On May 30, Small Business Times ran an article headlined, "Antidotes for high health care costs," which quoted Linda Gorman, a senior fellow from the Independence Institute.
A number of her statements were false. The most serious problem was her statement: "If you look around the world, the countries with government controlled health care, their quality is poor and their costs are higher."
If Gorman had studied actual statistics of health care systems around the world or traveled, she would have known that statement was false. In all the developed countries in the world, the government plays a larger role than ours in health care. Most of these systems have better health care quality statistics than the U.S. and much lower per capita cost.
Data from the World Health Organization (WHO) and the Organization for Economic Cooperation and Development (OECD) show the exact opposite of what Gorman stated.
The United States is ranked 37th in the world in health care, in spite of the fact that experts agree we have the best technology and the best physician training. However, the U.S. has an infant mortality rate almost twice as high as the better health care systems.
The U.S. has one of the lowest healthy life expectancies in the developed world and yet our system costs much more per capita than any other system in the world. One shameful area of quality in the U.S. is our death rate from medical error, which is one of the worst in the developed world and a factor of five worse than Japan.
There is no question that our superior technology makes us a magnet for the wealthy with advanced cancers from all over the world. But the average health care available to our general population is inferior in a lot of measures even for those of us who are insured.
A study by Harvard Medical School shows that average Canadian is much healthier than the average American and a study by the American Medical Association shows the average Englishman is healthier than his American counterpart, even adjusting for economic status.
Some of the reasons for the better outcomes have to do with universal coverage and the emphasis in the practice of health care on prevention. Universal coverage means that everyone has access and care can be applied early in the course of an illness. Many uninsured in the U.S. don't seek treatment until their illness has progressed where cost is astronomical and outcomes are poor.
Every country in the developed world recognizes the importance of universal coverage, and even countries like Taiwan that relied on a system like ours found that to keep costs under control, universal coverage was a must and government had to play a role in regulating the cost and quality of care.
Where medical insurance companies in the U.S. drive as much as 30 percent of the cost, in other developed countries, they play a much smaller role or in many cases are not existent.
The medical insurance industry, HMOs and large drug companies make a huge profit in our current system. They do not want things to change and have spent enormous sums creating disinformation.
One of their favorite targets is the English system (ranked 18th in the world, compared with our 37th.)
Can free enterprise make for better health care? Absolutely, the best systems in the world use a combination of government and consumer driven solutions. It's too bad that so-called "experts" pontificate about health care in the rest of the world without knowing anything about it.
Joseph Geck, a Waukesha business executive, consults and speaks on international issues such as health care and trade.
12 Comments
Joseph, John Stossel debunked the WHO's "study" nearly a year ago.1 As mentioned in the attached article, no one is saying the US system is perfect or the insurance lobby (and other lobbies) are an issue or that our government has played the largest role in screwing up our system to it's current level of bloat and inefficiency. Meerly that you look at the study's methodology before you quote part and parcel to validate what turns out to be a false statement on your part. Don't feel off put, we're all subject to the 'spin' these days.
1.Why the U.S. Ranks Low on WHO's Health-Care Study
By John Stossel
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 rankings, the United States finished 37th, behind nations like Morocco, Cyprus and Costa Rica. Finishing first and second were France and Italy. Michael Moore makes much of this in his movie "Sicko."
The Commonwealth Fund looked at Australia, Canada, Germany, New Zealand, the United Kingdom and the United States -- and ranked the U.S. last or next to last on all but one criterion.
So the verdict is in. The vaunted U.S. medical system is one of the worst.
But there's less to these studies than meets the eye. They measure something other than quality of medical care. So saying that the U.S. finished behind those other countries is misleading.
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.
Even with all that, it strains credulity to hear that 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 and Commonwealth Fund 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. As I reported in previous columns, 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, says the U.S. Census Bureau. 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.
Another study often sited is the Commonwealth Fund study. The methodolgy of that study does not meet any criteria for a usable, well conducted study Just to note, Canada ranked below the US on this study.
Some issues with the study are the lack of any controls, no representative sampling criteria, random weighting assignment that does not meet real world concerns.
Hope this helps.
Canada has a 30 million population, the US has 300 million. It is a physical/mathematical fact that as a system of independent entities grows by a large factor a top down management system will start to fail. This is essentially why all communistic systems of government have failed (remember the USSR?), and why we don't want the US government running health care. If you home school your child but support government health care, you have a contradiction to resolve. Scaling is a very important concept that many don't seem to understand. A consequent of this is thinking that any system can scale up indefinitely without collapsing.
And, oh, guys. Philip Morris released studies showing that smoking is not harmful to your health. I think Stossel aired it first.
Point well taken Jack. Studies are what is made of the numbers or sometimes the numbers are made by the study. What do you suggest we do?
We can ignore the evidence provided by countries that employ government run health care. We can ignore the problems within our health care. Or we can try to view both for the positives and find a new; better method using the failures and successes demonstrated by both approaches.
We Americans are innovative folks once we open up to all possiblilities rather than suggest it one way or the highway.
Bob, Taiwan sent experts to study every health care system in the world, and they ended up implementing a Medicare-like system for their entire population. Stop the $400 million of health care and insurance industry lobbying and campaign contributions and the US Congress will do the same for Americans. I don't want special interest money driving government decisions. I want politicians working for ME and their constituents!
For more info on the Canadian system. See http://tinyurl.com/29mbop
85% of Canadians prefer their system to ours, though if they increased funding they could eliminate the wait times for elective procedures. And as the one Canadian said, "... if Canada pulled one of every six people from our lines, as effectively occurs in the US, we'd not have wait times either."
Mr. Lohman: please cite sources for your Stossel claim. This is what I found -> http://www.realclearpolitics.com/Commentary/com-11_30_05_JS.html. Why would you believe reports on health care by organizations that have a vested interest? I have no vested interest, just knowledge of history, understanding of economics, and understanding of how politics works.
Dan,on Stossel I was being sarcastic. Sorry that didn't come through, but I have zero respect for his right-wing wacko beliefs.
On the health care issue I first believe my 35 years of direct experience in that market, the last 20 as a Medicare provider (I was CEO of a private lab). And I trust the lay people I've spoken with from Canada, as well as many physicians who wish like hell they never turned their practices over to the MBAs and their for-profit MO.
For more on Canada see http://tinyurl.com/29mbop
Now your thinking Jack. One key step is getting our politicos off the gravy train and back to working for the people. In that environment, the model adopted by Taiwan can florish even in at the US's 100 fold population. However, given the state or our politos pocket lining approach, I don't see it working now. Agreed?
The Taiwan approach, which is modeled after our Medicare, could work under the Dems because they seem intent on fixing Medicare. They are pushing hard for a Medicare-for-all bill (Taiwan) and reinstating the payments to physicians (which the R's tried to cut in their effort to kill Medicare). And though I am a McCain supporter, the rest of the R's in Congress have to be replaced either with D's or independents. Then we need to get public funding of campaigns so the critters are working for us instead of "them."
After that I don't think it will matter which party rules if the bulk of congressional races are funded by the people. At a cost of $10 per taxpayer per year that would be one hell of a bargain. Then laws can be passed without money changing hands.
I followed up the Taiwan healthcare ideas. They have definitely started to hit a snag but again, lets learn and improve upon.
http://content.healthaffairs.org/cgi/content/full/22/3/61
Second, I refuse to generalize between D's and R's. I've found good people in both parties with good ideas. The issue is there are far too many on both sides with bad ideas, no respect for history's lessons and they go native faster than we can replace them.
Third, I'm in for the $10 dollars a year.
Actually, the cost of publicly financed campaigns is $10 for federal and $5 for state, and would save $3000 and $1300 in government giveaways.
I do agree with you that there are good guys on both sides of the isle. Too few, perhaps, but some are really trying. Dan Star suggested term limits, and while I don't like them for the long term they may be the only short term fix.
And thanks for the Taiwan link.