The U.S. is the only high-income country in the world that does not guarantee health financing for all of its people. Therefore, many U.S. citizens can’t afford the care they need. Thus, even though South Korea, New Zealand and Japan spend only a fraction on health care as the U.S., their health outcomes are much better. U.S. life expectancy at birth is five to six years lower than in these countries. Rates of maternal and infant deaths in the U.S. are significantly higher and obesity rates in our country are almost twice that of other countries.

Although most in Utah and the U.S. now have some type of health insurance, many working-age adults are not adequately insured. In 2022, 23% of adults in the U.S. were underinsured and another 11% had a gap in coverage because of changing jobs or other factors while 9% had no insurance. Not surprisingly, 40% of Americans that year skipped or delayed care due to cost.

Health insurance should encourage the appropriate use of health care providers. People who skip care and put off seeing a doctor report greater use of emergency rooms and urgent care centers and less routine preventive care. We need a patient-centric system that helps all of us better understand and afford care options and provides care guidance to those at highest risk to manage our chronic diseases, improve quality and lower costs.

Unfortunately, seeking care in the U.S. is complicated and often confusing because of the way care is paid for. In other countries, people may only have one health insurer throughout their lives. In contrast, I have probably had 14 to 15 different health insurers in my life as my jobs and life circumstances have changed. Therefore, my health insurers have had little incentive to invest in my long-term health.

The many existing health insurers also inflate administrative costs and complexity with bureaucratic processes and vastly different payment mechanisms. As a result, in the U.S., administrative costs for health care are over four times higher than other comparable countries.

This cost accounts for over one-third of our health care costs. Of the administrative costs, 82% is attributed to billing and insurance costs. This comes from complicated processes that are often not productive such as prior authorizations and claim denials, more than half of which are ultimately overturned and approved.

Doctors and hospitals spend vast sums billing and managing health claims due to the hundreds of contracts they have with the dozens of insurance companies they must work with, which in turn have various sources of payment including from the federal government (33% of total health care funds), family policies (28%), private businesses (18%), state and local governments (15%), and other private sources (6%). Each of these payment sources have their methods, reviews and schedules. In contrast, citizens of other countries generally obtain their health care from one source throughout their lives, providing a stable, consistent and administratively lean health care benefit.

Clearly, something needs to be done to make health care more accessible and affordable to everyone. Assuring that everyone has proper health care financing benefits our society as a whole. Rather than the minor tweaks that most health reform legislation proposes, our system needs major surgery. Common Sense Health Care for Utah, on whose board I serve, will this year present a proposal to simplify and improve the way we pay for health care in Utah. While we recognize that many entrenched interests will fight these changes, we feel that significant changes to reduce paperwork, eliminate unnecessary processes, and drop barriers to health care are drastically needed. Please explore our website at https://commonsensehealthcareutah.org and join us in this effort.

Steve Walston has a doctoral degree from the Wharton Business School at the University of Pennsylvania. He has been a professor at Cornell, Indiana, University of Oklahoma and the University of Utah. He is a former hospital executive, health services researcher and author who is a member of the board of directors of Common Sense Health Care for Utah.