US Ranks Worst of Seven Countries on Health Care System

In case you have any doubts, not only does the US rank badly on health care metrics, the US has ranked at or next to the bottom of this survey in past years. But be careful in pressing these findings too hard on unreceptive audiences; I lost a friend who insisted the US had the best care in the world when I brought the results from 2007 to her.

From the Commonwealth Fund (hat tip reader Paul S):

Despite having the most expensive health care system, the United States ranks last overall compared to six other industrialized countries—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—on measures of health system performance in five areas: quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives, according to a new Commonwealth Fund report. While there is room for improvement in every country, the U.S. stands out for not getting good value for its health care dollars, ranking last despite spending $7,290 per capita on health care in 2007 compared to the $3,837 spent per capita in the Netherlands, which ranked first overall…

Earlier editions of the report, produced in 2004, 2006, and 2007, showed similar results. This year’s version incorporates data from patient and physician surveys conducted in seven countries in 2007, 2008, and 2009.

Key findings include:

On measures of quality the United States ranked 6th out of 7 countries. On two of four measures of quality—effective care and patient-centered care—the U.S. ranks in the middle (4th out of 7 countries). However, the U.S. ranks last when it comes to providing safe care, and next to last on coordinated care. U.S. patients with chronic conditions are the most likely to report being given the wrong medication or the wrong dose of their medication, and experiencing delays in being notified about an abnormal test result.

On measures of efficiency, the U.S ranked last due to low marks when it comes to spending on administrative costs, use of information technology, re-hospitalization, and duplicative medical testing. Nineteen percent of U.S. adults with chronic conditions reported they visited an emergency department for a condition that could have been treated by a regular doctor, had one been available, more than three times the rate of patients in Germany or the Netherlands (6%).

On measures of access to care, people in the U.S. have the hardest time affording the health care they need—with the U.S. ranking last on every measure of cost-related access problems. For example, 54 percent of adults with chronic conditions reported problems getting a recommended test, treatment or follow-up care because of cost. In the Netherlands, which ranked first on this measure, only 7 percent of adults with chronic conditions reported this problem.

On measures of healthy lives, the U.S. does poorly, ranking last when it comes to infant mortality and deaths before age 75 that were potentially preventable with timely access to effective health care, and second to last on healthy life expectancy at age 60.

On measures of equity, the U.S. ranks last. Among adults with chronic conditions almost half (45%) with below average incomes in the U.S. reported they went without needed care in the past year because of costs, compared with just 4 percent in the Netherlands. Lower-income U.S. adults with chronic conditions were significantly more likely than those in the six other countries surveyed to report not going to the doctor when they’re sick, not filling a prescription, or not getting recommended follow-up care because of costs.

Yves here. In theory, ObamaCare will improve some of these metrics, particularly equity, but it is entirely conceivable given the effectiveness of the other health care systems in this survey that the US’s relative standing will not improve. I was extremely impressed with the caliber of the care I received when I lived in Australia, particularly given how inexpensive it was (and I was not a participant in the official health care scheme).

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121 comments

  1. gordon

    I find it hard to understand how you could lose a friend because of a report on health care. Outside my experience, I guess.

    1. Yves Smith Post author

      I think this was more the proximate cause. She had a lot of cousins in Israel, and it did not go over well when I’d go silent when she went on about Lebanon during the invasion, or when she brought up Iran. But it was too bad, we had actually been good buddies for a few years.

      1. alex black

        Political “dialogue” in the US has become a much less civilized activity in recent years. When I soured on Obama in mid-2008, and most of my friends had Moonie-like infatuations with his glorious baritones, the simple fact that I would criticize what I was starting to see through the veneer didn’t “end” my friendships – but it distinctly but a serious chill on them that is only now beginning to thaw.

        I thought Jon Stewart nailed it. When he was invited to be a guest on Crossfire on CNN, a political talk show which featured panelists from the right and the left heatedly debating the issues of the day, not looking for common ground or respectfully acknowledging what was valid in their “opponents'” positions, but rather dueling and trying to score “points” – they expected him to be an amusing guest. Instead, he tore them a new one – decrying the fact that THEY and their ilk are THE problem in poitical dialogue now – that instead of civil discussion, for ratings, everyone is turing political debate into rhetorical gladiator matches for the entertainment of the masses, who were sitting at home, cheering every time “their” side won a point, booing every time the “other” side asserted anything.

        The best moment was when Tucker Carlson said, “You’re not as funny in person as you are on TV”, and Jon shot back “And you’re even a bigger prick in person that you are on TV.” He got it in before the censors bleeped it out.

        Debate has degenerated to a very unhealthy degree – everyone demagoguing and demonizing those who hold legitimate opposing views. Everyone seems bent on asserting their superiority rather than finding ways to come to terms with the fact that there is validity to many aspects of the opinions that oppose them. It’s ugly, and getting uglier. I truly miss the days when we could all debate our points while acknowledging that people with other ideas are people who also want “the greatest good for the greatest number”, but see different means of achieving that.

        There are precious few forums in which this happens anymore. The comment section at Naked Capitalism was one for a long time, but I’ve been checking the comments section here much less frequently lately, because every time I have recently, it’s been a kindergarten food fight.

        I’d love to see the comments elevated to the level of Yves’ outstanding blogging.

        1. DownSouth

          Given alex black’s history of comments here on NC, does he really expect anyone to buy into this load of horse manure?

          This all speaks to the double standard the right-wing wants to impose. If it’s Rush Limbaugh, Glen Beck or William Kristol, unreasonableness and belligerence are deemed to be attributes of the highest order. But if it’s some progressive spokesperson, those same vaunted attributes suddenly become demonic.

          But it’s always been that way. Right-wingers like alex black tried the same song and dance with Martin Luther King, Jr. So while the white racists could assemble and scream “Nigger! Nigger! Nigger!”, King was supposed to be “reasonable.” Here was King’s most eloquent response:

          But I say to you, there are certain things within our social order to which I am proud to be maladjusted and to which I call upon all men of good will to be maladjusted.

          …I never did intend to adjust to the evils of segregation and discrimination. I never did intend to adjust myself to religious bigotry. I never did intend to adjust myself to economic conditions that will take necessities from the many to give luxuries to the few. I never did intend to adjust myself to the madness of militarism, and the self-defeating effects of physical violence. And I call upon all men of good will to be maladjusted because it may well be that the salvation of our world lies in the hands of the maladjusted.
          –Martin Luther King, Jr., “The American Dream,” The Negro History Bulletin, May, 1968

          But perhaps it was Andrew J. Bacevich who nailed the right-wing rhetorical strategy to a tee:

          From his editorial command post at “Commentary” (and through organizations such as the Committee on the Present Danger, in which he figured prominently), Podhoretz did much to create and refine the fiercely combative neoconservative style. That style emphasized not balance (viewed as evidence of timidity) or the careful sifting of evidence (suggesting scholasticism) but the ruthless demolition of any point of view inconsistent with the neoconservative version of truth, typically portrayed as self-evident and beyond dispute.
          –Andrew J. Bacevich, The New American Militarism

          1. Mickey Marzick in Akron, Ohio

            Down,

            Bacevich is truly a rare find, a welcome antidote to the shrill shills of the right-wing void. I would gladly welcome the occasion to sit down with this “conservative” and discuss whatever came to mind. I’ve read several of his books and he is truly engaging and thoughtful, trying to bridge the “shrill debate” that seems to grip this nation.

            That’s probably why he is ignored by the RIGHT.

          2. DownSouth

            alex black,

            That’s right. Anytime anyone challenges the nonsense you and your little right-wing cohort spout here on NC, you immediatley start bawling for victim status, claiming your enemy is being “unreasonable” or engaging in “ad hominem” attacks.

            It’s amazing how you managed to take what Jon Stewart said and turn it on its head.

            To paraphrase Stewart: I’ll bet you’re even a bigger prick in person that you are here on Naked Capitalism.

          3. Michael

            “It’s amazing how you managed to take what Jon Stewart said and turn it on its head.”

            And what exactly did Alex say which did this?

          4. DownSouth

            Michael,

            What Stewart was bashing is the “Better PR is the solution to every problem” meme which Yves has critiqued several times here on NC.

            According to this paradigm, form is everything and substance is nothing.

            So instead of the debate being, for instance, about what Obama does, or about the merits or Obama’s policy proposals, it becomes about Obama’s style, i.e. whether he’s angry enough or too angry, whether he is firm enough or not firm enough, whether he’s too aloof or not aloof enough, and on and on and on ad infinitum.

            So enter alex black with the same nonsense, wanting to make the debate not about substance, but about style.

            It’s not the aggressive style Stewart is criticizing (he did, after all, call his sparring partner a “prick”), but the fact that these pinheads don’t have anything of substance to say.

          5. LeeAnne

            DownSouth, parden me for intruding; I couldn’t resist showing you this. In the spirit of a picture is worth a thousand words; to yours and Bacevich’s point –Kristol at his snide, dismissive best in a panel discussion on Book TV Neoconservatism Biography of a Movement: Bill Kristol, Strobe Talbott, E.J. Dionne, Francis Fukuyama and author Justin Vaisse

            See Kristol’s last word at 1:33, the very end of the video answering a question from the audience by Peter, I’m just a taxpayer at 1:26.

          6. DownSouth

            LeeAnne,

            Thank you very much.

            The perfect example of exactly what I’m talking about.

        2. NOTaREALmerican

          Re: Political “dialogue”

          This “concept” has never existed when applied to issues that matter.

          People do NOT discuss and change their minds when “discussing” topics that directly apply to the emotions involved with “outsiders”.

          It’s possible to discuss why the White Sox are better than the Cub, but beyond that it’s just yelling and screaming.

        3. K Ackermann

          Alex,

          Where do you read the comments section? If NC is a kindergarden foodfight, I’d love to know where you find adult discussion?

          I hope you do still listen to the small people.

      2. NOTaREALmerican

        I had the same problem after 9/11 and the country subsequent shift to overt fascism. Over the many month before Iraq my friend’s talk of extreme patriotism and punishment for those who weren’t patriotic scared me to the point I joined the ACLU – which, if you had asked me about this 15 years ago, when I was happily voting Republican to get even with “those people”, I would have told you was impossible.

        My friend and I now avoid all talk of politics, which makes for boring times as we have no interest in sports. What else is there?

  2. D. Warbucks

    But when it comes to denying health care to people that need it, the U.S. is #1

    And, it’s parasitic insurance industry is also #1.

    And, it’s #1 in hospital-acquired infections

    And, also #1 in obesity and lack of preventative medicine

    And, #1 in cover-your-ass diagnostics

    And, #1 in paperwork

    And, it’s #1 in right-wingers who will go all out to defend the current system.

    So by my metrics, which I think are better than yours, the U.S. is still #1 overall.

    1. NOTaREALmerican

      Re: right-wingers who will go all out to defend the current system.

      It’s also the peasants knowing who matters. “Those people” don’t count, and the peasants know that all these liberal surveys include “those people”. If you didn’t include “those people” our health insurance would be the best in the entire universe.

    2. John Galt

      We have a current regulatory scheme that completely distorts the health care system.

      Health care is providing the care to the patient. Insurance is a risk mitigation tool to prevent catastrophic events from finanicial ruin.

      By imposing a regulatory system that removes the pricing of the risk component, you create a ficticious insurance system with inordinant manadated inefficiencies. Really your insurance company is required to pay for annual physicals? How is that insurance? Really your insurance company is billing you for coverage for mamograms, and your a he?

      The market is supposed to create a price for value, the new systems mandates the price and nobody will receive value in the future.

      The only real argument is whether or not all people deserve free health care, whether or not they can afford it. I believe that it is a nice eutopia, but cannot work in the long run.

    3. Dr. Bob

      It is by far #1 in medical malpractice lawsuits which contributes directly toward your #1 ranking in “cover your ass diagnostics”. The US has reaped precisely what it sowed. (Doctors will) “embrace guidelines and a payment system that denies reimbursement for unnecessary medicine and protects doctors from malpractice suits if they follow the guidelines.” http://www.nytimes.com/2010/03/30/health/30use.html?scp=17&sq=medical+screening&st=nyt

      Or this article also from the NY Times:
      “Deep down, Americans tend to believe that more care is better care. We recoil from efforts to restrict care.
      Managed care became loathed in the 1990s. The recent recommendation to reduce breast cancer screening set off a firestorm. On a personal level, anyone who has made a decision about his or her own care knows the nagging worry that comes from not choosing the most aggressive treatment.
      This try-anything-and-everything instinct is ingrained in our culture….
      http://query.nytimes.com/gst/fullpage.html?res=9804EFDE103DF934A35757C0A9669D8B63&scp=18&sq=medical+screening&st=nyt

  3. scharfy

    Silly liberal think tank issues a scathing report of US healthcare? And cue the clown cars for Obama/Pelosi/Reid to save the day.

    Yea, its broken – but lets look at the disease and not the symptoms.

    Obesity epidemic, diabetes epidemic, sick fat unhealthy citizens, 20 million illegals get free coverage in Emergency Rooms (that’s not cheap), Drug companies sell generics abroad and skirt patent laws while the US pays for drug R&D, lawsuit frivolity, 300 million populus, Medicare/Medicaid red tape circus, non-competitive state to state markets, patients are removed – if not totally divorced from pricing, and most people who work for a union, state, municipality, or the GOV don’t have clue what insurance costs because its buried in their benefits package which is protected usually by law.

    So other than the fact the architecture of the scheme is for high costs and sloppy service to unhealthy people, it’s great.

    So that’s why I support a single payer system. But only on an state by state basis. So if Montana wants to go single payer and pay for it – voila put it into law. Don’t do it at the federal level. Europe doesn’t have ONE single payer system where people in Italy pay for people in Denmark, because maybe people in Denmark want different care than those in Italy. So we should follow their lead.

    That being said, if you have the $$$ and shop around and are healthy, American healthcare is pretty dam good. It’s why heads of state fly here to get work done, and students fly here to go to school.

    Did I miss anything in the standard right wing retort? oh yea…

    socialism….creeping socialism…

    But I get the point, the free market thing sucks, it’s failed, over.. We must unite.

    1. JTFaraday

      “300 million populus”

      I find it interesting that so many people on the internets can’t spell this word. I’ve seen it wrong so often that I’m starting to question myself.

      I’ve also seen “conscious” for “conscience” quite a bit, but that one I find kind of interesting.

    2. NOTaREALmerican

      Yup, this is all “those people’s” fault. Including the destruction of capitalism and our glorious financial institutions; who pay taxes unlike “those people” living on my hard earned tax money.

    3. dw

      does any body realize that Mexico has free health care? they aren’t here because of the benefits. its the jobs

      1. K Ackermann

        Yeah, they take our jobs and… buy food, and rent apartments, and… need to wear yellow arm bands!

        (I didn’t realize they had free health care in Mexico. How civilized)

  4. Cian

    Interestingly they rate the UK at number two. They rate it poorly for customer facing stuff, but the actual quality of care as high. Which sounds about right even if you’ll never get a newspaper in the UK to admit that…

  5. anonymous

    I’ve spent most of my life living in countries with national health-care and here’s the metric that counts: when a child is going to have serious surgery, or the risks are really, we want surgeons who have studied in the US. We don’t to settle for second best. National health-care systems freeload on the back of the US system. I’ve no problem with expanding coverage to all who need it. The US health-care system is the best in the world for those who can afford it. The fact there are lots of unhealthy people living in the US is immaterial.

    1. D. Warbucks

      That’s very interesting because when a person goes to see a doctor in the U.S., chances are pretty good he or she didn’t study in the U.S.

    2. Cian

      I’ve spent my entire life living in a country with a national health care system and that particular “metric” has never once occurred to me, nor have I ever heard anyone else use it. I rather suspect that the US imports rather more doctors than it exports.

      The UK certainly isn’t parasitic on the US. But I doubt you’ll believe that.

    3. liberal

      “…and here’s the metric that counts…”

      That’s a poor metric to use, one designed to play to emotions. I can’t imagine a worse idea from the point of view of policy.

      1. anonymous

        That’s the metric we used when our son was in infant ICU and I had my own cancer surgery.

        The fact that the chap up thread never entertained the idea of stepping outside of the UK health system confirms he has no idea which country is paying for and providing medical innovation and keeping the west free.

        When the US declines, the quality of life for all of us does, too. Taking drugs, smoking, consuming large quantities of alcohol, fat, and sugar is matter of making some seriously poor choices.

        Cuba has a superb health system compared to pretty much all other Latin American countries. That doesn’t mean I want to get my dental work done there.

        1. Cian

          Seriously, those were your criteria. And you expect to be taken seriously as a sentient breathing human being.

          The UK has several very highly rated medical research institutes and is very active in cancer research (among other things). But hey, what are facts compared to tribalism, right?

          1. Externality

            Please consider arguing the facts, or the law, and not attacking your opponent.

            References to “tribalism” or others’ intelligence contribute little to the discussion.

        2. hibikir

          My uncle, from Spain, thought the same way you do: The US has the best healthcare in the world for those with money and all that. Well, he got lung cancer, and decided that the Spanish doctors couldn’t be good enough, so he spent a hundred thousand bucks to visit the Anderson Cancer Clinic in Houston. Over there, after running test, they told him that one of the leading researchers in that kind of cancer was in his hometown, back in Spain, and that all they could do was put him through the same procedure this local doctor would have done. They gave up after three weeks, and gave him this “experimental new drug”, which happened to be sugar pills.

          The US doesn’t have an advantage in actual care anymore. Where you do have an advantage is in making hospital rooms be as close as possible as a 5 star hotel, which does wonders for hospital profits.

    4. Eagle

      Another data point for those who are incredulous about this poster’s claim – if you’ve ever looked into medical tourism, you’ll notice the doctors all claim degrees from top US schools.

      There was a revealing statement Obama made in the healthcare debate – a gaffe if you will – an interviewer asked Obama why, if the US healthcare system has such problems, why do the rich from all over the world come to the US to be treated. And Obama replied (paraphrasing), I’m not really concerned where Saudi princes get their treatment – I’m interested in the common man. It was the first time I’d seen a politican acknowlege that there has been a tradeoff between equity and quality (really, seeing them acknowlege any tradeoff is rare), and that he was coming down on the side of equality, presumably at the expense of quality for the relatively wealthy.

      1. Glenn Stehle

        Well let’s just hope that American medical knowhow hasn’t suffered the same fate as American drilling knowhow, which can now be classified as little better than third-world in comparison to countries like Saudi Arabia and Brazil.

      2. Cian

        Well all that would prove, if true, is that medical tourists think that US trained doctors are better. They may be correct in that assumption, but equally they may not. Your average punter is not qualified to judge medical expertise.

    5. renting_space

      ‘we want surgeons who have studied in the US’

      Strange – I have yet to hear a single German parent, like the friends who had heart repair on done on their 1 year old daughter, express that thought. Not a single one. But then, Germans also seem uninterested in importing General Motory cars either, regardless of what some people think of Cadillacs.

    6. Francois T

      “we want surgeons who have studied in the US.”

      Is that so?

      The explain to me why a majority of peer-reviewed publications in surgery comes from outside the US since 1993?

      I’ll grant you one important point: US surgeons benefit from better technology for very advanced surgery. That is not in dispute. That said, it is worth remember that the majority of surgical procedures do not require top notch technology, but smart surgeons with well organized support teams.

      1. K Ackermann

        I’m glad you didn’t bring up Iran and their serious contributions to the field of medicine.

        Whatever we do, we musn’t bring up Iran.

    7. Vinny

      Granted, there are many good US-trained surgeons, but on average, US medical training is not very impressive.

      Vinny

    8. Yves Smith Post author

      Sorry, I’ve seen the exact reverse, people who were in a position to have procedures done either in the US or Australia (different reasons in each case) and they all chose Australia.

    9. Vinny

      “The US health-care system is the best in the world for those who can afford it. The fact there are lots of unhealthy people living in the US is immaterial.”

      Maybe in your dreams only…LOL

      Vinny

    10. emca

      “National health-care systems freeload on the back of the US system.”

      That statement is unsupported.

      The problem outlined, is the quality of health care delivery in the U.S. (and its costs), not the quality of medical education in this country.

      And if your arguing that foreign medical students (or graduate practitioner) seek the lucrative U.S. market to practice, via education, then I would be inclined to agree.

      By the way, I would have no problem going to Cuba for dental work, or T.J. for that matter.

    11. NOTaREALmerican

      Odd, I’ve never heard that. The Swiss people I know, both who are doctors, don’t think very highly of US hospitals. They equate them to northern Italian hospitals; ok but – if they had to pick – they’d go for Swiss, German, or Scandinavian hospitals.

    12. dearieme

      I’ve lived in the UK, Australia and NZ and have never heard of the “get a US doctor” rule. (I have heard the “get a Scot or a Jew” rule, however.)

    13. dw

      what does where the surgeon studied have to do with the quality of the health care? doctor’s can get their education in many countries. but not work in the country that they got their education in. as some one noted, lots of doctors in the US aren’t educated here

    14. MB

      It’s actually the system that fails here. Diagnostic techniques, treatments, drugs – all are about as good here as anywhere. In quality of care the U.S. fails because either we don’t consistently do what we know should be done, or we haven’t learned what the best practices are. The national health care systems just do a better job of bringing consistent, evidence based care to most patients.

      And, as far as foreign trained doctors go, they may not have attended medical school in the U.S. but evidently they do have to train here:

      “U.S. rules require foreign doctors to do a residency in the United States.”

      http://www.cepr.net/index.php/beat-the-press/protectionist-restrictions-threaten-health-care-economists-dont-care/

  6. Jose L Campos

    My wife and I were seen at the same ophthalmology office. Both had cataracts. I was operated on first and the operation, I was told where it would take place, would be done in a for profit spot. The cost of my operation was $9200. My wife some time later had the same operation in a regular hospital and her bill came to $3300. We both see perfectly well.
    I wrote to my congressman Fred Upton, about this disparity and he has not answered. Wonder why.

  7. IsabelPS

    People keep confusing “healthcare” and “healthcare systems”.

    This survey is about “healthcare systems”. It is totally irrelevant that some of the best performing techniques are developped in a country if only a small percentage of its citizens have access to them. That doesn’t affect much the overall performance of its healthecare system.

  8. kstills

    I would suggest that if the Netherlands had the diversity of citizenry found in the US, they would suffer similar social ills, HC being one.

    Stupid metrics will always fool stupid people.

    1. aet

      Please be more specific: “stupid metrics”?
      In what way?

      IMO, as it stands, your response to the article is stupid.

        1. aet

          “Diversity”?
          Oh, I see now: America has a problem with “diversity”.
          Gee, you sound like you judge people depending uopon which group they belong to…or you feel that different groups ought to have “separate but equal” dacilities.

          1. aet

            Oh – maybe you mean that the gap between rich and poor is so great compared to that in Holland, the rich would not sit still beside poor people in the waiting room.
            Yeah, if Holland had the swarms of poor that the US has, it too could not run a universal-access healtth cae system.

      1. kstills

        It is highly illogical to assume that the government, by increasing it’s participation in HC can modify the personal behavior of those who recieve the HC. Or, for that matter, reduce the costs.

        Unless you have an example of a government program that actually replaced a private sector program at lower cost?

        Since that’s absurd on it’s face, we can continue.

        The government can expand HC (increasing the costs) or restrict HC (decreasing the access). It cannot nor will it do both.

        So that leaves us with the attitudes of those who use the HC system. And as was pointed out, if a significant number of them are here illegally, if a significant number of them are fat, lazy and addicted to one substance or another, then the chances of any meaningful reform of the costs of the HC system are pretty close to nil.

        We, collectively, have spent years making people believe that they should be taken care of by the government, instead of taking care of themselves.

        Welcome to your brave new world.

        1. Ina Deaver

          That’s perversely blind. ALL national systems replaced for profit systems – unless you think that doctors were working for free before the national systems were instituted. The costs were prohibitive for enough of the population that national plans were instituted. End of story. It’s a choice that a society makes. We made a different one and we’re suffering the consequences.

          I lived for many years on the border to Mexico. While some wealthy Mexicans cross the border to get health care in the US, because they can afford it, they are outnumbered at least 1:1,000 by people from the US crossing into Mexico for dental care, eye exams, doctor’s visits, and pharmaceuticals who CAN’T afford it here. Seems those “nondiverse” Americans don’t mind sitting next to some Mexicans in the waiting room of a doctor’s office one little bit. Except, perhaps, they would like to be able to afford care here.

          I’m afraid that you are going to find at some time soon that disease doesn’t know whether you are white or rich or self-satisfied. It just cares whether you are a satisfactory host: and all those expendable masses are a vector that you can only ignore for so long.

        2. DownSouth

          “….if a significant number of them are fat, lazy and addicted to one substance or another….”

          Vinny, where are you?

          Vinny linked to a study the other day (sorry I’ve lost the link) that indicated 29% of Americans suffer from sort of substance abuse or mental disorder.

          In Mexico, where I live, that number is only 12% (the drug of choice of most Mexicans being alcohol).

          This statistic is given credence by the $35 billion a year that the United States dumps on Mexico’s drug cartels, more foreign income than Mexico receives from any other single source, whether that be oil, tourism, maquliadoras, or the money that 12 million Mexicans working in the US send back home to support their families.

          All this creates a bit of a problem for right-wingers like kstills, because the right is also committed to the notion of American exceptionalism.

          Which brings me to my final point, made by a fellow American expatriate, John Ross, living in Mexico. Ross is an avowed Marxist. I’m not a Marxist, but I believe they nevertheless bring needed critiques to the table:

          Like Mexico’s participation in the North American Free Trade Agreement, the decision to enlist in the U.S. War on Drugs was not determined by popular referendum, but was rather a matter of political and economic expediency imposed upon the nation by the last of three of its presidents. These arrangements have exposed Mexico to grave violations of its “national security”—-often from yahoo gringo law enforcement agents who seem to think the War on Drugs erases the border. Mexico’s participation in the U.S. Drug War has cost the lives of hundreds of members of its security forces, deepened the poisoning of the police and the military, sustained a culture of violence and impunity, and, most of all, is doomed to failure because it is really not in Mexico’s “national security” interest or inclination to keep the gringos from burning out their neurons with self-designated “illegal” drugs.

          [….]

          The use of drugs in the United States is not a Mexican problem, and, indeed, if drugs were legalized and the profit motive stripped from trafficking in them, they would probably not be a problem north of the Rio Grande either.

          [….]

          The use of drugs and the war on it are an expression of great unhappiness amongst the population of North America. But whether alienation, boredom, frustration, fear or loathing drives so many North Americans to use drugs in such impressive numbers is not really the concern of Mexicans. They have plenty of problems of their own. Nonetheless, Mexico has been threatened and condemned for not doing more to defend its best trading partners from this self-inflicted scourge. I suspect it is the price of admission that is being paid for here—-being annexed by the American dream also means being annexed by the American nightmare.
          –John Ross, The Annexation of Mexico

          1. aet

            What’s with the “blame the sick”?
            That a near cousin of “blame the victim’?
            After all, it’s the sick who cannot afford the health-care…

          2. DownSouth

            Who’s blaming the sick?

            I’m blaming the society and the culture that makes these people sick.

            And to paraphrase Martin Luther King: It is a tortuous logic that views the tragic results of neoliberalism as an argument for the continuation of it.

        3. aet

          Single payer publicly-funded universal Strip the insurance cos profits and duplications out, and re-invest in doctors, nurses and facilities.

          For-profit health care gives people an incentive to make other people sick. Or sicker.

        4. liberal

          “The government can expand HC (increasing the costs) or restrict HC (decreasing the access). It cannot nor will it do both.”

          Wrong. There’s a different alternative: expand _useful_ healthcare, gut _useless_ healthcare, like the tens of billions spent on pointless spine surgery for back pain.

          Outcome: same or better health, lower cost.

          1. Yves Smith Post author

            Can’t agree more. I am pretty healthy, and have had doctors recommend unnecessary tests often, even unwarranted surgery.And they are also very keen to hand out meds here. I’m unusual in that I argue or just say no. How many patients do that? Particularly if you are not in generally good health?

          2. Anonymous Jones

            I also say no, and I encourage my friends to say no. With almost all medications I have been given, the side effects at least *seemed* worse than the original problem (except with pain medication when I had kidney stones…really needed that).

            I have been appalled at the level of most doctors I have encountered here in Los Angeles. One once tried to say I had a permanent hypothyroid condition and would need to be on medication for life. Another looked at a blood test in which a large majority of the results came back abnormal, couldn’t figure out what could cause my system to go so haywire, and literally suggested that I go on Prozac. This *happened*. While I have had many pleasant interactions with many very skilled and intelligent doctors, the “prescription solves everything” disease is rampant here, and you should all be very, very wary of what any particular doctor suggests. Get a second opinion and read up on the efficacy (and side effects) of the medication.

        5. Vinny

          “We, collectively, have spent years making people believe that they should be taken care of by the government, instead of taking care of themselves.”

          Wow! Is that right? How do you then explain the tens and tens of millions of Americans (not illegals) without access to health care?

          They just could not take care of themselves could they? You must be referring to the part paying $8000 a year for health insurance on a $12,000 a year salary, right?

          No offense meant, but the utter stupidity of your statement makes you look really badly here… just a thought.

          Vinny

    1. alex black

      Although it was some years ago…. I came down with Dengue Fever in Bangkok. Went to the best hospital. Saw the chief physician. He wanted me to come in daily for a week to follow up with him, including a daily blood test to check WBC count. No idea what the bill would be (I would just be paying cash), but since I was completely purple from internal bleeding, I didn’t care.

      The bill after 7 consultations and 7 blood tests? $50 US.

      1. Skippy

        Your lucky…my friend whilst he was working and writing his thesis, was visited by his wife in hospital and obligatory house staff, and informed of his need to brow beat them for improper house cleaning…attention to detail.

        Skippy…of course not in the room but, out side with them lined up like ducks…he is single now…lol.

        1. anonymous

          Asian medical theory has a few things to teach the west. But virtually all the wonderful cheap techniques performed in Thai hospitals originated outside Thailand. In time that will change. Perhaps in a generation or two. Medical tourism is a big source of cash for Thailand catering to UK citizens fleeing National Health who can’t afford or imagine going to a US hospital.

      2. Vinny

        Medical and dental tourism are already big business. It saves on average 80% over the costs of US procedures, and that includes travel.

        Vinny

  9. Kenneth Alonso

    The Commonwealth Fund agenda is one of national health care. The methodology descirbed in the article link is one of a “telephone survey” (as in political or public opinion polls) coupled with a view of official statistics (that may not adequately measure the defined category).

    While in the US rationing is done by price, in national healthcare systems rationing is done by waiting lists (and unpublished but widely understood criteria such as age and contribution to society). The fear many of us who support single payer have over the independent (and answerable to no one) commission established in Obamacare is that it will quickly ration by social criteria and not by medical evidence. Oregon remains the only State where medical evidence was joined with social criteria to direct Medicaid funding. There is no other equitable method of rationing; yet, the elected representatives of the people (or elite, if you prefer) back away from public consultation and the consideration of an Oregon-like process.

    Further, Medicare has distorted the educational process, has furthered the shift into subspecialty care, and, even in Obamacare, does little of substance to return to a primary care system. .

    Oh yes, the national healthcare system in Spain, where physicians salaried by the state earn 3000 euros monthly, are losing physicians to the UK. It is about how much a physician will be able to earn practicing medicine.

    Yves, please pay closer attention to sources.

    1. liberal

      “It is about how much a physician will be able to earn practicing medicine.”

      Not a problem for the US—since physicians here make far more than anyone else in the world, they can have their pay cut and they’ll have nowhere else to go.

      Furthermore, the “market” for physician labor is significantly distorted by the AMA, which secures monopoly rent for physicians by restricting immigration of qualified MDs, and by limiting the number of spots in US medical schools.

      1. Mickey Marzick in Akron, Ohio

        Best and by far the most powerful union, I mean professional association, in the country. No talk of union-busting here though! It’s different! We’re professionls. We went to school…

        But the journeyman electrician who apprenticed to learn his trade and earn his journeyman card [diploma] wired this professional’s mansion properly so that it wouldn’t burn down is gouging, but the doctor who owns the mansion isn’t. It’s just different!

        One group has been licensed and certified to steal and it’s the diffference that’s killing US.

      2. DownSouth

        Liberal,

        I should have provided the link to the “Links Summer Solstice” thread too, because some of the comments that article triggered were outstanding:

        http://www.nakedcapitalism.com/2010/06/links-summer-solstice.html

        But the bigger issue I wanted to address is that when you have people who are every bit as smart, have invested an equal amount of time, energy and money into their careers and work just as hard as any surgeon or medical specialist does, and yet make only a small fraction of what a surgeon or medical specialist makes, it belies two linchpins of American mythology:

        1) Market ideology. As you point out, it is the political muscle of the AMA and its ability to control supply that drives up the earnings of MDs. But the AMA has only a little finger on the levers of political power. It is the finance industry that really has its hands firmly on the levers of power, and the results in pay prove it. As Reinhold Niebuhr observed:

        [I]t is impossible to justify the degree of inequality which complex societies inevitably create by the increased centralization of power which develops with more elaborate civilizations. The literature of all ages is filled with rational and moral justifications of these inequalities, but most of them are specious…. No impartial society determines the rewards. The men of power who control society grant these perquisites to themselves. Whenever special ability is not associated with power….his excess of income over the average is ridiculously low in comparison with that of the economic overlords, who are the real centres of power in an industrial society.

        2) The middle-class creed. The American middle class regards its superior advantages over the world of labor as the just rewards of a diligent and righteous life. Failure to achieve such a competence is in itself proof of a lack of virtue. That you have property is proof of industry and foresight on your part or your father’s; that you have nothing is a judgment on your laziness and vices or on your improvidence. The world is a moral world; which it would not be if virtue and vice received the same rewards. Quoting Niebuhr again:

        This middle-class creed sprang so naturally from the circumstances of middle-class life that it ought perhaps, to be regarded as an illusion rather than a pretension. But when it is maintained in defiance of all the facts of an industrial civilization, which reveal how insignificant are the factors of virtuous thrift and industry beside the factor of the disproportion of economic power in the creation of economic inequality, the element of honest illusion is transmuted into dishonest pretension.

    2. Yves Smith Post author

      You think there isn’t rationing in the US? It’s called denying approvals for major surgeries, which happens all the time, and queuing for specialists (except those who cater to the non-insurance crowd, dermatologist, plastic surgeons, endicronologists who have anti-aging practices). And in NYC, you have queuing even to see general practitioner. They are a scarce breed here.

      1. lidia

        Yves, late in reading/replying here. When I lived in the US and paid $800/month for Tufts HMO in Boston (a city crawling with doctors) to see my primary care physician they would normally give me an appointment 6 weeks out. Here where I live in Italy, PCPs have office hours a few mornings/afternoons a week and it is walk-in, first-come, first-served. I even have my PCP’s cell phone number.

        For specialists my husband and I have not experienced longer waits than in the US. For elective surgeries there is indeed a longer waiting period, but the direct cost to the patient is virtually nil. There is always the option to go the private route, but the care is not necessarily better, according to my Italian MD brother-in-law (the facilities are nicer). Sometimes you can access the same structures, if they are “convenzionati” (i.e., they accept public patients).

        1. lidia

          P.S. Just to precise.. my decades of MA experience were pre-RomneyCare. Missed it by just a few years.

    3. NOTaREALmerican

      I’m always amazed that liberals (socialists, progressives, leftists, whatever) who want a US socialist (like) health care system but – like all idealists – assume the resulting system will be more like Germany than (say) Greece.

      The US society is hopeless corrupt. Anything it creates will be hopelessly corrupt. For any system to work in the US the users (creators) of the system have to somehow isolate it – as much as possible – from the sociopaths that WILL show up to grab the loot.

      You can’t expect a government, run by sociopaths for the benefit of sociopaths elected by dumbasses, to create anything but a scam.

      At least a state run health-care system would have 50 different organizations for the sociopaths to capture. Why don’t you liberals at least make it a BIT harder for the sociopaths to win once in awhile!

      1. Anonymous Jones

        I really do like your comments. You were on fire earlier this week, and there were so many good comments, I didn’t know which ones to compliment.

        You are right here as well…it’s about society saying enough with the smart amoral scumbags and being loud and clear about it, “We’re going to marginalize you.” Until that happens, it’s just rearranging deck chairs on the Titanic.

        That said, many on the “left” are dealing with completely incoherent and factually bereft arguments all day long from the “other side.” I mean, seriously, to claim that it is *impossible* to have a government-run health care system that is better than the system now in place in the USA. That’s just not true. It may be impossible in the USA, but it’s not impossible in other countries. It is difficult not to be distracted by this type of lunacy. Most people, on both the “left” and “right” (which is, as I’ve said before, an imaginary dichotomy and totally foolish labeling (mostly self-applied!!!)), are so sure of their perspective and their solutions that the only way they can deal with temporary cognitive dissonance is to reject new facts and new logical arguments by rejecting them or by warping them into an unrecognizable state so that they can be safely incorporated into the pre-existing views.

    4. Externality

      The tendency of diseases to become politicized is a major concern. The “innocent victims” of diseases, or diseases that affect influential groups are much less likely to be the subject of rationing.

      In the early days of the AIDS epidemic, neither political party wanted the government to spend a dime on what was then called GRID – Gay Related Immune Deficiency.
      After massive protests by gay groups and the mostly GBLT group ACT UP, the government began funding AIDS research and treatment in America.

      For the past thirty years, professional bioethicists, the media, and politicians have all argued that scarce AIDS funding should focus on the so-called “innocent victims of AIDS” — heterosexual women, children, and people who were infected through blood products. Apparently, heterosexual women are always more “innocent” than gay men or transgendered women. Priority on waiting lists, the “experts” argued, should go to these “innocent victims.”

      Eventually, additional funding was set aside for these “innocent victims,” while the gay men and transgendered women who started AIDS organizations were marginalized. AIDS funding for Africa receives bipartisan support because the disease predominantly affects heterosexuals there.

      Government concerns about stigmatizing groups play a similar role in health care decisions. The government continues ban blood donations by any man who who has engaged in homosexual conduct,even once, since 1977. Statistically, the government should also ban black people because they are nine times as likely as the general population to have HIV/AIDS. (Gay men are 15 times.) Black women are 18 times as likely to have HIV as White women. Among people who do not know their status, black women are MORE likely than gay men to have HIV/AIDS. Despite this, the public health experts are afraid to even raise the issue of banning black people from donating blood. Why? Fear of being accused of racism and of stigmatizing the black community. No one is afraid of stigmatizing gays.

      http://www.slate.com/id/2257655/pagenum/all/
      http://www.queerty.com/why-isnt-the-fda-banning-blood-from-black-women-20100622/

      Any publicly funded or controlled system inevitably leads to a struggle over who should receive limited resources. One constantly reads that care should be denied to the elderly, disabled, illegal immigrants, the obese, alcoholics, children of illegal immigrants, drug users, criminals, the mentally challenged, the mentally ill, smokers, etc.

  10. Sneeves

    American expat living in, France, country that has, according to everyone, the best rated healthcare system in the world (and for some reason was not included in this survey) is fascinated to read that there are people who still manage to defend the worst healthcare system in the industrialized world.

    Actually mind-boggled would be a better word.

    1. liberal

      Never underestimate the ability of people to be blinded by ideology.

      After all, the free market “system” in the US blew itself up with the housing/banking crash, and how many true believers (libertarians et al.) have changed their tune?

    2. Michael

      When you’ve been told all your life that you’re the best of the best in the world, i doubt any amount of evidence will be able to shift that. It’s not just that the medical system in the usa is crap and expensive, but additionally that a ‘socialist’ public healthcare system is better and much cheaper.

      So the best country in the world isn’t the best after-all, and worse, those evil ‘socialists’ aren’t so evil.

      Accepting that the healthcare system is a shambles completely demolishes the foundation of their entire world, so it just can’t be accepted no matter what the evidence.

    3. NOTaREALmerican

      Re: Actually mind-boggled would be a better word.

      Americans must believe the stories. The only thing America has left are the bullshit stories of greatness.

      Once those go, the system collapses.

      REAL Mericans know that the US health-care system would be the best in the world if you’d just stop including where “those people” get care. Look, upper class suburban hospitals are fine; what ELSE matters?

    1. aet

      As a Canadian, I plead ignorance as to the details of the US health-care system – if there actually is such a thing: it seems an awful patch-work,enough complexity in itself to make one sick just to think on it….

  11. Dave of Maryland

    It would be interesting to see / study the underlying enabling legislation. Betcha the Dutch didn’t need 1000+ pages for their health care bill.

    Oh, heck. Let’s look at commercials on TV. Again & again & again we see competition, competition, competition. The best car, the best hair color, the best cure for male impotence.

    Why not a range of commercials that would teach weary, defensive people how to socialize with each other? How to make small talk? The importance of being fair? Of telling the truth – even when it hurts?

    To my surprise, these are the sorts of things you learn when you take up a foreign language, because in learning to speak a new language you must, by definition, learn how to speak & interact with others.

    What was Rex Harrison’s famous line? In America they haven’t used it [English] for years – ?

  12. brian

    28-33 cents of every health insurance premium dollar goes to pay the overhead of private health insurance companies
    thats bloated salaries, shareholders, sales and marketing
    all costs a public option or Medicare buy in would not have
    comparible rate for medicare is 6 cents

    and the congress has been bought to keep the system as is

    1. NOTaREALmerican

      And the liberals will keep voting for the “Progressive” wing of the Republicrat Party, and they will keep expecting different results.

      Redeploy Steven Vote Democratic.

  13. toxymoron

    I understood the Veterans Administration has all the good qualities you might go shopping for. So good health care is possible in the US – if it comes from the government.

  14. sapeurcamembert

    French and living for a long time (more than 30 years in Canada) I can say that US healthcare system, if you compare to public funded system, is probably the worst….Cost by people in France is in the range of 3500 $ US a year for anything excluding medicine for short term disease (there is very low cost insurance for this, no question ask…). Break down for health care cost in US are 40 % for administration, computing systems, billing, 30 % something for medicine (3 times as much as France..), 10 % for real care….Cost in Canada are going up, thanks mainly to the conservative canadian government that want to privatize and gives a chance to the free market….

  15. Eagle

    I never care for the design of these studies; let’s compare the experience of those of median wealth in a metropolitan area in each country and the results would be more interesting.

    I agree this healthcare bill is just a sop to the industry that will likely worsen outcomes for all of us. Of course, it would take actual work to force the AMA to train more doctors and tackling drug-reimportation so other countries stop free-riding off of our innovation.

    1. Cynthia

      There’s no question that the US has got a severe shortage of primary-care physicians. But this don’t necessarily mean that we’ve got a glut of MDs employed as specialists. In fact, I’d say that the supply of physician specialists is just about in line with our population’s demand for them. So in order for us to overcome this problem of having too few primary-care physicians, we can either train more medical residents to become primary-care physicians or train more nurse practitioners to do their job. I think the latter solution is the better way to go.

      Keep in mind, the AMA doesn’t want medical schools to greatly expand their enrollments. If they do, this will put downward pressure on physician salaries. The AMA, after all, is just like all other union of workers in that its primary job to keep our demand for its workers slightly ahead of its supply of them, preventing them from entering the great global wage race to the bottom. And with health-care dollars becoming increasingly scarce, increasing the supply of primary-care physicians will cause more health-care dollars to shift away from the specialists into the hands of generalists, thus causing physicians salaries to drop across the board. So unless the AMA thinks it has something to gain by creating a rift between its specialists and its generalists, I think that the AMA would be acting in the best interest of all physicians by handing over most of the primary-care work to nurse practitioners. Don’t get me wrong, I’m not suggesting that primary-care physicians should be phased out all together. What I am suggesting is that they should take on the role as supervisors to nurse practitioners — very similar to the way anesthesiologists have been supervising nurse anesthetists in operating rooms over the decades.

  16. Jim

    This is pure agenda driven research, deeply flawed in its methodology and assumptions. Take a look at the actual metrics that they use in the study.

    The “Safe Care” subcomponent largely measures the percentage of patients reporting a medical error occurring over a given time interval, usually 2 years. Obviously patients who visit doctors more often will report more errors in absolute terms, and it is well established that Americans visit doctors much more frequently: http://www.nationmaster.com/graph/hea_con_wit_doc-health-consultation-with-doctors. This subcomponent tells us almost nothing about actual safety; what matters is the rate of medical errors per unit of medical care consumed.
    This same problem applies in several of the ranked components in the study.

    The study also relies on the assumption that for patients to make their own decisions regarding the costs and benefits of medical care is inherently indicative of a poor health system. This dubious assumption is very heavily weighted, entirely driving one of the major components of the study, “Equity”, and contributing strongly to another, “Access”. The authors more or less admit that this double counts the effect on pg. 14. Yet they give no clear rationale in the first place for the assumption that reducing patients’ ability to make their own health care decisions is a positive feature for a health care system.

    This study is clearly biased by these and other issues and it results are far from reliable.

    1. Francois T

      Let me start by stating the obvious; health care outcomes research is a maddeningly complex field of study. (And I’m not talking about the politics of it here) Anyone who has done, review or design such studies will attest to this fact. Meaning, it rarely “settles” a question in a definitive way. That is just the nature of the beast. Hence, those in search of yes-no, black-and-white answers shall be sorely disappointed.

      Second, surveys are most useful when done serially, trying to detect trends. I don’t agree with the “deeply flawed methodology” assertion. It would be more correct to posit that this research, by its very design, cannot use optimal methodology for some parameters under study.

      For example, parameters like “safe care measures” should be compared and contrasted in two ways: the survey and for instance, systematic medical charts review of those surveyed with predefined accepted criteria of safety. Defining what is “safe care” isn’t as simple as it appears to be.

      Note however, that systematic chart review has its own limitations. Not everything that takes place in a visit makes it to the chart. This can be corrected in part by interviews with the treating physician but the complexity, logistic and cost of these methods quickly grow geometrically.

      In a word, it is imprudent to read too much into a single survey like this one without looking at the trends over time.

      Now, to this “assumption that for patients to make their own decisions regarding the costs and benefits of medical care is inherently indicative of a poor health system,”

      I’m not sure what is meant here. What is sure here is that patients making their own decisions regarding costs and benefits is not necessarily indicative of a good health system, since it assumes rationality. When it comes to making decisions about self care, rationality can be in dire short supply for a myriad of reasons. After all, there is a good reason why assessing patient capacity to decide is part of the medical interview.

      “Obviously patients who visit doctors more often will report more errors in absolute terms, and it is well established that Americans visit doctors much more frequently…”

      Two problems compounding this statement: Different cultures may label health care interventions as “errors” in different ways; this is not defined in the document. Moreover, what a patient consider an “error” might not be one ascribable to anything specific to the health care professional-patient relationship. Would’ve been nice to have access to more raw data.

      Second, the data Jim linked to is from 2000. It is not surprising to see a high number of visits during this period: 1) health care insurance companies were just ending a brutal war for market share by slashing premiums, something that (for once damnit!) favored the consumers. More affordability at a time when the economy had been booming for the last decade made preventive and elective care more accessible to more people than usual. I am willing to bet a grand, right here right now that numbers of visits for 2008 and onward must be quite lower in the US.

      In conclusion, the sweeping statement that “this is pure agenda driven research” cannot be taken at face value. There are way too many variables at play here to reach such a conclusion. As for the “deeply flawed in its methodology and assumptions” part, Jim is partially correct: this research, while intrinsically valid, cannot be taken in isolation to affirm that the US health care is worse overall than in other advanced countries.

      THAT SAID, it is patently untrue to broadly state that the US system is inherently better than others. Anecdotes of foreign big shots coming here for treatment is all great and far out, but it takes MUCH MORE than that to make a great health care system. These “Man Who” statistics (“I know a man who…………) quoted everywhere up to Granma’s fridge just doesn’t cut the mustard. Accessible, affordable, and well-coordinated care run by well-trained professionals goes a very long way to lower costs and generate superior outcomes.

      In a more extensive post, I’ll provide several examples supporting this last statement. Get ready to experience beliefs demolition and prejudice blasting. Don’t worry, it won’t hurt that much. :-D

  17. Paul Tioxon

    Yves, the more I read what you bring to the attention of an elite group of Wall Street banker/traders/whatever you call yourselves, the more impressed I am with your expanding and systematic analysis of the social order. I have written here before of the attempts to bring some management to the overall system. It has a macro dimension, that was unavoidable when I studied it in 1978 with every nightmare prediction from then coming to pass as of 2010. Just as the value of the dollar varies from region to region, the quality of America differs from region to region. You can not even begin to compare NYC, Philadelphia, Boston with Phoenix, Houston or Las Vegas. What I have encountered from the average citizen west of the Mississippi and south of the Mason Dixon, are people who do not see the founding states as their America. Too much of the Southwest and the South has decoupled from any semblence of the America I learned about in school and from the living legacy in places where so much of what we come to call American originated. There is a Masonic Temple across the street from Philadelphia’s city hall, clearly demonstrating, with the historic record and artifacts that the founding fathers were active Masons, not Bible Cultists, Baptists or much of anything else recognizable as Christian. And 15 block North of there, one of the poorest, worst industrial slums in the Western world, in N Philadelphia, has much of its medical care provided by the doctors of Temple University hospital and med school, and in conjunction with the entirely free Shriners Children Hospital. In West Philadelphia, much the same is delivered to the poorest of the city at U of Pennsylvania Hospital and Philadelphia Children’s Hospital. I do not think you will find so few for profit or private hospitals elsewhere in America. The strain is showing on the hospitals of my city, but if you are poor and sick, there is not a better place in the world to live. But, again, the trajectory of growth, overall of American health care, is eating up the GNP at an unsustainable rate. It was an emergency in 1978, when it approached 10% of the GNP, it is a disaster in 2010 as it approaches the 20% milestone. And in our economically stratified society, with a disproportionately small group eating up most of all society’s resources, it is clear that medical care is part of that equation. That leaves 10’s of millions with the crumbs, and the faltering, inexcusable misallocation of health care. The need for uniformly distributed medical attention will keep us all healthier, as the worst problems now come from virus epidemics that will not stop at the doormen and cameras of the gated communities on the hill.

    1. Ina Deaver

      Um, WHAT? There is one hell of a medical center in Houston. It’s across from Rice University, and UT and Baylor have med school residency programs there. There is a — still totally nonprofit and church owned — hospital in that medical center. It’s St. Luke’s.

      I get annoyed that the Bible-thumping modern Pharisees have hijacked my religion, but I don’t think that you can characterize a whole region as lost. I would say that the problems you appear to decry are, much to my dismay, not geographically limited.

  18. Patrick

    Any report that includes the canard about infant mortality rates tells you everything you need to know about the authors and their supporters.

    1. IsabelPS

      Really?

      Here’s what the CDS has to say about the subject:

      http://www.cdc.gov/nchs/data/databriefs/db23.htm

      “Reporting differences have little effect on the percentage of preterm births because most preterm births occur well after 22 weeks of gestation. For example, the percentage of preterm births for the United States in 2004 was 12.5% when all births were included and 12.4% when births of less than 22 weeks of gestation were excluded.”

      There is, by the way, a paper comparing infant mortality in the US and in the countries that report live births exactly the same way (off the top of my head I remember Germany, Sweden and a couple of other Scandinavians, at least), and the US’ ranking is still well below any of those. I will post it when I’ll find it.

      1. IsabelPS

        Sheeesh! I should read the links I myself provide.

        Table 1 shows that the majority of the countries reports all live births, those that do not are a minority.

        Talk of canard.

        1. Patrick

          you really should read your own links instead of just sending out your talking points:

          “The United States compares favorably with Europe in the survival of infants born preterm. Infant mortality rates for preterm infants are lower in the United States than in most European countries. However, infant mortality rates for infants born at 37 weeks of gestation or more are generally higher in the United States than in European countries.

          The primary reason for the United States’ higher infant mortality rate when compared with Europe is the United States’ much higher percentage of preterm births. In 2004, 1 in 8 infants born in the United States were born preterm, compared with 1 in 18 in Ireland and Finland. Preterm infants have much higher rates of death or disability than infants born at 37 weeks of gestation or more (2-4, 6), so the United States’ higher percentage of preterm births has a large effect on infant mortality rates. If the United States had the same gestational age distribution of births as Sweden, the U.S. infant mortality rate (excluding births at less than 22 weeks of gestation) would go from 5.8 to 3.9 infant deaths per 1,000 live births, a 33% decline. These data suggest that preterm birth prevention is crucial to lowering the U.S. infant mortality rate.”

          Our preterm critical care is second to none for the most part. Secondly and more importantly preterm births are the most important reason. Spend a little time studying the underlying causes of preterm births.

          1. IsabelPS

            Do you have any suggestions? Could it be that antenatal care is not as good in the US as in other developed countries?

            And do you have an explanation for this sentence you quoted yourself,

            “However, infant mortality rates for infants born at 37 weeks of gestation or more are generally higher in the United States than in European countries.”

          2. Patrick

            “Do you have any suggestions? Could it be that antenatal care is not as good in the US as in other developed countries?”

            It has nothing to do with antenatal care and you already know that.

  19. Vinny

    Yeah, but that’s a small price to pay in order to maintain health insurance pay in the multi-millions, physicians’ pay in the near-million a year range, and bribes and campaign contributions to politicians in the billions and billions a year range. I say, these fine “benefits” make it well worth having the worst health care in the world…

    Vinny

    1. NOTaREALmerican

      Re: I say, these fine “benefits” make it well worth having the worst health care in the world…

      AND, it can’t be changed. Why do liberals push for a health care system in an obviously corrupt society? What the hell is the point? Did you expect that the Democrats PARTY wasn’t owned by the nobility?

      You guys are fond of pointing out the quote about “insanity and expecting different results”. Well, are all liberals insane?! At least fascists (conservatives, teabaggers, whatever) know why they vote Republican; they are mean assholes and want mean assholes to run thing.

  20. Hal Horvath

    The statistics in the excerpt speak for themselves.

    Only ideologues have trouble accepting the overwhelming evidence of repeated confirmation of the basic picture from multiple, independent sources.

    The greatest weakness of the U.S. system has been that a large part of the population, perhaps 60%, feels that even with insurance, going to the doctor is expensive and getting good treatment for a condition is many times prohibitively expensive (as compared to other nations).

    The solutions are not easy, because there is such a large portion of the American economy dependent on exactly the huge costs they impose for the health care they provide. People making $400K, or even $200K per year will fight hard to prevent any change, including open competition, that disrupts the means by which they funnel patients (and economic victims) into their services.

    Bothered by American healthcare subsidizing other nations?

    Fight for actual, unlimited free market drug imports from Canada, Mexico, etc. — actually stand up for your principles and write letters and do something.

    And about that elephant in the room — doctors networks structured as cartels to prevent insurers from getting free market competitive bids for services. Offer real ideas, and stop being part of the problem. Start being part of the answer.

    1. NOTaREALmerican

      Re: Start being part of the answer.

      There is no answer. The political system works for the “connected” (services-for-fees) from local government through the Feds. The system is working perfectly, exactly the way a services-for-fees political system is supposed to work. Professional politicians are vetted through the system – basically proving they are sociopaths and have the ability to con the peasant dumbasses.

      The US doesn’t have a democracy (or Republic) at any level of government. Why do people keep suggesting democratic solutions in a one part state?

  21. D.H.

    The debate has never been that our health care system needs to improve. The areas of debate are should the federal or state/local governments provide for the changes. Obamacare does nothing to improve quality, efficiency, access, healthier lives and questionable whether it impoves equity, not to mention cost!

    Please read:
    http://s3.amazonaws.com/thf_media/2009/pdf/wm2666.pdf

  22. Someone

    Here are some thoughts from someone in the health care field:

    Individual incentives are what they are. If you lower physician salaries in the US through single payer, you will see the best students leave for other fields. Many of my friends who graduated with me in engineering have switched to health care fields because of poor pay. Now, there is grumbling in the health care field of switching to banking, law, or consulting if there is a similar drop in compensation in health care.

    Granted, the US can largely solve that problem by importing physicians from other countries where education is subsidized. However, that’s a bit of a beggar-thy-neighbour practice and the shortage will just propagate down the line to those countries. We’re seeing this today with African countries, many of which suffer from shortages in physicians.

    Another issue is with lines. Massachusetts has enacted health care reform. Waiting times are longer as a result and the shortage of primary care is even more pronounced. See: http://www.cjr.org/campaign_desk/health_reform_lessons_from_mas_7.php

    You can solve this problem with imports (that’s being done now) and converting PAs and NPs to primary care. Sure, that’ll work in resolving numerical shortage, but you’ll have to live with the consequences of being treated by people with a different education set. I don’t know how that’ll work out, but don’t be surprised if there are a different set of complaints down the road. The grass always looks greener, after all, and people are short-sighted.

    Low-hanging fruit here may be to shift medicare payment away from specialists and towards generalists. Doing this will shift student residency decisions and have more primary care docs in 10 years, which will result in earlier detection and treatment of diseases, which will save lots of money.

    As for drugs, right now, there is little incentive to focus research on things like antibiotics, which are needed as resistance develops. Instead, research follows where the money is. AIDS is a big field. ED, obesity, and cardiovascular are also hot areas. Essentially, drug companies will abandon niche areas and focus on highly profitable fields.

    If you allow for the importing of generics, don’t be surprised to see important research dwindle even more. After all, companies charge different prices in different countries based on ability to pay (in part driven by liberal demands for cheaper drugs for Africa). Americans are rich in comparison to the rest of the world and have historically subsidized drug development and allowed for cheaper drugs for the poor countries.

    I guess the take home message is that yes, you can implement reforms from other countries or states, but be forewarned and learn to accept the consequences that result as individuals adjust their behaviours.

  23. A fan

    I have solution to this problem.

    Everyone here should quit their jobs and enroll in medical school. Four years later, we can all then begin residency. It’s not so bad. We can all work 30 hour shifts.

    Then, once we get out of residency, we can then volunteer to provide our services, to anyone, for FREE!

    This would have the following benefits to society:

    The costs to others would lower (hey they’re free!).
    Less paperwork and administrative inefficiency (no one to bill!)

    But best of all: we would not be imposing our will on others who have already made this investment in their careers. That should give us all a nice warm feeling inside!

    1. Ina Deaver

      I’m a lawyer. I have to provide a certain amount of pro bono a year – it’s how our profession is set up. And my product that I sell is my time, so if I spend hours on working for the good of humanity, then I necessarily can’t bill someone for that time.

      Lawyers do it, and people hate us. Why can’t doctors provide a certain number of free hours a year to the community?

      It’s not “all or nothing.” You are supposed to be in a profession, which purportedly people enter to help people. Nobody is saying you have to do it for free, but profit maximizing is quite a different matter, isn’t it?

  24. Mark Pontin

    [1] In 2000, Peter Drucker told me that in 1955 he’d been one member of an Eisenhower-instigated commission to institute universal healthcare in the US. In the Eisenhower scheme, this would have meant ‘catastrophic coverage,’ whereby if healthcare costs for an American resident/citizen would equal or exceed 10 percent of that individual’s income in one given year the Federal government would kick in the difference.

    What killed it, Drucker claimed, was an alliance of the AMA and the United Auto Workers. That latter organization, because the fancy employer-paid health coverage instituted during WWII for the unions in lieu of pay raises constituted the last big perk the unions could offer in the 1950s.

    Not news. Still, I mention this in the hope of clearing up anybody’s delusions about the US healthcare system being anything but a historical accident, which then enabled the consequent concentrations of wealth and influence to buy the necessary political help in DC. Note, too, that there’s plenty of blame to go around on every level of American society: the ‘screw everybody else’ zero-sum sociopathology of the Detroit unions/workers then (if Drucker was telling the truth) has reached its endgame today.

    Drucker also predicted in 2000 that the US would continue to fight and procrastinate over healthcare till we ended up with a botched version of the compulsorily purchased health insurance the Germans then had. And lo: Obamacare cometh.

    [2] Now some purely anecdotal evidence. In the UK, I have a father of 83 who just got sick and was treated by the NHS. In the US, a mother of 80 treated by the wonderful for-fee health-insurance-based system for which Americans pay 40 percent more than anywhere else in the world.

    My 83-year-old father is back on his feet, running his small manufacturing business with its ten employees. My 80-year-old mother is dying in pain from a totally preventable affliction that wasn’t caught — though my mother had complained for eight months — because her line-doctor fought strenuously at every step to do nothing but prescribe various expensive drug regimes.

    [3] Purely anecdotal evidence, I agree. But n general the US healthcare I’ve witnessed has been inferior to that I’ve seen elsewhere. Yes, the US has pockets of some of the finest medical care available on the planet. Overall, however, Americans pay 40 percent more than anywhere on the planet to receive the 27th to 37th worst outcomes.

  25. Wellescent Health Forums

    The health reform bill will really not help improve the results of such a study in the future because at its core, it is about improved access to health insurance. It also contains some initiatives for prevention. However, neither of these factors are directly about improving health care. The first ensures that more people can access care regardless of the quality. The second, prevention, improves overall health of the population but does not improve the delivery of care.

  26. alex

    I live in the Netherlands where health insurance costs, all in all, about 100 Euros per month. There are a lot of nasty things to be said about Holland, but the medical system isn’t one of them. In constrast the US system is barbaric. In fact, the country has become a disgrace: the political system is completely dysfunctional, the schools are a bad joke and the culture — whose popular version was at least vibrant fifty years ago — is plainly squalid.

    In short, I agree with the posts above. The US is dying and the population insists on staying blissfully ignorant. Unfortunately, all that can be said at this point is good ridance.I wish it were otherwise.

  27. ChristineWithRegence

    One thing we can do is take control of our health care decisions, in order to help control costs. Check out Whatstherealcost.org for ideas.

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