FLAGRANT
Lack of preventive care
in the U.S. has led to
excessive hospitalizations
and deaths from chronic
disease. Left: A White
House ceremony honoring
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Kamala Harris and Second
Gentleman Doug Emhoff.
NEWSWEEK.COM 27
PUBLIC HEALTHcounterparts in the U.K., for example.
Not only are people sicker in the U.S. than else-
where, they get financially punished for the privi-
lege. Healthcare costs have ballooned by more than
50 percent since 2010, to levels that are, on average,
more than twice that of other advanced countries.
“We pay two times as much, and still get the worst
outcomes,” says Georges Benjamin, a physician and
executive director of the American Public Health
Association (APHA).
Meanwhile, about 30 million Americans have no
health insurance to help with those soaring costs
(up from 27 million when Trump took office four
years ago). The insurance subsidies of the Affordable
Care Act made health care more accessible and es-
tablished penalties for those who weren’t covered,
which led to insuring 17 million of the 44 million
people with no insurance before the law was en-
acted. But the efforts of the Trump administration
to undermine Obamacare—by dropping the tax
penalties for remaining uninsured (the “individual
mandate”) and eliminating funding for promoting
the program, among other things—have pushed the
number of uninsured up again.A Lack of Prevention
who to blame? there’s no clear answer to that
question, which points to a big part of the prob-
lem: The U.S. has no central government agency re-
sponsible for health, as most developed countries
do. Instead, responsibility is scattered across a vast,
little-organized conglomeration of federal, state
and local government agencies, private healthcare
providers and insurers. The Department of Health
and Human Services (HHS) houses the CDC and the
Centers for Medicare & Medicaid Services (CMS),
but has little sway over the private insurance and
healthcare most Americans rely on, or over the state
agencies that make most health-related decisions.
What falls between the cracks of this system is
preventive health. “Our fragmented, mostly com-
mercial healthcare system largely ignores it,” says
Larry Levitt, executive vice president for health pol-
icy at the Henry J. Kaiser Family Foundation. U.S.
hospitals, the great majority of which are essential-
ly commercial operations, operate on a “fee-for-ser-
vice” basis, which means they are paid to treat sick
patients, not to keep them from getting sick in the
first place. The Veterans Health Administration is