Thursday, June 24, 2010

Mirror, Mirror, on the Wall, Where is the Fairest Health System of Them? And Is Criticism of U.S. Health System Fair?

Personally, I am growing weary of criticism of the U.S. health system from policy wonks and liberal think tanks about the abysmal state of U.S. This criticism rarely mentions our system is a creature of our culture – our expectations, our desire for immediate access to high tech care, our quick treatment by specialists, the heterogeneity of our culture with its marked regional differences, our toxic litigious practice environment.

The latest criticism comes from the Commonwealth Fund, a New York City progressive think tank. The Commonwealth Fund’s press release reads, “New Seven-Nation Study Ranks Last on Health System Performance,’ and is based on its report “Mirror, Mirror on the Wall, How The Performance of the U.S. Compares Internationally.”

As I read the report- comparing the U.S. to Australia, Canada, Germany, The Netherlands, New Zealand, and the United Kingdom, I thought of asking its authors, “Mirror, Mirror on the Wall, do you realize your conclusions precisely mirror your political belief – that centralized governments offering universal coverage are best?” As in your previous Mirror, Mirror reports, in 2004, 2006, and 2007, you say government-led systems are always best in access, quality, efficiency, patients safety, coordination, equity, and cost while the U.S.ranks last.

Your conclusions are always predictable. I have the sneaking suspicion you structure your conclusions to justify your assumptions going into the report. It is a superb example of selective reporting to support one's point of view.

Your PR blitz is familiar. Karen Davis, the lead author of the report and President of the Commonwealth Fund, hosts a conference call to national media reporters. She then informs them that things are in bad way in the U.S. and the new health care law will improve our international standing by expanding coverage to 32 million without coverage, enhance affordability to those already covered, and slow the annual increase in costs.

It will achieve lower costs through new regulations, medical homes, patient-centered care and bundled bills between hospitals and doctors.

The expansion to 32 million of the disenfranchised is true, but what isn’t said is that we are woefully short of primary care doctors and general surgeons, among others, to take care of them. And what also isn’t said, is that current evidence suggests the new law will increase premiums for those with coverage, will cause many employers to drop coverage, and will escalate, not decrease, overall costs. And so far, the patient-centered medical home and bundled bills between hospitals and doctors in accountable care organizations is a figment of wishful thinking policymakers.

I hope, as the Commonwealth Fund does, that the new health law will help the U.S. “close the gap, and, in some cases, lead.” But I fear the report is more a product of wishful ideological thinking rather than reality.

The Commonwealth Fund’s thinking is predictable in their conclusion.

“The most notable way the U.S. differs from other countries is the absence of universal health insurance coverage. Health reform legislation recently signed into law by President Barack Obama should begin to improve the affordability of insurance and access to care when fully implemented in 2014. Other nations ensure the accessibility of care through universal health insurance systems and through better ties between patients and the physician practices that serve as their long-term "medical homes." Without reform, it is not surprising that the U.S. currently underperforms relative to other countries on measures of access to care and equity in health care between populations with above-average and below-average incomes.”

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