U.S. Spends The Most On Health Care, Yet Gets Least

npr.org/blogs/health/2010/06/23/128027472/survey-says-u-s-health-system-sicker-than-most-other-nations

commonwealthfund.org/usr_doc/site_docs/slideshows/MirrorMirrorEmbargoed/MirrorMirror.html

Pretty much no matter how you measure it, our health care system stinks.

Once again that's the sobering conclusion of the 2010 version of the annual Commonwealth Fund comparison of the U.S. health system with those in other industrialized nations.

This year the competitors were Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom. The U.S. finished last.

Multiple problems with this link.

1) It doesn't even describe its methodology. How do we know how they generated these rankings? Take a look at the WHO report everyone loves to quote. The methodology in that report was constructed to make government controlled health care look wonderful. How did these guys do it?

2) It looks at infant mortality and life expectancy, yet it fails to take into account differences in how these statistics are calculated and differences in cultures and lifestyles. This has been hashed out before, but infant mortality and life expectancy are poor metrics to use.

3) This report looks at *out-of-pocket *expenses as an indicator. Of course countries with greater amounts of government funding will look better. But that isn't a real measure of cost.

4) Most of the access was about timeliness of care, which is a supply/demand issue, not a cost one. For example, it talks about how long it takes to get in to see a specialist, or the waiting time in an emergency room. Government takeover of healthcare will neither increase the number of doctors nor decrease the amount of demand.

5) The inability to access (freely--you have to buy the report) the OECD 2009 report, makes it hard to determine how they measured health care costs as a percentage of GDP. Is it only payment to doctors and facilities? Or is it a combined cost of premiums and payments? Does it take into account overhead? How did they compute these numbers?

6) They use fuzzy words like "easy," "fair," and "poor". These are subjective terms that are hard to quantify, and almost certainly subject to the attitudes and expectations of those in each country.

7) They lump dental care into medical care. Most people do not lump routine dental care into medical expenses. Certainly insurance companies here in the US do not.

8) They consider weekends and holiday access to regular medical care an issue that the US ranks poorly on. Really, is regular access to medical care on a holiday an issue on which we can base the quality of the US healthcare system?

And the big one. They have a whole category on "equity". This is so blatantly equal outcome, rather than equal opportunity, it is obvious what the aim of this report was. It wanted to prove that socialized medicine is the best, because it guarantees equal outcome.

[quote="Suudy, post:2, topic:203000"]
It wanted to prove that socialized medicine is the best, because it guarantees equal outcome.

[/quote]

One could easily make the case that the US, through its use of child programs, Medicare, Medicaid, government employee, veterans administration, heavy regulation of drugs and doctors, bailout and subsidies to drug and insurance companies, and free emergency treatments is at least a half-a**ed medicine-socialized country.

About the only good news for America, said Commonwealth Fund President Karen Davis, who was also the study's lead author, is that the new health law could put the U.S. on a path towards improvement.

:rotfl:

Tell that to the Euros that wait months/years for a hip replacement.

Tell it to the people in socmed countries that have death panels. "Sorry granny, that drug is too expensive and you're too old".

Tell that to the citizens in socmed countries that pay cash to get good treatment rather than go to the socmed places.

Interesting (and obviously tragic) for RC's that these socmed countries pay for abortion on demand.

Seen it in action; I'll pass, thanks

It is well established that countries with some form of 'socialized medicine' enjoy better health care coverage than the United States.

[quote="jjdrury81, post:6, topic:203000"]
It is well established that countries with some form of 'socialized medicine' enjoy better health care coverage than the United States.

[/quote]

Platitudes are nice, and you are really good at them. The problem is that you consider equal outcome "better" than quality.

And it is no more "well established" than anthropogenic global warming, especially when expressed as you did.

[quote="jjdrury81, post:6, topic:203000"]
It is well established that countries with some form of 'socialized medicine' enjoy better health care coverage than the United States.

[/quote]

They do have better health care coverage, because they are all covered. ;)

That is not the same as saying they have better health care itself, which is the important thing, though. In other words, I don't give a fig if I'm covered if the care is bad.

Have the sniffles--see a socmed doctor. Anything serious, go private.

[quote="Luigi_Daniele, post:8, topic:203000"]
They do have better health care coverage, because they are all covered. ;)

That is not the same as saying they have better health care itself, which is the important thing, though. In other words, I don't give a fig if I'm covered if the care is bad.

Have the sniffles--see a socmed doctor. Anything serious, go private.

[/quote]

This is how you see a socmed doctor in France. You go at 9:00 AM. And wait in a room full of people. When the nurse comes to the door of the waiting room, the next person gets up and goes in. Somehow, with no numbers, you know who's next. Then you leave at 12:00. You come back at 14:00, and you start all over again. Same queue.

[quote="qui_est_ce, post:9, topic:203000"]
This is how you see a socmed doctor in France. You go at 9:00 AM. And wait in a room full of people. When the nurse comes to the door of the waiting room, the next person gets up and goes in. Somehow, with no numbers, you know who's next. Then you leave at 12:00. You come back at 14:00, and you start all over again. Same queue.

[/quote]

Exactly.

This is the problem. When you are paying little or nothing, there is no disincentive to go. For anything. Things that could be treated at home (or by the pharmacist ;) ) now require a "trip to the doctor-after all it's free".

So a bunch of colds are seen, and those with serious illness have to wait-for hours.

[quote="Luigi_Daniele, post:8, topic:203000"]
They do have better health care coverage, because they are all covered. ;)

[/quote]

Sorta. Uncle Sam could pass a bill granting everyone $1 of coverage, and it would be accurate to say we have as good of coverage as other countries? I'm guessing jjdrury and others would say no. But that is basically what this study and the vaunted WHO report does say.

[quote="Luigi_Daniele, post:5, topic:203000"]
Tell that to the Euros that wait months/years for a hip replacement.

[/quote]

Well, seeing that it would cost a fraction of the U.S. price for surgeries (such as bypasses) in Thailand or India, I might consider going there instead. In fact, some insurance policies specify treatment abroad if there is substantial cost reduction.

[quote="ProVobis, post:12, topic:203000"]
Well, seeing that it would cost a fraction of the U.S. price for surgeries (such as bypasses) in Thailand or India, I might consider going there instead. In fact, some insurance policies specify treatment abroad if there is substantial cost reduction.

[/quote]

A bicycle is a fraction of the cost of an Indy 500 car. Wouldn't want want to race the 500 with one, though

I don't imagine any of those countries has 12-20 million third world illegal residents, many of whose idea of medicine is only a step away from conjuring, and who buy prescription meds over the counter in their home countries, bring them here, and self-treat inappropriately. (Ever wonder why we have "super-TB", lung diseases following treatment of it, and pervasive MRSA here, as well as, say, out-of-control diabetes the individual has been self-treating with methicillin? Guess.)

I didn't see France on the "approved list", though I have seen it touted on here before. The only reason I bring it up is because I know a little bit about it, and it may well be illustrative of some of the problems with subjective judgments like this, or even statistical information.

In France, there are essentially two systems; one public and one private. The private sector is pretty much on its own, is better than the public system and is less transparent than the public system. Nobody even knows what physicians charge in the private system because their fees are totally unregulated. The private system is about 30% of the whole.

In France, everybody pays "up front" for medical care (except hospitalization, and they're working on that) and is reimbursed from the public plan, if at all. Very likely that significantly dissuades overutilization.

Illegals cannot be on the public system at all. It's "cash up front, no reimbursement".

Malpractice cases are handled by special courts, judges only. The lawyers don't get contingency fees, therefore no big payoffs. The government pays for the malpractice insurance of the "public sector" doctors, and their medical education as well.

Lots of drugs available in the U.S. are not available there, for the simple reason that the government doesn't want to pay for them. In the private system, you can get them. In the public system, you can't.

Government subsidies (like malpractice insurance, medical education and many drugs) are not included in the cost of care numbers. There are also varying subsidies in the different political subdivisions of France as well as on the national level.

So, there are all sorts of differences in the various systems that make it hard, or even impossible, to compare apples to apples. One cannot legitimately make persuasive comparisons without disclosing very exquisite detail about the ones being compared, and making adjustments. In some cases, as with France vs the U.S., it isn't possible to really compare.

[quote="Luigi_Daniele, post:10, topic:203000"]
Exactly.

This is the problem. When you are paying little or nothing, there is no disincentive to go. For anything. Things that could be treated at home (or by the pharmacist ;) ) now require a "trip to the doctor-after all it's free".

So a bunch of colds are seen, and those with serious illness have to wait-for hours.

[/quote]

This is scary. I have a health benefits card that I pay pre-tax dollars into. Currently we can buy OTC medications as well as prescriptions on it. Starting next year, only prescription drugs can be charged on it. I guess I'll be getting a lot more prescriptions next year. :shrug:

[quote="ProVobis, post:12, topic:203000"]
Well, seeing that it would cost a fraction of the U.S. price for surgeries (such as bypasses) in Thailand or India, I might consider going there instead. In fact, some insurance policies specify treatment abroad if there is substantial cost reduction.

[/quote]

I find this hard to believe. Requiring a facility or doctor not licensed in the US to get reimbursement? In fact, I think it likely the opposite--insurance refusing to pay for those procedures.

[quote="Suudy, post:11, topic:203000"]
Sorta. Uncle Sam could pass a bill granting everyone $1 of coverage, and it would be accurate to say we have as good of coverage as other countries? I'm guessing jjdrury and others would say no. But that is basically what this study and the vaunted WHO report does say.

[/quote]

I agree.. My point is coverage does not insure good care. ;)

[quote="Suudy, post:16, topic:203000"]
I find this hard to believe. Requiring a facility or doctor not licensed in the US to get reimbursement? In fact, I think it likely the opposite--insurance refusing to pay for those procedures.

[/quote]

It has been discussed, but there is no major insurance that does this. Can you imagine the liability nightmare?

[quote="qui_est_ce, post:15, topic:203000"]
This is scary. I have a health benefits card that I pay pre-tax dollars into. Currently we can buy OTC medications as well as prescriptions on it. Starting next year, only prescription drugs can be charged on it. I guess I'll be getting a lot more prescriptions next year. :shrug:

[/quote]

Yup. Presuming that the bill is still in existance in its current forum next year, though ;)

[quote="ProVobis, post:12, topic:203000"]
Well, seeing that it would cost a fraction of the U.S. price for surgeries (such as bypasses) in Thailand or India, I might consider going there instead. In fact, some insurance policies specify treatment abroad if there is substantial cost reduction.

[/quote]

I would guess that we could well be seeing more medical tourism in the future. If any of the big clinics have not been looking at land in Monterrey, I would say they aren't thinking socialized medicine in the U.S. through. If that's the way it turns out, the poor Canadians will have to travel all the way to Mexico for the best treatment, instead of New York.

Alternatively, if the government allows a private medical sector the way France does, we'll probably end up about the same way France has. A private sector used by about 30% of the population which gets better care, and a public sector that's inferior by comparison.

The current health insurance law was designed to fail, and will fail. If this government is still around when it crashes, and the government single payer plan so beloved by the left is passed, most of us will be on "NP Medicaid with co-pays".

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