Lately, we have had an influx of libertarians arguing that health care in the United States is bad, but not nearly so bad as in "socialist" countries and that what we really need is to allow the free-market to work. I know, seriously, have they been asleep for the last 8 years? Anyway, I wanted to dispel some of the myths that were brought up and also just talk a little bit about some health care facts. Warning, Giant Graphic after the break.
Uh-oh, data! Don't worry, it isn't as complicated as it looks. First things first, this data is a comparison of reported data from the OECD. What is the OECD?
For more than 40 years, OECD has been one of the world's largest and most reliable sources of comparable statistics, and economic and social data. As well as collecting data, OECD monitors trends, analyses and forecasts economic developments and researches social changes or evolving patterns in trade, environment, agriculture, technology, taxation and more.
The Organisation provides a setting where governments compare policy experiences, seek answers to common problems, identify good practice and coordinate domestic and international policies.
Therein is the first myth to be debunked, that Canada is the only health care system that to which we can compare ourselves. Let's just assume that Canada's system sucks, then only comparing ourselves to them would be the equivalent of Canada only comparing their energy regulation policies to those in California. To understand the problem, you have to look deeper. OECD gives us that ability.
The color code:
Yellow - United States of America
Red - Countries that perform WORSE than the USA
Green - Countries that perform BETTER than the USA
So, what does this data tell us? Quick take, the other countries are almost all better than us in almost every category. The USofA has lost its competitive edge.
Data Columns 1 and 2 are different ways of looking at how much we spend on health care relative to other countries. As you can see we spend from 1.5 - 2.0 times as much on health care as any other economically developed country.
Data Column 3 measures how much we spend publicly (that is government-financed) compared to the overall cost of health care. Notice here that NO ONE has a program that is funded only through the government. Also notice that we dedicate fewer government dollars to healthcare compared to the total cost, making us the MOST free-market health care system in existence.
Data Column 4 is the oft-mentioned infant mortality rating. Well, at least we are better than Mexico (look at that rate, and folks wonder why Mexicans flock to the US) and Turkey. Myth alert, free marketeers will tell you this number is inflated because we save more babies with high risk conditions, that die in the NICU soon afterwards. The problem is that we are also at the bottom of the list when you look at child mortality rates, which does not include infants. Face it, we kill off our children at a much higher rate and a part of that is attributed to being uninsured or underinsured.
Data Column 5 is an interesting statistic that I hadn't seen before. We spend 2X as much as anyone else on health care, yet we see health care providers less than almost any other country. Not included here is the data showing we are near the bottom of the scale when it comes to practicing physicians. My quick take on that data is that we've always been bottom 1/4th of countries when it comes to number of practicing physicians.
Data Columns 6 and 7 show the estimated life expectancy of girls and boys born today. As you can see, we do better than a few of the less wealthy, less economically advanced countries on the list - but basically we get our butts kicked by truly comparable countries like Switzerland, France, Japan, Iceland, Austria, Germany. Not included in here is the data that shows those countries also have fewer cases of diseases that make the end of life more miserable like lung diseases, heart conditions, and diabetes.
So, those are the facts. We pay more and get less AND we have 50 million people uninsured. Don't forget that those other countries pay that much per capita and have more or less FULL INSURANCE. They insure every person, they survive childhood better, they live longer, they live healthier, they see physicians more often - and they spend less using national health care than we do relying on the free market.
The next myth you'll hear is that better care is all fine and dandy if you don't mind waiting around for it, because the US has no wait time and Canada has wait times so long they come here for care!!!
Well, don't believe it. First off, the US does not report wait time. So, there can't be a real comparison of wait time in the United States with OECD countries because we don't report it. Comparisons are only made based on scholarly research articles use telephone interviews or data mining; more on this in a minute. Second problem is that those horrible wait times in Canada are actually due in part to horrible record keeping in Canada. Again, why compare yourself to the worst system? It seems that Canadian hospitals did(do)not take patients off their wait lists if they: get the surgery at another hospital, decide not to do it, die, or for any other reason. So, average wait time is skewed by these outliers.
Wait times appear to be influenced by two things, number of beds available and the amount of money spent on health care per capita. There are exceptions, Japan spends almost 1/3rd that of the US and has wait times similar to ours. And, the United States has far fewer beds available/capita than other countries but does not have long wait times.
Wait times for what? Elective surgery. When it comes to emergency surgery there are no wait times. We are talking about things like elective heart surgery, hip replacement, etc. So, why does the US have such short wait times with far fewer beds/capita? Well, we don't insure about 1/6th of our population so there is a good chance, I would say a great chance that those folks are not asking to use beds for knee replacement, cataract removal, breast augmentation, or rhinoplasty. Yes, they count. So, we have a better wait time and less beds per capita because 1/6th of our capita does not have access to elective surgery and another 15 or 20 million are UNDERinsured and don't have these procedures covered either.
In 2007, the Commonwealth Fund found:
In the U.S., 37 percent of all adults surveyed—and 42 percent of those with chronic conditions—skipped medications, did not see a doctor when sick, or did not obtain recommended care in the past year because of the cost. These rates are well above those found in the other six countries. Few people in Canada, the Netherlands, and the U.K. reported skipping care because they could not afford it.
Okay, so maybe our wait times are so good because we screw the uninsured when it comes to elective surgery, what about everything else?
Although the United States does not have long wait times for non-emergency surgical procedures, this does not appear to be the case for primary care doctor visits. In a survey of five OECD countries in 2004, U.S. respondents were the second-least able to make a same-day doctor’s appointment when sick and had the most difficulty getting care on nights and weekends. They were also the most likely to delay or forgo treatment because of cost.
Okay, so we finish 4th out of 5 when it comes to seeing a primary care doctor when sick and are the most likely to just skip it all together. So, looking at something that is a lot cheaper and in which the uninsured and underinsured are more likely to partake of, we stink. In other words, in a category where the full 300 million people in the United States are trying to use the system, it fails miserably compared to "socialist countries".
The long and the short of it is that health care in the United States is great, if you can afford it, which you can't. Health care in every other OECD country costs half as much and results in better health and longer life. So, how would socialized medicine work here in the United States?
The National Committee for Quality Assurance, meanwhile, ranks health plans on 17 different care metrics, from hypertension treatment to adherence to evidence-based treatments..."Winning NCQA's seal of approval is the gold standard in the health-care industry. And who do you suppose is the highest ranking health care system? Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every single category, the veterans health care system outperforms the highest-rated non-VHA hospitals."
What makes this such an explosive story is that the VHA is a truly socialized medical system. The unquestioned leader in American health care is a government agency that employs 198,000 federal workers from five different unions, and nonetheless maintains short wait times and high consumer satisfaction. Eighty-three percent of VHA hospital patients say they are satisfied with their care, 69 percent report being seen within 20 minutes of scheduled appointments, and 93 percent see a specialist within 30 days.
Seems to me that socialism is alive and well in the United States and it works pretty damn well.