***
“I believe we have the best health care in the world.” --Congresswoman Bachmann
There is some truth to this. For instance if you look at certain categories of the health care the US does very well. For instance, America’s five-year survival rate for breast cancer is the best (of nine peer countries).
But do we want to sit around and pat ourselves on the back or do we want to see if we should do better?
Warning, this is going to get a little rough. If you are devoted to the idea of American Exceptionalism you might want to set that aside for a moment and approach this subject from the view of a “world citizen.” Perhaps look to the example of Thomas Paine, who put it this way:
“The world is my country, all mankind are my brethren, and to do good is my religion.”
The information in this presentation will largely be based upon a new book by T. R. Reid.
The Healing of America:
A Global Quest for Better, Cheaper, and Fairer Health Care Amazon
He also had a Frontline episode based on some of the same information. This can be watched here
He begins by considering the example of Nikki White:
***
"Prologue: A Moral Question
“If Nikki WHite had been a resident of any other rich country, she would be alive today.
Around the time she graduated from college, Monique A. "Nikki" White contracted systemic lupus erythematosis; that's a serious disease, but on that modern medicine knows how to manage. If this bright, feisty, dazzling young woman had lived in, say Japan--the world's second-richest nation--or Germany (third richest), or Britain, France, Italy, Spain, Canada, Sweden, etc., the health care systems there would have given her the standard treatment for lupus, and she could have lived a normal life span. But Nikki White was a citizen of the world's richest country, the United States of America. Once she was sick, she couldn't get health insurance. Like tens of millions of her fellow Americans, she had too much money to qualify for health care under welfare, but too little money to pay for the drugs and doctors she needed to stay alive. She spent the last months of her life frantically writing letters and filling out forms, pleading for help. When she died, Nikki White was thirty-two years old.
"Nikki didn't die from lupus," Dr. Amylyn Crawford told me. "Nikki died from complications of the failing American health care system. It was a lack of access to health care that killed Nikki White."
--The Healing of America: The global quest for better, cheaper, and fairer health care, pg. 1
This is the soft version of the story. He gets into the details of the surgeries she endured before her grim and senseless death.
And she’s one example.
He then cites this relevant statistic from America’s most prestigious science institute:
"a study by the National Academy of Sciences found that 20,000 Americans die each year because they can't get the health care they need."
This doesn’t happen in any other developed country. We accept avoidable deaths, pain, misery and bankruptcies, because of how we as a country answer this fundamental question…
Does a wealthy country have an ethical obligation to provide access to health care for everyone?
Every other wealthy country in the world has asked this. And every wealthy country in the world has answered: YES
We answer NO. And what has this gotten us? This brings us to:
The Paradox
• “The American medical establishment boasts many assets that no other country can match. The United States has the best-educated doctors, nurses, and medical technicians of any nation. We have the best-equipped hospitals. American laboratories lead the world in medical research; American companies set the global standard in developing miracle drugs and advanced medical technology.
But the sad fact is we’ve squandered this treasure. We’ve wasted our shining medical assets because of a health care payment system –a crazy quilt of several overlapping and often conflicting systems– that prevents millions from receiving the treatment they need and that undermines the quality of care for millions more. Three basic problems: coverage, quality, and cost.” -- pg. 29
• Of of 191 countries, the World Health Organization rated the US 54th in terms of “fairness.” Just ahead of Chad and Rwanda. --ibid, pg. 30
• Worst for medical bankruptcies (“a uniquely American problem”). --ibid pg. 31
Excerpt:
Many of our outcomes are mediocre by world standards:“When I was traveling the world on my quest, I asked the health ministry of each country how many citizens had declared bankruptcy in the past year because of medical bills. Generally, the officials responded to this question with a look of astonishment, as if I had asked how many flying saucers from Mars landed in the ministry’s parking lot last week. How many people go bankrupt because of medical bills/ In Britain, zero. In France, zero. In Japan, Germany, the Netherlands, Canada, Switzerland: zero. In the United Staters, according to a joint study by Harvard Law School and Harvard Medical School, the annual figure is around 700,000.” --ibid pg. 31
• Of 19 countries, worst for “avoidable mortality.” --ibid pg. 31
• 19th in “Death from curable diseases.” Almost twice as high as France, Japan and Spain. --ibid pg. 32
• “Deaths Due to Surgical or Medical Mishaps” highest by far in the US. --ibid pg. 32
Life Expectancy… below most European countries --ibid pg. 33
Of 23 peer countries, in the “healthy life expectancy at age sixty,” the United States tied for last. --ibid pg. 33
A common rebuttal to the America’s poor showing in longevity is that our score is skewed by our high rates of violence and murder. The above statistic largely avoids this. wiki
COST
• The United States spent $2.2 trillion on health care in 2007, or $7,421 per person. This is 16 % of (GDP).
• France 11.1%
• Germany 10.4%
• UK 8.4%
• Canada 10.1%
• Japan 8.1%
LINK
Why are our costs so much higher:
• American doctors make a lot more money.
• US prescriptions cost 2 to 10 times as much. Same pill, made in same factory. --ibid, pg 35
• We have the highest Mal-practice costs. Mal-practice insurance in Europe can be as little as 1% of the US cost. --ibid, pg 35
• The US is the only developed country that relies on profit-making health insurance companies to pay for essential care. --ibid, pg 36
• The US is the only developed country that lets insurance companies “cherry pick” customers. --ibid, pg 36
For profit health insurance companies have medical loss ratio of about 80/20. They can’t spend more than about 80% on actual health care, or the CEO gets fired for not generating enough profit. This adds to the high administration costs.
• The US… only developed country where you lose your insurance when you lose your job. --ibid, pg. 40
• US has most complex system by far. A crazy quilt with different systems for: over 65, Military personnel, Veterans, Native Americans, Different state by state, countless payers and fee schedules. --ibid, pg 41
• For every two doctors in the US, there is one health-insurance employee, more than 470,000. In 2006, it cost almost $500 per person to administer.” --http://www.theatlantic.com/doc/200909/health-care/2
At a U.S. Senate Finance Committee meeting on Nov. 19, 2008, Dr. Reinhardt said:
“We have 900 billing clerks at Duke (medical system, 900-bed hospital). I’m not sure we have a nurse per bed, but we have a billing clerk per bed . . . it’s obscene.” --http://tinyurl.com/9fx2v7
Also consider CEO compensation:
“McGuire's exit compensation from UnitedHealth, expected to be around $1.1 billion, would be the largest golden parachute in the history of corporate America.” --wiki
Is there another country in the world that would find it acceptable to compensate one individual working in the business of healthcare, to the tune of a billion dollars?
And it’s not getting better, it's getting worse:
“Per-person health care expenditures in the United States have risen 6.5 percent per year since 2000. In contrast, consumer inflation has averaged just 2.6 percent per year.” --http://tinyurl.com/8xgfcl
Now let’s consider how some of our peer countries do it.
FRANCE
• Best performance in “Mortality Amenable to Health Care.” --The Healing of America, pg 49
• Life expectancy at age 60 = 23.3 years, (In the US = 17.9 years). --ibid, pg 49
• More doctors, more beds, same wait times, more choice. --ibid, pg 50
• Less cost: $3,165 per person vs. $7,000 in US. --ibid, pg 52
• 67% less administration. --ibid, pg 59
• Fixed prices for care are one third to one quarter of US prices. --ibid, pg 61
France has the “smart card,” the “Carte Vitale.” All health records, all billing information, all stored on an inexpensive, encrypted card (which was designed in America). Bills are paid in three days.
Excerpt:
GERMANY“The expensive layer of administrative workers and paper handlers fond in every corner of American medicine doesn’t exist in France. Dr. Bonnaud told me that he and his patterns would never consider hiring a secretary or office manager. “Why would I pay somebody to do my billing?” the doctors said. “C’est automatique.” Automatic payment also makes French hospitals, public and private, dramatically cheaper to run than any U.W. hospital. Although French hospitals generally have more docters and nurses per patient than an American establishment, they have 67 percent fewer administrative personnel to keep track of paper work and billing.” Ibid, pg. 59
• At or near the top in all studies --The Healing of America, pg 67
• Insurance is private, prices fixed, 200 plans to choose from. --ibid, pg 67
Excerpt:
• They also have the digital health card. --ibid, pg 68“In many areas of medical practice, there’s less government control of medical care in Germany than in the United States. It’s sheer nonsense to suggest that Germany, or any of the other countries using the Bismarck approach, is engaged in government-run “socialized medicine.” --ibid, pg 68
• Non-profit “sickness funds” have 1/3 of our administration costs.
• You don’t lose coverage with your job.
• Complete choice
• Malpractice cost to doctors can be about 1/50th of US cost. --ibid, pg 78
JAPAN
• Doc’s most competitive and capitalist in the world. --ibid, pg 83
• They love to see their doctors: 14.5 visits per year. --ibid, pg 84
• 36 day “average” hospital stay (the U.S. is 6 days) --ibid, pg 84
• Care for everyone, minimal fees, no waits, excellent results and… 8% of GDP. (1/2 of U.S. cost) --ibid, pg 85
• Costs are capped at $650 per month. You can’t pay more than that. --ibid, pg 86
• MRI of head, $105 (vs. about $1,200 in US) --ibid, pg 92
• Maternity is not covered but you receive a $3,000 maternity grant --ibid, pg 94
• Doc’s earn about 1/3 of what US Doctors do. --ibid, pg 92
• Supply exceeds demand, patients just walk in. Fee for hospital bed (not private), with food, is $11. --ibid, pg 96
United Kingdom
• Full coverage, no bills. (sales tax 16%) -ibid, pg 104
• The British National Health Service cares for 1/5 of US pop. For 1/15 of the cost. --ibid, pg 104
• Better recovery rates than the US from most major diseases. --ibid, pg 104
• Private insurance and doctors are available, but only 3% bother to use it. --ibid, pg 104
• 85% of prescriptions are free, administration costs are 1/3 of US. --ibid, pg 112
• Wait times much better --ibid, pg 114
Excerpt:
CANADA“But some people still have to wait, particularly for procedures that the NHS considers elective. In the fall of 2007, Dr. Badat told me how long his patients typically stay in the queue for specific complaints: “If you need a hernia repair, and there’s no acute pain, I think it’s about three months. Varicose veins is about six months. But if it’s acute, that’s different. We are much faster now. Any suspected cancer, seen by the consultant within two weeks. Any cardiac, we get you in the hospital the same day. If you got chest pain, I send you to cardiac within an hour.” --ibid, pg 114
• Better health statistics at about ½ the cost. --ibid, pg 127
• National Health Care passed unanimously in 1966. Tommy Douglas, the man most responsible for creating the system was recently voted the “Greatest Canadian.” --ibid, pg 132
• Prescriptions are 50-75% less for the same pill, made in the same factory, by the same company as in the US. --ibid, pg 133
• Doctors make about ½ as much as US doctors, malpractice is tiny, all records are digital, schooling costs doctors about half. --ibid, pg 139
But is the care as good? Note:
“The most comprehensive study ever under taken on the two health care systems, the US and Canada’s, was done jointly by Harvard University and McMasters University:
“Overall, 14 of the 38 studies showed better outcomes in Canada, while only 5 favored the U.S. The remaining 19 studies showed equivalent or mixed results in the two nations. When the studies were combined statistically, the mortality rate was 5% lower in Canada.” LINK
Well then why are all those Canadians coming down here for their care? Answer: They’re not.
• "Only 90 of 18,000 respondents to the 1996 Canadian National Population Health Survey indicated they had received health care in America in the past year, and only 20 of these had gone to the U.S. specifically for that purpose.”
• Twenty people out of 18,000 represents .11 percent
• “…a recent study by the UCLA Center for Health Policy Research estimated that nearly 1 million people from California alone seek medical, dental or prescription services in Mexico each year.”
-- http://tinyurl.com/6wsk839
But what about those wait times we hear about?
Canada has had wait times for some procedures that have been too long. In 2007 Canada had a conference about this and is spending $4.5 billion to address this. This is being carefully measured and tracked by hospital. Currently:
“The median wait time in Canada to see a special physician is a little over four weeks with 89.5% waiting less than 3 months.” --LINK pdf
"The median wait time for diagnostic services such as MRI and CAT scans is two weeks with 86.4% waiting less than 3 months.” --ibid
“The median wait time for surgery is four weeks with 82.2% waiting less than 3 months.” --ibid
"In a recent survey, only 3.5 percent of Canadians reported feeling that they waited too long for care...” LINK
Are Canadian “hosers” getting hosed to pay for this health care? Their taxes must be really high!
Nope:
“The average after-tax income of Canadian workers is equal to about 82 percent of their gross pay. In the U.S., that average is 81.9 percent.” --LINK
The top income tax bracket in Canada is 29%. In the US it is 35%.
However, they do pay more for their booze and cigarettes
And having an efficient health care system really helps a countries competitiveness:
“Canadian workers are $4 to $5 cheaper to employ partly thanks to the taxpayer-funded health-care system in Canada…”
-- Gerry Fedchun , President of the Automotive Parts Manufacturers' Association, explaining why Toyota turned its back on hundreds of millions of dollars in subsidies offered from several American states in favour of building a second Ontario plant. -- http://www.freerepublic.com/focus/f-news/1435920/posts
Does less competition/capitalism cause stagnation in innovation? Apparently not:
"Canada has produced a disproportionately large number of major biomedical breakthroughs,..." LINK
In contrast, the US industry spends more on advertising their drugs than they do on R & D. Canada doesn't have that: there are no drug ads. According to this analysis the US spends nearly twice as much on advertising as on R & D: "Big Pharma Spends More On Advertising Than Research And Development, Study Finds" Science Daily
What do Canadians and Americans think of their respective healthcare systems?
"By an overwhelming margin, Canadians prefer the Canadian health care system to the American one. Overall, 82% said they preferred the Canadian system, fully ten times the number who said the American system is superior (8%)." --"Never mind the anecdotes: Do Canadians like their health-care system?" Chicago Tribune. http://tinyurl.com/nqvsr6
"The vast majority of Canadians, 91 per cent, felt that Canada's health care system was better than the United States..." --CTV, Jun. 29 2008, http://tinyurl.com/6ra3mwq
"Canadians strongly support the health system's public rather than for-profit private basis, and a 2009 poll... 86.2% of Canadians surveyed supported or strongly supported "public solutions to make our public health care stronger." http://www.healthzone.ca/health/article/679824
American responses:
"...extensive ABCNEWS/Washington Post poll, Americans by a 2-1 margin, 62-32 percent, prefer a universal health insurance program over the current employer-based system." -- http://tinyurl.com/72wnl
"...just 29 percent of Americans think the overall U.S. health care system is better than Canada's; more, 37 percent, think it's worse than Canada's." --ibid
"Harris Interactive polling..., found that 45 percent of Americans thought the U.S. medical system generally was the best. The remaining 54 percent either didn't know or thought other countries' systems were better..." --Bloomberg, "Americans Say Health Care Lags Canada, France in Harvard Poll" http://tinyurl.com/7av9wlg
In conclusion, it's also important to note what T.R. Reid calls the: Universal Laws of Health Care Systems:
1. No matter how good the health care in a particular country, people will complain about it.
2. No matter how much money is spent on health care, the doctors and hospitals will argue that it is not enough.
3. The last reform always failed.
Some of the common lies being spread about health care debunked here.
Bonus info to consider:
The Veterans Administration
The VA is “one of the world’s purest models of socialized medicine at work.” Yet, the government-run U.S. Veterans healthcare system is now considered significantly more efficient at providing quality care than private-sector healthcare:
• The New England Journal of Medicine ("Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care, May 29, 2003)
• The Annals of Internal Medicine ("Diabetes Care Quality in the Veterans Affairs Health Care System and Commercial Managed Care: The TRIAD Study," August 17, 2004)
• U.S. News & World Report (America's Best Hospitals, Military Might, July 18 2005);
• The American Journal of Managed Care ("The Veterans Health Administration: Quality, Value, Accountability, and Information as Transforming Strategies for Patient-Centered Care," 2004,10; part2);
• Washington Monthly ("The Best Care Anywhere," January/February 2005)
• The Washington Post ("Revamped Veterans Health Care Now a Model," August 22, 2005).
More data on the VA:
"Overall, VHA patients received better care than patients in other settings." LINK
"The quality of care in the VA health care system substantially improved after the implementation of a system wide reengineering and, during the period from 1997 through 2000, was significantly better than that in the Medicare fee-for-service program." New England Journal of Medicine
"The findings mark the sixth consecutive year the VA health care system has outranked the private sector for customer satisfaction." Washington Post
"Improving Quality of Care
How the VA Outpaces Other Systems in Delivering Patient Care" Rand study
"How do VA costs compare to the cost of non-VA providers?" DAV
Also: 'Socialized' or Not, We Can Learn from the VA
