Thursday, August 23, 2007

U.S. health care system - U.S. Health Care Quality – Compared to What?

If you’ll recall, I recently did a post commenting on a NYT editorial “The World’s Best Health Care?” The Times concluded the U.S. system was lousy. My post, which said you can’t judge a national health system unless you take its culture into account, evoked a flurry of responses. Many dismissed the NYT piece as political.

On August 22, Real Clear Politics, a website which prints articles from across the ideological spectrum, headlined a piece by John Stossel, a commentator for 20/20, an ABC News program. The article was written specifically for Real Clear Politics.

Here are a few of Stossel’s comments:

The New York Times recently declared "the disturbing truth that the United States is a laggard not a leader in providing good medical care."

As usual, the Times editors get it wrong.

They find evidence in a 2000 World Health Organization (WHO) rating of 191 nations and a Commonwealth Fund study of wealthy nations published last May.

In the WHO ranking the United States finished 37th, behind nations like Morocco, Cyprus and Costa Rica. Finishing first and second were France and Italy.

So the verdict is in. The vaunted U.S. medical system is one of the worst.

First let's acknowledge that the U.S. medical system has serious problems. But the problems stem from departures from free-market principles. The system is riddled with tax manipulation, costly insurance mandates, and bureaucratic interference. Most important, six out of seven health-care dollars are spent by third parties, which means that most consumers exercise no cost-consciousness. As Milton Friedman always pointed out, no one spends other people's money as carefully as he spends his own.

It strains credulity to hear the U.S. ranks far from the top. Sick people come to the United States for treatment. When was the last time you heard of someone leaving this country to get medical care? The last famous case I can remember is Rock Hudson, who went to France in the 1980s to seek treatment for AIDS.

So what's wrong with the WHO studies? Let me count the ways.

The WHO judged a country's quality of health on life expectancy. But that's a lousy measure of a health-care system. Many things that cause premature death have nothing do with medical care. We have far more fatal transportation accidents than other countries. That's not a health-care problem.

Similarly, our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada.

When you adjust for these "fatal injury" rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation.

Diet and lack of exercise also bring down average life expectancy.

Another reason the U.S. didn't score high in the WHO rankings is that we are less socialistic than other nations. What has that got to do with the quality of health care? For the authors of the study, it's crucial. The WHO judged countries not on the absolute quality of health care, but on how "fairly" health care of any quality is "distributed." The problem here is obvious. By that criterion, a country with high-quality care overall but "unequal distribution" would rank below a country with lower quality care but equal distribution.

It's when this so-called "fairness," a highly subjective standard, is factored in that the U.S. scores go south.

The U.S. ranking is influenced heavily by the number of people -- 45 million -- without medical insurance. Our government aggravates that problem by making insurance artificially expensive with, for example, mandates for coverage that many people would not choose and forbidding us to buy policies from companies in another state.

Even with these interventions, the 45 million figure is misleading. Thirty-seven percent of that group live in households making more than $50,000 a year, Nineteen percent are in households making more than $75,000 a year; 20 percent are not citizens, and 33 percent are eligible for existing government programs but are not enrolled.

For all its problems, the U.S. ranks at the top for quality of care and innovation, including development of life-saving drugs. It "falters" only when the criterion is proximity to socialized medicine.


Dino William Ramzi said...

Stossel's assertiions are a load of rubbish.

Nearly every ranking is based on a certain set of assumptions. There is no doubt that varying those assertions will change the ranking. That is where culture comes in, not as a criterion for a ranking. I can't think of a way to operationalize the question of cultural congruence.

It is interesting that WHO, UNDP, Commonwealth and Barbara Starr's research all agree... the US could do much better.

As for the tripe about the uninsured (again)... I will just point out that the Federal Poverty Guideline is a subsistence level income, not a poverty level and varies according to household size. The numbers are unsubstantiated and pure garbage, repeated via neocons without any anchor in reality.

And when you add them up, they exceed 100%.

Shame on you for repeating Stossel's garbage. I would tell him, but they don't do comments.

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