Both from the perspective of doctors and their patients, it may not be apparent why the United States needs to be on a different trajectory for healthcare.  For those of us who have lived or traveled abroad in the developing world, we have seen the inadequacy of healthcare services firsthand and feel fortunate to have state-of-the-art medical resources at home.  Not only is exceptional medical treatment available to American patients, it is also true that we boast some of the best medical schools and medical technology in the world.  For many healthcare workers outside of the U.S., it is often a dream to be able to study medicine and hone their skills on American soil.

Personal experience with socialized medicine and universal healthcare models may also make us feel lucky to have the system we do.  Excessive government control of medical services can lead both to fewer choices as well as lower quality of healthcare due to a lack of competition. Complacency and stagnation may threaten the quality of medical care we receive almost as much as insufficient resources and poverty.

As Americans, we realize that exceptional healthcare is available to us, but we also recognize that many people struggle to afford their insurance premiums.  In my practice, I have often heard the stories of patients who are unable to retire as they cannot afford health insurance without any employer subsidies.  For many, the cost of insurance seems to be the only real healthcare crisis, and we have all heard and read about Americans whose premiums went up, not down, with the Affordable Care Act.  For those individuals, Obamacare did exactly the opposite of what was promised, so, although the high cost of insurance is unequivocally a problem, the ACA legislation does not feel like the correct fix.

The issue, however, only becomes clear when we step back and look at the big picture, viewing American healthcare from a public health point-of-view.  Back in 1970, most developed nations, the U.S. included, spent between 5% and 7% of their national Gross Domestic Product on healthcare.  Talking about the percentage of GDP needed for healthcare is helpful as it not distorted by the effects of inflation.  Today, the total cost to provide healthcare to our European counterparts has risen to approximately 10% of GDP, but here in the U.S., depending on the source of your statistics, we spend a whopping 17.2% of our GDP for medical care.

17.2% of GDP is a massive expenditure of resources just to stay well.  Imagine if a pioneer in the American West had to devote 17% of his or her resources towards managing illness:  it would be all but impossible to survive.  The amount of money necessary to sustain American health is a great personal burden, but, with government subsidizing well over half of the costs, it is also a devastating social strain.  If our healthcare costs can rise 50% faster than costs in countries like France and Germany in just 35 years, imagine what we will face in decades to come.

Of course, we would like to think that our investment in health--roughly three to four times per capita compared to other nations--pays off with better health and longer life.  In reality, the U.S. ranks poorly in many key indicators.  When it comes to arguably the most important statistic, life expectancy, Americans live shorter lives than people in about 30 other countries.  Perhaps even more shocking, there are many places with far lower rates of infant mortality. 

So there you have it:  Americans pay more than anyone in world for healthcare that, despite its potential for excellence, does not actually provide care comparable with most other developed nations.  In a nutshell, this is the core argument for healthcare reform.  Viewed from this angle, American healthcare has to change. 

The solutions are out there.  It is easy to see which countries today are the most successful at delivering the best possible medical care for the least amount of money.  Undeniably, the Spanish, the Israelis, and, perhaps most of all, the Japanese, top the charts as providing their citizens with the greatest wellness and longevity for the least amount of money.  If you were Japanese, you would be likely to live about 4 years longer than the average American and for about one-third of the cost.

The future of the Affordable Care Act is uncertain.  In its short history, it became obvious that the ACA suffered from deficiencies, and few Americans prefer government mandates if there are alternatives.  Nevertheless, Obamacare is inspired by the most successful healthcare models in the world, those which deliver medical services to as many people as possible without an untenable financial burden on individuals or society.  If the ACA is repealed, let us hope that lawmakers keep their eyes on the big picture and recognize that a future where 25% or more of our national resources are committed to keeping us healthy and alive is simply not sustainable.  Without a major overhaul of the healthcare system, Americans are headed either towards a future where healthcare becomes a luxury or keeping Americans alive bankrupts the nation.