编辑“美国”（章节）

==Domestic policy==
===Poverty===
According to a study from the Brookings Institute:<blockquote>53 million Americans between the ages of 18 to 64—accounting for 44% of all workers—qualify as “low-wage.” Their median hourly wages are $10.22, and median annual earnings are about $18,000.<ref>Brookings Institute | Low-Wage Work is More Prevalent Than You Think, and There Aren't Enough Good Jobs to Go Around</ref></blockquote>Almost ''half'' of the American workforce is officially "low-wage," and that's only if we use an ''extremely'' low standard (below minimum wage, in some states). This is especially horrifying when we remember how many deaths can be directly linked to poverty and deprivation in the United States. According to a study from Columbia University:<blockquote>Overall, 4.5% of U.S. deaths were found to be attributable to poverty... the number of deaths the researchers calculated as attributable to low education (245,000) is comparable to the number caused by heart attacks (192,898), which was the leading cause of U.S. deaths in 2000. The number of deaths attributable to racial segregation (176,000) is comparable to the number from cerebrovascular disease (167,661), the third leading cause of death in 2000, and the number attributable to low social support (162,000) compares to deaths from lung cancer (155,521).<ref>Columbia University | How Many US Deaths Are Caused by Poverty, Lack of Education, and Other Social Factors?</ref></blockquote>Hundreds of thousands of people are dying every year because of poverty, deprivation, and lack of access to social services. Almost half of people 55 or older have no retirement savings.<ref>{{News citation|newspaper=Gao|title=Retirement Security: Most Households Approaching Retirement Have Low Savings, an Update|date=2019-05-26|url=https://www.gao.gov/products/gao-19-442r|archive-url=https://web.archive.org/web/20220414181743/https://www.gao.gov/products/gao-19-442r|archive-date=2022-04-14|retrieved=2022-07-01}}</ref>
===Healthcare===
The American healthcare system is among the most dysfunctional institutions imaginable, with the highest costs in the world, and some of the worst outcomes of any advanced country.<ref>{{News citation|author=Roosa Tikkanen, Melinda K. Abrams|newspaper=The Commonwealth Fund|title=U.S. Health Care from a Global Perspective, 2019: Higher Spending, Worse Outcomes?|date=2020-01-30|url=https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019|archive-url=https://web.archive.org/web/20220424201656/https://www.commonwealthfund.org/publications/issue-briefs/2020/jan/us-health-care-global-perspective-2019|archive-date=2022-04-24|retrieved=2022-05-01}}</ref> That being said, there are still those who deny the necessity of completely overhauling the system, and as such, it is useful to take some time and go over the essential facts of the matter. As always, all sources will be listed at the end.

The United States also ranks at the very bottom of the developed world in terms of preventable deaths. Annual deaths could be reduced by 101,000 if the U.S. had a health care system as good as other comparable countries.<ref>Reuters | US Worst in Preventable Death Ranking of Industrialized Countries</ref>
====Health Outcomes====
The USA ranks near the bottom of the developed world in most essential health outcomes. A 2020 paper from the American College of Physicians (published in the ''Annals of Internal Medicine)'' reports that "despite higher spending, the United States generally has less favorable outcomes than other countries." Let's take infant mortality, for example. According to a 2016 study from the American Economic Association:<blockquote>The United States has higher infant mortality than peer countries... The US disadvantage persists after adjusting for potential differential reporting of births near the threshold of viability.</blockquote>The ACP paper confirms that America's poor infant mortality ranking persists "even after adjustment for reporting differences." According to the AEA, this subpar performance "is driven by poor birth outcomes among lower socioeconomic status individuals." As if this wasn't bad enough, maternal mortality is also shockingly high in the USA. According to an article from NPR (reporting on data from the CDC):<blockquote>More American women are dying of pregnancy-related complications than any other developed country. Only in the U.S. has the rate of women who die been rising.<ref>NPR | U.S. Has the Worst Rate of Maternal Deaths in the Developed World</ref></blockquote>To make matters worse, there is evidence that the official statistics actually leave out a great number of deaths, meaning that the actual rate is probably much higher. According to an article from ProPublica, "the new rate, while capturing just how poorly the U.S. ranks among other countries, is actually a significant underestimate of the problem."<ref>ProPublica | The New U.S. Maternal Mortality Rate Fails to Capture Many Deaths</ref> This only makes the issue even more horrifying. In addition, healthcare-amenable mortality is generally higher in the United States than in peer countries. According to the American College of Physicians:<blockquote>The United States has a higher mortality rate for medical conditions for which there are recognized health care interventions than Germany, the Netherlands, Japan, France, and Australia.</blockquote>A 2017 study in the ''Lancet'' looked at global amendable mortality, finding that the United States ranked 35th in the world in overall performance. In a press release following the publication of the paper, Dr. Christopher Murray (the study's lead author) said the following:<blockquote>What we have found about health care access and quality is disturbing. Having a strong economy does not guarantee good health care. Having great medical technology doesn’t either. We know this because people are not getting the care that should be expected for diseases with established treatment. [...] America’s ranking is an embarrassment, especially considering the US spends more than $9,000 per person on health care annually, more than any other country. Anyone with a stake in the current health care debate, including elected officials at the federal, state, and local levels, should take a look at where the US is falling short.<ref>The Lancet | Healthcare Access and Quality Index Based on Mortality from Causes Amenable to Personal Health Care</ref></blockquote>While many people acclaim the US health system for its advanced technology, it is clear that this does no good if people cannot actually access the care they need. All-in-all, it clear that outcomes in the American healthcare system are extremely subpar, especially when one takes into account the ludicrously high cost. On that note, let's discuss cost and expenditures.
====Cost and Expenditures====
The United States spends more per-capita on healthcare than any other country on Earth. According to the aforementioned study from the American College of Physicians:<blockquote>The United States spends far more per capita on health care than other wealthy countries, and spending is increasing at an unsustainable rate. [...] The pricing of health care goods and services is substantially higher in the United States than in other developed nations. A 2003 analysis of OECD data showed that health care utilization in the United States did not exceed that of other countries, and price was the key driver of spending differences.</blockquote>Much of this excessive cost is due to the enormous inefficiency and bureaucracy of the American system. There is a massive amount of administrative spending in the US, which is due primarily to the fragmented multi-payer nature of the healthcare system. According to the ACP:<blockquote>In large part owing to its pluralistic financing system, the United States spends more on administration of health care than peer countries. One study estimated that in 2012, the United States spent $471 billion on billing and insurance-related costs—$375 billion (80%) more than in a “simplified financing system,” such as Canada's single-payer model. Another study concluded that administrative costs were 31% of total U.S. health care expenditures, nearly double those of Canada.</blockquote>These findings are validated by a study in the ''Journal of the American Medical Association'', which said the following:<blockquote>The fragmented financing system is one of the principal explanations for the high cost of medical care in the United States. A careful consolidation of financing into some form of single-payer system is probably the only feasible solution.<ref>Journal of the American Medical Association | Health Care Spending in the United States and Other High-Income Countries</ref></blockquote>Another study from the same journal says the following:<blockquote>The United States spent approximately twice as much as other high-income countries on medical care, yet utilization rates in the United States were largely similar to those in other nations. Prices of labor and goods, including pharmaceuticals, and administrative costs appeared to be the major drivers of the difference in overall cost between the United States and other high-income countries.</blockquote>According to a 2020 study in the ''Lancet'' (conducted at Yale Medical School), a single-payer system would save an enormous amount of money and (more importantly) lives:<blockquote>Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US $450 billion annually (based on the value of the US$ in 2017). [...] Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1.73 million life-years every year compared with the status quo.<ref>The Lancet | Improving the Prognosis of Health Care in the USA</ref></blockquote>Claims that a single-payer system would be unaffordable are entirely baseless, and contradicted by the overwhelming mass of evidence. A 2020 meta-analysis in ''PLOS Medicine'' found "a high degree of analytic consensus for the fiscal feasibility of a single-payer approach in the US." As they put it:<blockquote>There is near-consensus in these analyses that single-payer would reduce health expenditures while providing high-quality insurance to all US residents. To achieve net savings, single-payer plans rely on simplified billing and negotiated drug price reductions, as well as global budgets to control spending growth over time. Replacing private insurers with a public system is expected to achieve lower net healthcare costs.<ref>PLOS Medicine | Projected Costs of Single-Payer Healthcare Financing in the United States: A Systematic Review of Economic Analyses</ref></blockquote>
====Access to Care and Lack of Insurance====
To make matters worse, a large chunk of the American population is uninsured, and many are forced to go without the care that they need. According to the ACP:<blockquote>The United States is the only wealthy industrialized nation without universal health coverage, a crucial component to ensuring quality health care for all without financial burden that causes delay or avoidance of necessary medical care... nearly 30 million remain uninsured, millions more are underinsured, and the number of uninsured persons is expected to grow.</blockquote>The high rate of uninsured people is extremely troubling, especially seeing as a lack of insurance is associated with increased risk of mortality. A 2009 study in the ''American Journal of Public Health'' said the following on the matter:<blockquote>Uninsurance is associated with mortality. [...] Lack of health insurance is associated with as many as 44 789 deaths per year in the United States, more than those caused by kidney disease.</blockquote>A 2017 study in the ''Annals of Internal Medicine'' validated these findings, saying:<blockquote>The evidence strengthens confidence in the Institute of Medicine's conclusion that health insurance saves lives: The odds of dying among the insured relative to the uninsured is 0.71 to 0.97.<ref>Annals of Internal Medicine | The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly?</ref></blockquote>The high costs of US medical care cause a great deal of financial strain for patients. According to a 2019 study in the ''Journal of General Internal Medicine'' (carried out by the American Cancer Society), "medical financial hardship is common among adults in the USA, with nearly 140 million adults reporting hardship in the past year. Among those aged 18–64 years, more than half report problems with medical bills or medical debt; stress or worry; or forgoing or delaying health care due to cost." A 2019 Gallup poll found that 25% of Americans say that they or a family member have put off treatment for a "serious illness" in the past year because of cost, with a further 8% saying they or a family member has put off treatment for a "less serious illness" in the past year.<ref>Gallup Poll | More Americans Delaying Medical Treatment Due to Cost</ref>

Overall, there is strong evidence that the United States' lack of universal healthcare causes tens of thousands of deaths every year, and financial ruin for many more.
===Sources===
*Annals of Internal Medicine | Envisioning a Better U.S. Health Care System for All
*American Economic Association | Why is Infant Mortality Higher in the United States Than in Europe?
*Physicians for a National Health Program | America's Ranking on Amenable Mortality is an Embarrassment
*Journal of the American Medical Association | Is Single Payer the Answer for the US Health Care System?
*American Journal of Public Health | Health Insurance and Mortality in US Adults
*Journal of General Internal Medicine | Prevalence and Correlates of Medical Financial Hardship in the USA