117 billion a year.) 

Preventing illness before it happens translates into better care. OECD goes on to say that 80% of American women are screened for cervical cancer, compared to 63% of women in the United Kingdom, 49% of women in the Netherlands, and 64% of women in Denmark. If you’re a woman over 50, you’re markedly more likely to get breast-cancer screening if you live in the United States than if you live in Switzerland, Germany, or Norway. And American children are more likely to receive the measles vaccine than their counterparts in Canada or France. 

Proactive approaches bring better health outcomes — and, in many cases, reduced costs for everyone. That’s the key reason the United States invests in preventive care: between public programs that cover children and the elderly, and private insurers looking to keep costs low, the United States has struck on a hybrid system that ensures better access to preventive services. 

There are legitimate questions about how much money is saved by preventive care. Some interventions improve patients’ health and quality of life without dramatically lessening costs, and insurers aren’t eager to pay for those. That’s why the Affordable Care Act’s requirement that insurers cover preventive services at zero cost to patients was necessary, and why we should applaud the current administration’s refinements to improve access for people with chronic conditions.

Of course, even as the United States outspends the rest of the world on preventive care measures, not everyone sees the benefits. The U.S. system excels at serving people with private health insurance — but people lacking continuous coverage are almost four and a half times more likely to receive no preventive care at all. Gaps in coverage also disrupt preventive care: people with intermittent coverage are 64% more likely to receive no care, highlighting the risks of efforts to disrupt ACA re-enrollment. Still, publicly funded systems face problems of their own. Preventive care is one of the first areas to be hit by austerity and cost-cutting, especially as politicians seek to preserve higher-profile, front-line services. In the EU, for instance, preventive care spending fell sharply during the 2008-12 financial crisis. My home country, France, spent just 4.6 billion euros (or 1.9% of total health expenditure) on prevention in 2015, well below the OECD average. 

There are signs of change. In France, President Macron came to power in 2017 promising a “prevention revolution,” with mandatory preventive-care training for medical students and support for innovations such as AI technologies that have the potential to revolutionize preventive care. Globally, health systems are increasing their investments in preventive care faster than in any other area of healthcare. 

In the United States, too, there is enormous public support for investments in preventive care. It is one of the rare areas where both Democrats and Republicans can plausibly claim support for their positions: the GOP can rightly point to preventive care as an area where the private insurance system excels, and Democrats can legitimately argue that more equitable and widespread access to preventive care would reduce costs and improve outcomes for everyone. 

The bottom line is that as we try to imagine a better version of the U.S. healthcare system, it’s important to recognize the things that it already does well. Preventive care is an area where the U.S. system shines, thanks to a combination of insurer-driven efficiencies and government-led investments and regulation. 

As Democrats and Republicans tussle over the future of U.S. healthcare, they should bear in mind that while ideological purity plays well in primary races, delivering effective healthcare in the real world is a more complicated business. When it comes to preventive care, the focus should be on preserving and improving the existing approach, not on tearing it down and starting from scratch. 

Laurent Vandebrouck is the CEO of Chronolife, a Paris-headquartered AI digital health company and creator of Nexkin, a washable smart T-shirt that continuously monitors key physiological parameters to enable prevention, risk reduction, and remote monitoring. 

Picture: AlexLMX, Getty Images