Americans hold the world record of health spending. According to a study by the Economic Politics Insitute published in October 2018, health-related spending accounted for 17.2% of US Gross Domestic Product (GDP) in 2017. On average, it is less than 10% for all developing countries. OECD (Organization for Economic Co-operation and Development). In comparison, the United States spent more than $ 10,000 on medical care per capita against $ 4,600 for France, according to figures from the World Health Organization.

While all health posts are increasing since 2015, how did the United States get there? Why is the price of the health system so high, when life expectancy is falling? That's the silly question of the week.

A system based on the market economy

"The general idea is that the US health care system is based on the market system", summarizes Elisa Chelle, a political scientist and author of "Understanding health policy in the United States". The American system does not have a general health insurance plan and relies on a set of private insurance. There are public insurance (like Medicare and Medicaid), but they only cover certain categories of people. According to a study by the US Census Bureau, 67.5% of the US population had private insurance in 2016, most of them via their employer. When drug prices or medical visits increase, the market response is to increase insurance premiums. Unlike all other industrialized nations, the United States has no centralized system to curb the rising costs of medicine.

A private system with weak bargaining power

In the United States, health providers have a very important power, especially insurers and pharmaceutical giants. Grouped in the form of lobbies, pharmaceutical laboratories rule without regulation. Since most hospitals and laboratories are owned by large private groups, it is very difficult for the government to regulate and negotiate drug prices. "We must not forget that the cost of some makes the income of others. The American health care system is lucrative, and some players do not wish to negotiate a price reduction ", recalls Anne-Laure Beaussier. Health is the second largest industry and one of the two largest sources of jobs in the United States, after energy.

Researcher at the CNRS, the specialist has studied the link between health care and political games in the United States. The analyst recalls: "France and the United States have different legal traditions. Americans start from an analysis on the ground without a global logic where each rule is established locally. There is no clear health system because the actors are numerous and fragmented. There is no single rule, each state has its own rules. We are witnessing a pile of laws. In the end, it's very complex. "

Expensive studies and a strong innovation

In the United States, it takes almost 80 dollars on average – much more in big cities like New York -, for a consultation with the doctor (against 25 euros in France) and more than 4,000 dollars for a day of taking charge at the hospital (800 in France). Mostly independent, doctors and practitioners themselves must take out insurance. These fees then affect the price of the consultations. They must also repay the financial credits they took during their studies, deemed to be expensive. Medicine is also a sector that has a very high scientific level and researchers are flocking to it. "The United States has a health system that promotes innovation. This translates into higher health costs, " says Elisa Chelle.

Social reforms difficult to implement

The health project has failed many politicians. In 2010, Barack Obama managed to enact the Affordable Care Act. More known under the name of Obamacare, this measure has allowed millions of households to insure, but has also cringed a part of Americans, who believe that it is an attack on their freedom of choice. "The American liberal model and the individualist system often take precedence over solidarity. To think that freedom is more important than solidarity is still a common idea in the US, Elisa Chelle analysis. Yet, many Americans support the idea of ​​a more affordable health policy. On hold since the Republicans came to power, the symbolic law of the Obama era is still resisting the numerous attacks by US President Donald Trump.


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