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U.S. health-care system: Still bad

Years ago, the World Health Organization came out with a ranking of health systems that placed the US 37th. Over time, there's been a fair amount of controversy over the WHO's methodology, and so the Commonwealth Foundation began a new project to assemble a comparative international picture: They chose seven countries and conducted deep, ongoing polls of both patients and health-care providers. The surveys test experiences with the system, cost questions, efficiency, convenience, health outcomes and much more. The result is a comparison based not on an outsider’s methodology but on the experiences of patients and providers.

Here, too, the U.S. underperforms. Before looking at that data, it's always worth reminding people of how much more we pay than anybody else. The following chart measures per-person health-care spending. And remember, while reading it, that the U.S. is actually advantaged by this measure: Unlike other countries, we don't have universal health care, so about 50 million of us are spending less than we otherwise might:

averagespendingpercaphc.jpg

But even with all that spending, "the U.S. ranks last overall, as it did in the 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last on dimensions of access, patient safety, coordination, efficiency, and equity. The Netherlands ranks first, followed closely by the U.K. and Australia."

The issue isn't just that we don't have universal health care. Our delivery system underperforms, too. "Even when access and equity measures are not considered, the U.S. ranks behind most of the other countries on most measures. With the inclusion of primary care physician survey data in the analysis, it is apparent that the U.S. is lagging in adoption of national policies that promote primary care, quality improvement, and information technology." Here's a summary table:

healthrankings.jpg

Full report here.

By Ezra Klein  |  June 23, 2010; 11:35 AM ET
Categories:  Health of Nations  
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Comments

Do you know if the data would allow for comparisons between different quartiles? So how do people in the US who receive the best care compare with those receiving the best care elsewhere? How does the median compare? Is health care just really bad for working class people in the US or is it across the board?

Posted by: Levijohn | June 23, 2010 12:30 PM | Report abuse

We're number 7! We're number 7!

I love how we spend by far the most, Canada spends the least, and we're still slightly behind Canada.

Posted by: slag | June 23, 2010 12:35 PM | Report abuse

I take it back about Canada spending the least. That honor belongs to New Zealand.

Posted by: slag | June 23, 2010 12:42 PM | Report abuse

Given that HCR failed to integrate any of the policies that the highest ranking countries have, my assumption is that our ranking under Obamacare will probably be 11 and our costs will increase faster than the higher ranked countries.

Posted by: sgre144 | June 23, 2010 1:09 PM | Report abuse

@sgre144...Health Care Reform has not gone into effect yet. To make a judgment about how Obama's reform package has impacted the health care system in this country reflects the demagoguery and lack of understanding about health care reform by the right wing of this country - the same right wing that brought us to the brink of economic catastrophe.

Posted by: dc1020008 | June 23, 2010 1:28 PM | Report abuse

Does anyone believe Obamacare is going to improve the quality of health care? It defies the laws of supply and demand. The law of supply and demand don't allow much defiance in anyone's attitude, even if they are the President of the United States.

Posted by: Vickie803 | June 23, 2010 1:43 PM | Report abuse

Apples to Oranges. Tell me one person who is comfortable waiting 6-8 weeks to see an oncologist after being diagnosed with cancer? That's status quo in Canada and the UK. Never would fly here, nor should it.

They pull their own teeth out in the UK because there is a shortage of dentists.

Also, are we really comparing a country our size with lax immigration laws to a country as small as the Netherlands that won't let anyone in? Not to mention they return 40% of their pay in the form of taxes.

We've got plenty that needs fixing, but I think people need to appreciate the things that we are far better at than our counterparts, and there are some!

Posted by: Gary34 | June 23, 2010 1:45 PM | Report abuse

According to Republicans, America has the Best Health Care System in The World!!!

Another example of the fantasy land they live in. Never let facts get in the way of what you believe.

Posted by: thebobbob | June 23, 2010 1:47 PM | Report abuse

@sgre144
You are making assumptions on the basis of what assertions? Right now your statement is a retreaded right wing argument without any form of analysis and reflect the lack of understanding about the impact of health care reform and what would happen if nothing is changed.

Posted by: beeker25 | June 23, 2010 1:50 PM | Report abuse

My doctor has already stopped taking medicare patients. The democrats have already kicked the 21% cut in medicare doctor payments 6 months down the road. My ex doctor said that the 21% cut will take place for sure when Obamacare cuts in and they will no longer be able to postpone the cut. I'm currently looking for a new medicare doctor but no luck so far.

Posted by: farmsnorton | June 23, 2010 1:59 PM | Report abuse

Of course a system where users pay will produce more user complaints than if the Government pays.

If someone gave me a free car, I'd have fewer complaints about features and performance than if I bought the car.

I personally LOVE my healthcare.

Posted by: jfv123 | June 23, 2010 2:04 PM | Report abuse

I hear the shrieks of tortured data in the air. Does anyone seriously believe that the U.S. lags behind the UK in "Timeliness of Care"?

Posted by: ostap666 | June 23, 2010 2:06 PM | Report abuse

Health care, schmealth care!

Who needs health care when you can own fifty gazillion guns, gays can't get married, and there's school prayer in the classroom.

Health care!

Such trivial nonsense!

Geez! What's wrong with you people?!

Posted by: montana123 | June 23, 2010 2:25 PM | Report abuse

The Dutch came #1! This is a testament to the private free enterprise system they have for their health care. This shows that universal health care can be achieved by utilizing private insurance, doctors, and other providers. This data reaffirms my belief that a public option would only undermine America's health care system.

Posted by: nathanpunwani | June 23, 2010 2:38 PM | Report abuse

"Tell me one person who is comfortable waiting 6-8 weeks to see an oncologist after being diagnosed with cancer? That's status quo in Canada and the UK."

Of course if you average in the wait times for Americans with no health care coverage, who can experience infinite wait times ("Never - how does never work for you?") then ..., uh. Well I don't know how to average in infinite numbers (I'll ask the intern). I'm guessing longer than 6 - 8 weeks.

Posted by: jeirvine | June 23, 2010 2:41 PM | Report abuse

It's worth noting that this is a Commonwealth FUND study, not a Commonwealth FOUNDATION study. The Commonwealth Foundation is a conservative think tank in Pennsylvania.

Posted by: MDA123 | June 23, 2010 2:51 PM | Report abuse

Health care is rationed off in the US as well. Procedures that are deemed too expensive are not given the go ahead by the insurance company and you don't get the test - I know - it happened to me.

The US is rated 37 out of 140 or so nations by the World Health Organization. Canada is 33. France and Italy are the number one and two but as far as cancer treatment and rates and overall outcomes Japan seems to be better than both.

The insurance companies siphon off 20% of the money for people in large groups and between 30 and 40% for those in smaller groups.

Of the 2.5 trillion we spend, at least 480 billion goes to the insurance companies. That they find it difficult to make a profit is a testimony to poor management and corporate greed. Health care CEO's are extremely well paid, the highest paid CEO's in the country.

Our medical technology however is excellent because during the 50's and 60's the US government made investment in basic research when no one else did.

So to say the US health care system is bad needs 100 and 1 qualifiers. And we have the capacity to treat 530 million people not the 350 million that are currently in our borders.

Posted by: agapn9 | June 23, 2010 2:52 PM | Report abuse

"This shows that universal health care can be achieved by utilizing private insurance, doctors, and other providers"

What you don't mention is that Dutch private insurance companies are VERY HEAVILY regulated. The premium a Dutch health insurance company may charge is strictly regulated and insurance policies are REQUIRED to cover and pay most medical treatments.

Let me assure you NO Dutch private insurer would EVER resort to recissions, pre-existing conditions, and other such chicanery as is done here in the mighty US of A to deny a patient medical treatment recommended by his/her doctor.

Lastly, I would also bet no CEO of a dutch health insurance company gets paid the obscene salaries health insurance company CEO's in the U.S. are paid nor do they get bonuses for limiting health insurance claims. These are euphemistically referred to as "medical loss ratios" which health insurance companies in the U.S. seek to minimize.

What we have in the U.S. is a multi-tiered health care system based on one's ability to pay. The wealthy naturally get the best health care this country has to offer and the rest of us get what we can through our employer or charity.

I wish Republican's would have the guts to say they believe the life of a wealthy person is worth more than a poor person because that is the health insurance system they advocate.

Republicans simply don't believe the son or daughter of a bus driver or waitress should have access to the same life saving health care as the son or daughter of a fortune 500 CEO.

Posted by: montana123 | June 23, 2010 2:57 PM | Report abuse

LAUGHABLE


Kid (D), anyone with a brain knows that Commonwealth Foundation is a POLITICAL FRONT for the STEAL-O-CRAT Party (D).

Anyone who would believe any of their analysis is either a FOOL, DUPE, or mentally-challenged.

Kid (D), you have to do better than this LIE.

Next, you'll try to claim that Elizabeth Warren (D) and OWE-bama (D) know how to use calculators.

Nov. 2 -- the DEADWOOD (D) gets DUMPED.

Posted by: russpoter | June 23, 2010 2:58 PM | Report abuse

Ezra,
An observation about the data and the report . . .

I am 54 years old. I can tell you that never in my life has $7,290 been spent in any one year on health care costs for me by either my health insurance provider or by me out of my pocket.

Posted by: kwascom | June 23, 2010 3:14 PM | Report abuse

"I am 54 years old. I can tell you that never in my life has $7,290 been spent in any one year on health care costs for me by either my health insurance provider or by me out of my pocket."

This proves that you have been (so far) a remarkably healthy individual. And this proves absolutely nothing else.

Posted by: Patrick_M | June 23, 2010 3:28 PM | Report abuse

Yeah big surprise...considering we're the only so called civilized nation in the world that hasn't figure out you can't have FOR PROFIT health care. Not to worry though the Republicans will make sure it stays exactly the same so they can rake in the money from their health care buddies.

Posted by: imgibson | June 23, 2010 3:32 PM | Report abuse

Why is Singapore excluded from this list? Clearly the authors attempt to make U.S. health care look like a joke, but Singapore in turn makes most other nations' healthcare systems look like rip offs by comparison. Lowest costs by far and almost certainly longest productive lives. It can't be population size - they felt fit to include New Zealand on the list.

Jervine,

"Of course if you average in the wait times for Americans with no health care coverage, who can experience infinite wait times ("Never - how does never work for you?") then ..., uh. Well I don't know how to average in infinite numbers (I'll ask the intern). I'm guessing longer than 6 - 8 weeks."

This effect should be taken into account via the equity criterion. Putting into timeliness is going to mislead people into thinking insured people are failing to receive care due to waitlists/denials more often than in the UK's NHS - this is probably not the case. If 85% of the population can get quick access and 15% can't get access, saying the entire system isn't timely isn't false. There is just an equity issue.

Posted by: justin84 | June 23, 2010 3:44 PM | Report abuse

Well this is no surprise. The US policy is to promote health care through subsidizing health care workers. Nurses make a starting salary of more than $65k, which is more than average engineers. While the nursing union in Minnesota, where average nurses make close to $80k per year are striking the hospitals since they believe that the proportion of nurses to patients is too low. In addition, the average nurses received a salary increase of more than 2% this year, even when the economy is in a downturn and people are losing jobs. The high unemployment rate can be partly blamed on the nation's high-cost low quality health care system. The average American can no longer afford health insurance. One news report cited a women shooting herself in the shoulder in order to be admitted and treated at a hospital. The system is run by self-serving companies who have no interest in providing health care to the public.

The question that must be posed is: Why do we have a government controlled health care system if it fails in its duty?

IMO the health care system should be opened up to more competition. Nurses should receive a starting salary of $35-45k DOE. Hospitals are understaffed because their staff is overpaid. Work permits should be granted to foreign workers so they may practice medicine in the United States and the nursing unions should be broken up. Many people are in need of job, so I say fire the nurses and rehire at a more reasonable rate. There are many nurses who graduated, but cannot find a job because those who do have nursing jobs in the hospital are overpaid.

Posted by: mkomko | June 23, 2010 4:20 PM | Report abuse

"Many people are in need of job, so I say fire the nurses and rehire at a more reasonable rate. There are many nurses who graduated, but cannot find a job because those who do have nursing jobs in the hospital are overpaid."

Is that so? Gee, people who actually seem to know what they are talking about tell us that there is currently a shortage of nurses in the USA:

http://www.aacn.nche.edu/Media/FactSheets/NursingShortage.htm

Let us know the data about all of those unemployed nurses, so that we can straighten out the widespread misunderstanding and proceed with your suggested firing of all of nurses in America.

What could possibly go wrong with that?

Posted by: Patrick_M | June 23, 2010 4:36 PM | Report abuse

I love reading these comments written by ignorant cretins who have never ventured farther from their trailer park than the local Walmart. These profoundly unsophisticated people's only experience with health care in other countries is from listening to Rush Limbaugh and thus third-hand and heavily spun information at best. They pretend that they are authorities on the subject but it is painfully obvious that they are just benighted hillbillies without even the beginnings of a clue about that which they speak.

Really, rednecks, if you choose not to, then don't listen to the World Health Organization reports or the Commonwealth Foundation reports or any of the myriad other reports that rate American healthcare poorly. Don't expect Limbaugh or BillO to be any more authoritative, however. Don't believe any of them. Find out for yourself. Just gas up your pickup truck, venture forth from the trailer park and head north. When you hit Canada, just find any random Canadian and ask them if they would be willing to give up their health care system in exchange for what US citizens get. You'll be very surprised.

If you can swing it, go to any of the other countries listed on the report above, or go to France, or Japan, or Korea, or Taiwan, or any other advanced nation and ask locals there if they would be willing to trade their health care systems for an American style one. The answers that they all will give you (after they finish laughing at you) should better inform your future opinions about what a "good deal" you get in the States.

Posted by: Geezle | June 23, 2010 5:32 PM | Report abuse

Looks like the lib-tards and the nurse union bosses and the blind followers of the black messiah have been at work posting there lies. All you have to do to get basic health care is get a job loosers

Posted by: SavedGirl | June 23, 2010 6:48 PM | Report abuse

"All you have to do to get basic health care is get a job loosers."

Not every employer offers a paid health care plan.

However, all you need to correctly spell the word losers is to successfully complete a third grade education.

Posted by: Patrick_M | June 23, 2010 7:35 PM | Report abuse

This comparison is absolutely absurd. My career over the past 29 years has taken me all around the world on a frequent and continual basis causing me to have experienced healthcare at 5 of these seven countries. Not one of those healthcare systems could ever measure up to the U.S. system in regard to quality, cleanliness, professionalism, waiting time, etc. As was the case with the WHO rankings, this study was likely published by left-wing socialist zealots salivating to implement nationalized healthcare in the U.S. However, those with half a brain and capable of conducting their own research don't have to dig too deeply to discover the woeful inadequacies of the Canadian and British systems in particular, neither of which should be listed in the same league as the U.S. system due to their immense inferiority in virtually every aspect.

Posted by: Stingray1 | June 23, 2010 9:58 PM | Report abuse

Anyone who believes this is obviously not doing there home work. By having a Government run health care system all you are doing is allowing the Feds to control all aspects of your life. Read the bill and you will see what i say to be true. Also I am not a republican or a democrat, I hold my constitutional and my god given rights very close and all those who wish to take them away are my sworn enemy.

Posted by: jerzyguy29 | June 23, 2010 10:27 PM | Report abuse

"Anyone who believes this is obviously not doing there home work. "

If you had done your homework, you would know the difference between "there" and "their."

Posted by: Patrick_M | June 23, 2010 10:34 PM | Report abuse

It's very interesting to note that the country with the most government health care system has the #1 most effective health care, the UK (and at less than half the cost per person of the US)

They are well beyond even single payer; the hospitals and the doctors actually work for the government.

Posted by: RichardHSerlin | June 23, 2010 11:13 PM | Report abuse

Notice that the ranking criteria includes equity and access. Because USA does not have universal healthcare we are ranked behind everyone else. The fact is USA is #1 in most categories for options, speed, availablilty of care and success rates in diseases like cancer. WE are #1!!!!!

It's the rating system. They give no facts on what was rated or how it was ranked. In otherwords - very misleading reports.

If you don't believe me, pick up any life science textbook that prints actual ratings.

I also find it difficult to believe that we rank 5 in timeliness of care and Canada is 7 when it takes over 1 year to get an othopedic surgeon to treat a broken leg in Canada. What's it in USA? A few hours.
The WHO's entire ranking system is corrupt.

Posted by: debmries | June 24, 2010 12:55 AM | Report abuse

debmries: "The fact is USA is #1 in most categories for options, speed, availablilty of care and success rates in diseases like cancer."

That's simply not true. Even if you just look at outcomes, we do not do better than our peer countries. You can look at life expectancy, or life expectancy once you reach 60, or five-year survival rates for various ailments. Occasionally we do better, but often we do worse. We do better with breast cancer than some countries, but we trail Australia, Canada, and New Zealand in colorectal cancer. And all this while spending at least a third more and often twice as much per capita. http://www.nytimes.com/imagepages/2009/06/17/business/17leonhardt.graf01.ready.html I don't see how that makes us #1.

"it takes over 1 year to get an othopedic surgeon to treat a broken leg in Canada."

I don't think that's the case. According to T.R. Reid's book "The Healing of America" which looks at other nations' systems, there's a long wait for elective procedures in Canada but they are very good with urgent care. I highly recommend T.R. Reid's book for those interested in comparing our system with those of other nations.

gary34: "They pull their own teeth out in the UK because there is a shortage of dentists....I think people need to appreciate the things that we are far better at than our counterparts, and there are some!"

The British spend about half of what we do. If they wanted to spend more on health care, they might be able to accommodate more dental patients. And the numbers don't lie; we do do some things better than our peer nations, but health care is not one of them (see above).

Vickie803: "Does anyone believe Obamacare is going to improve the quality of health care? It defies the laws of supply and demand."

That assumes the laws of supply and demand apply to health care in the first place. We don't consume health care like we do ordinary products. Some people argue that if you make health care "free," people will use more of it. That's true for most products. But as Uwe Reinhardt has written, how many wealthy people (who can consume as much health care as they want) do you see saying "Gee, I won't play golf today, I'll make an appointment to see my doctor instead!"? Also, free market competition usually drives down prices, but not always (see higher education costs, professional athlete salaries). Health care may be one of those exceptions; indeed it seems to be so.

Posted by: dasimon | June 24, 2010 2:15 AM | Report abuse

"Because USA does not have universal healthcare we are ranked behind everyone else."

Yes, our failure to provide care to tens of millons of citizens does hurt our performance.

"It's the rating system. They give no facts on what was rated or how it was ranked. In otherwords - very misleading reports."

There is ample information about how these studies are done, you simply are too lazy to look.

"If you don't believe me, pick up any life science textbook that prints actual ratings."

These are "actual" ratings. Please cite the "actual" data that is found in "any life science textbook" (?) that disputes this data.

"I also find it difficult to believe that we rank 5 in timeliness of care and Canada is 7 when it takes over 1 year to get an othopedic surgeon to treat a broken leg in Canada. What's it in USA? A few hours."

Utter fiction. If you arrive at a Canadian ER with a broken leg that requires surgery, you will get that surgery immediately. The difference is that in the USA you will have the added experience of being harassed by a hospital employeee while you are in exrcuciating pain awaiting needed surgery, while that employee tries to verify your financial responsibility. And, even if your insurance is pretty great, you will end up with significant bills to pay.

In Canada, you will be spared that added stress.

Watching the brain dead trolls come out again (with all the wrong info and name-caliing) for a post connected to the subject of health care is most entertaining.

Posted by: Patrick_M | June 24, 2010 2:21 AM | Report abuse

Work permits should be granted to foreign workers so they may practice medicine in the United States


Newsflash buddy, the US takes in more foreign doctors than all other countries in the world, COMBINED.

35% of all doctors in the USA are either foreign born or foreign trained. Thats also a higher ratio than anywhere else in the world.

Of course, most of those foreign docs tend to practice in areas such as NYC or Boston, which, as you guessed, have the highest number of doctors per capita in the entire world and also have the highest healthcare costs in the entire world.

More doctors = higher healthcare costs, not lower.

Posted by: platon201 | June 24, 2010 6:40 AM | Report abuse

Work permits should be granted to foreign workers so they may practice medicine in the United States


Newsflash buddy, the US takes in more foreign doctors than all other countries in the world, COMBINED.

35% of all doctors in the USA are either foreign born or foreign trained. Thats also a higher ratio than anywhere else in the world.

Of course, most of those foreign docs tend to practice in areas such as NYC or Boston, which, as you guessed, have the highest number of doctors per capita in the entire world and also have the highest healthcare costs in the entire world.

More doctors = higher healthcare costs, not lower.

Posted by: platon201 | June 24, 2010 6:40 AM
---------------------

"More doctors = higher health care costs, not lower."

100% true. Here is an article about a study in Mass. that proves that more doctors me hirer costs and more unessential treatments:

http://www.npr.org/templates/story/story.php?storyId=113571111

Posted by: Independent4tw | June 24, 2010 8:35 AM | Report abuse

Again those wanting to believe USA healthcare is so bad are fools. We can not be compared to any other country - none is like USA. Netherlands is #1 according to the report - They are smaller than NYC. Get real people.

I said earlier look at any medical school, pharmacy school, nursing school current textbook - I just did and USA is #1 in cancer, surgery options, treatment options and lives saved. We are ranked low because "free" healthcare - which costs 4.4 - 6.5% of your income in Netherlands - is the highest ranker in the system. So the numbers are not accurate or true. The system is rigged to favor socialism. Pure and simple. I have a friend who is currently working in canada - his co-worker tore up his knee and broke his leg skiing. He had a 1 year wait to SEE an orthopedic surgeon. My friend got his company to fly him to USA and in 1 week was seen and surgery completed. Canada is the only system we should be compared to because it is set up similar to USA - Large area, rural locations very far from big city. Can't and should not compare us to Netherlands, Europe, Japan or any other county small and condensed.

Open your eyes - go do some research on your own. We are the best healthcare in the world.

Posted by: debmries | June 24, 2010 9:12 AM | Report abuse

Open your eyes - go do some research on your own. We are the best healthcare in the world.

Posted by: debmries |
-------------
I haven't seen one single study that says that the American health care system is the best in the world.

NOT A SINGLE STUDY.

Just keep your head in the sand and let the adults do the thinking.

Posted by: Independent4tw | June 24, 2010 9:29 AM | Report abuse

Say what you want about our health care compared with other countries. We're still SPENDING TWICE AS MUCH as anyone else. I could certainly find better uses for my money than GIVING IT TO THE INSURANCE COMPANIES.

Posted by: scottilla | June 24, 2010 9:29 AM | Report abuse

Say what you want about our health care compared with other countries. We're still SPENDING TWICE AS MUCH as anyone else. I could certainly find better uses for my money than GIVING IT TO THE INSURANCE COMPANIES.

Posted by: scottilla | June 24, 2010 9:29 AM\
------------
EXACTLY. We spend TWICE as much and STILL FAIL.

Posted by: Independent4tw | June 24, 2010 9:35 AM | Report abuse

My doctor has already stopped taking medicare patients. The democrats have already kicked the 21% cut in medicare doctor payments 6 months down the road. My ex doctor said that the 21% cut will take place for sure when Obamacare cuts in and they will no longer be able to postpone the cut. I'm currently looking for a new medicare doctor but no luck so far.

Posted by: farmsnorton
---------
The reason it is kicked down the road is because the Republican leadership created this doc fix back in 1997 for short term budget scenarios and that makes it much harder to fix once for all without being attacked by the very opposition that created it.

Erza did an article about the doctor fix sometime Sunday of this week: the quick background. In 1997, the Republican Congress created a payment formula meant to govern Medicare called the Sustainable Growth Rate. The formula was supposed to be a little tweak that saved a couple billion dollars. But the formula was wrong, and it quickly proved a wrenching readjustment that would've driven physicians out of the program by sharply slashing their payments. But rather than undo it, Republicans in Congress, and then Democrats when they took over Congress, passed temporary fixes, because no one wanted to come up with the money to fix the thing permanently.

When health-care reform started, Democrats made an admirable effort to end the shell game and just fix the system. But doing so cost almost $300 billion, and Republicans, who caused this mess in the first place, attacked the Democrats' fix as if it was part of their health-care reform plan rather than part of the Balanced Budget Act that Republicans passed in 1997. So Democrats abandoned the effort and left the fix out of health-care reform.

Posted by: beeker25 | June 24, 2010 9:56 AM | Report abuse

Debmries: "We can not be compared to any other country - none is like USA. Netherlands is #1 according to the report - They are smaller than NYC."

But why does that matter? So we're a big country. So what? We're also a rich country. We also spend far more per capita than anyone else. And we don't do better overall in terms of outcomes. I don't see why urban versus rural should make much of a difference--especially when the vast majority of Americans live in or near urban centers. (By the way, the population of the Netherlands is quite a bit larger than NYC. http://en.wikipedia.org/wiki/Demographics_of_the_Netherlands)

As far as being #1 in cancer treatment and other fields, I posted a link to five-year survival rates that shows we don't do the best with at least certain forms of cancer even among our English-speaking peers, much less with other nations. I don't know how one can rig five-year survival stats to favor "socialism" (whatever that means--with Medicare, Medicaid, and the VA, much of our system is already "socialist"). And the question remains as to whatever marginal performance we get is worth spending up to and sometimes more than twice as much as our peer nations.

"I have a friend who is currently working in canada - his co-worker tore up his knee and broke his leg skiing. He had a 1 year wait to SEE an orthopedic surgeon."

As T.R. Reid points out, every system has its horror stories. Ours does too, where people die because they don't have insurance and families go bankrupt because someone got sick. That's why we have to look at the data, not just stories.

Yes, if you have all the money in the world to spend, you can get great health care here. But that's not treatment that most Americans have access to, and it shows up in the numbers just in terms of outcomes without any consideration of whether care is provided for "free" or not.

Please read T.R. Reid's book. We don't have the best outcomes overall, and where we do in some areas it's not by much. And we're spending way, way too much for what we get.

Posted by: dasimon | June 24, 2010 10:18 AM | Report abuse

"More doctors = higher health care costs, not lower."

Do costs increase or does utiization increase? I'm not sure why the cost of a particular procedure or visit would go up with more providers, but the number of procedures and visits surely will. You have an inelastic demand curve. Increasing supply in a 'market' without price signals turns entirely into increased output. If you measure cost as 'spending per capita', then yes 'cost' will increase, but I'm pretty sure we're talking increased utilization.

Posted by: justin84 | June 24, 2010 10:46 AM | Report abuse

"More doctors = higher health care costs, not lower."

Do costs increase or does utiization increase? I'm not sure why the cost of a particular procedure or visit would go up with more providers, but the number of procedures and visits surely will. You have an inelastic demand curve. Increasing supply in a 'market' without price signals turns entirely into increased output. If you measure cost as 'spending per capita', then yes 'cost' will increase, but I'm pretty sure we're talking increased utilization.

Posted by: justin84 | June 24, 2010 10:46 AM
---------------
The more doctors there are in an area, the more procedures that each doctor has to do in order to stay busy.

For instance, it turns out that if you increase the number of doctors in an area, chances are that the use of medical services will rise. If there's one doctor in a town with 100 patients, then he'll schedule your heart checkups for once every six months, but if another doctor comes to town — and now the first doctor has 50 patients — the doctor will just schedule your heart checkups for once every three months. There's a very simple reason why, says Frank Read, an eye specialist who participated in the doctor groups.

"I don't want to be sitting on my thumbs all the time — I want to be busy. And that may unconsciously loosen my criteria for doing a procedure."

(source)
http://www.npr.org/templates/story/story.php?storyId=113571111

Posted by: Independent4tw | June 24, 2010 11:22 AM | Report abuse

platon201: "Of course, most of those foreign docs tend to practice in areas such as NYC or Boston, which, as you guessed, have the highest number of doctors per capita in the entire world and also have the highest healthcare costs in the entire world."

But then one needs to ask: what would account for NYC or Boston having the highest health care costs (assuming that's true)? Could it be that high concentrations of poverty run up disproportionately high expenses through ER visits? And that such concentrations occur in large cities? Whatever the reason, why would the doctor ratio make a difference?

Correlation is not cause; one really needs to dig deeper into the data. A comparison among cities with similar demographics but different doctor ratios would be helpful.

"More doctors = higher health care costs, not lower."

Again, conflation of correlation with cause. Other countries have similar doctor/population ratios as we do, yet their costs are far lower. It's an error to say "this is up, and that is up, so this causes that." It could be happenstance, or there could be other factors at work. Or it could be causal. But just pointing to pairs of numbers usually isn't enough to conclude a causal relationship.

Posted by: dasimon | June 24, 2010 11:28 AM | Report abuse

OK again let's get facts straight:

We have higher healthcare costs in USA becasue of:

1. Gov't run Medicare (worst system in the world - makes you and me pay for their underpayment and regulations and extensive paperwork - adds about 25% administration fee to each doctor visit - in other countries that averages 4%)
2. Illegal immigrants - sorry but it's a true fact
3. More options, more treatment procedures, best devices, most expensive devices
4. Dental care (did you ever notice the teeth of many british?)
5. High taxes on hospitals, doctors, pharma companies and medical devices (which are getting a special tax under the new healthcare plan - how does taxing bedpans lower cost?)
6. Union hospitals
7. Federal rules and regulations - most in the world
8. FDA
9. Rural areas (if you don't know how this is bad - you maybe should do some research)
10. Lawyers and lawsuits average 100- 1000 times that of other countries

Should I go on? Our new healthcare plan only ADDS to the existing problems and will INCREASE COST which every report has said.

So if we got rid of medicare, illegals, limit procedures, ration, get rid of unions, eliminate 90% of lawsuits, eliminate FDA and gov't rules and regulations we would then we would reduce costs and be just like the utopia of Netherlands.

If we are so bad in healthcare why did the Newfoundland Premier Danny Williams undergo heart surgery in Fed 2010 in the United States?

Posted by: debmries | June 24, 2010 12:00 PM | Report abuse

I haven't seen one single study that says that the American health care system is the best in the world.

NOT A SINGLE STUDY.

Just keep your head in the sand and let the adults do the thinking.

Posted by: Independent4tw | June 24, 2010 9:29 AM | Report abuse

----
Then you need to stop reading liberal media and do some independent research. Even the liberal college books ALL say we are the best!

If you only watch mainstream media - 80% liberal and NPR - you are only getting a one sided 20% accurate truth. Go to a college bookstore and open up a medical, pharmacy nursing book that evaluates medical pratices around the world and USA is #1.

Posted by: debmries | June 24, 2010 12:41 PM | Report abuse

debmries: "If we are so bad in healthcare why did the Newfoundland Premier Danny Williams undergo heart surgery in Fed 2010 in the United States?"

Already answered. As I wrote above, we have great health care for anyone who can pay for it. But most people can't pay for it out of pocket, so they don't get it, and it shows up in the overall numbers.

The administrative costs in Medicare are far, far lower than for private insurance. Medicare has done a better job of holding down costs than private insurance. It seems to me that most people think Medicare is pretty well run, at least compared to the private system.

And think about how it takes the group of the people with the highest expenses out of the private system. If Medicare didn't exist, either private insurance would be even more expensive and unaffordable to more people in order to cover the elderly, or many in the elderly population would have to go without insurance entirely. So we'd either have a system where many of the elderly do without, or we help bear the costs through our own premiums. There is no way to provide health care for the elderly (or those with preexisting conditions) without some kind of subsidy, either privately or through the government. They are high-cost, and we will either pick up those costs as a society or they will go without decent care. That's the choice we have.

We don't necessarily offer more options than other countries. T.R. Reid went to France to ask about treatment for his bum shoulder and had the same panoply of options that he would have had here. Same in Germany, same in Japan. (If T.R. Reid wanted elective shoulder surgery, he could have gotten it in comparable or less time in Germany, France, or Japan than in the US. Canada would have taken a year, and Britain wouldn't do it at all until it got worse). Some people argue that patients will predominantly choose expensive care if it's offered to them, but other countries have shown that it just doesn't happen that way. And even if we did have "best devices" and "more options," the benefits are not showing up in the results.

Posted by: dasimon | June 24, 2010 12:45 PM | Report abuse

debmries (continued):

I'm not denying the US has rural areas; I question only the extent to which they are primary drivers of health care costs, especially considering that most people don't live in rural areas. I suspect that if you just looked at US cities, we'd still be spending far more per capita than our peer nations. And I understand we are more litigious; but the studies I've heard of do not show that they are primary drivers of high health care costs (not that that should be an excuse not to do something in that area).


Other countries have rural areas. Other countries have heavy regulation. Other countries offer many treatment options. I don't think most of the reasons you cite are the main causes of our higher costs. T.R. Reid says the main problems are: our system is very fragmented (many private providers, Medicare, VA, and uninsured), and our administrative costs are comparatively huge.

Also useful is Atul Gawande's article in The New Yorker, about how health care costs even among similar demographic areas in the US differ drastically with no correlation in quality of care. http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande So we don't need to look abroad to see that there's a huge amount of waste in our system. I highly recommend reading it, along with T.R. Reid's book.

Whatever the reasons for our high costs, I think the examples of other countries, and even within this country, show that we don't need to give up quality of care to get a lot more bang for our bucks.

"Go to a college bookstore and open up a medical, pharmacy nursing book that evaluates medical pratices around the world and USA is #1."

Again, I don't know how you fudge 5-year survival rates. Liberals should not listen only to the data that supports their views. And neither should conservatives.

Posted by: dasimon | June 24, 2010 12:47 PM | Report abuse

Obviously you are not in the medical profession and are not up to speed on the mess our gov't has made of the system.

I have 3 medical professionals in my family and know the data in this article is very misleading and does not reflect care in the USA.

No one is denied care in the US. No one.

Our costs are higher and the reasons are listed in earlier posts.

I have never known anyone who has not been able to get treatment in the USA. No one.

I know many people without insurance - they all get treatment.

This is not simple matter and my research - and it's been extensive - clearly shows USA is the place you want to get sick in. the only treatment options not available here are banned by our GOV'T.

Since I post on this liberal site I clearly read all media and research all sides.

Go do the research I suggested and follow up on the items I listed as why are costs are higher - you will sing a different tune.

The newyorker? Liberal. T.R. Reid? Kaiser family foundation. About as progressive socialist as you can get. LOL for claiming to be well read.

Posted by: debmries | June 24, 2010 1:14 PM | Report abuse

Independent4tw,

That's exactly my point. Now can you imagine this from NPR:

"For instance, it turns out that if you increase the number of mechanics in an area, chances are that the use of autorepair services will rise. If there's one mechanic in a town with 100 cars, then he'll schedule your oil changes for once every six months, but if another mechanic comes to town — and now the first mechanic has 50 customers — the mechanic will just schedule your oil changes for once every three months. There's a very simple reason why, says Frank Read, an mechanic who participated in the mechanic groups.

"I don't want to be sitting on my thumbs all the time — I want to be busy. And that may unconsciously loosen my criteria for doing requiring and oil change."

If everyone's autoinsurance policy covered free oil changes (or $5 co-pays), then maybe you would see stories like this. People might think every three months is a bit much, but if they aren't paying for it, then they don't need to see much benefit in order to accept the transaction.

Now it's tough to work around the fact that a) serious problems are very expensive b) serious problems can be detected early and cost less in terms of health and money if treated early and c) catastrophic insurance for a) doesn't do much for b).

But it is clear that you have to turn off the money spigot by setting budgets - either at the consumer or government level. I can think of six ways along the libertarian-liberal spectrum (I'd prefer either 2 or 3):

1) Libertarian solution: No government involvement - individual budgeting. Doctors tailor prices to perceived client ability to pay. Large network of medical charities arise to help smooth out the rough edges, and many doctors consider pro-bono work.

2) Liberaltarian single payer: The government sets a budget for single payer (say $500,000 per person per lifetime), and you can spend from that account as you see fit, and you can augment that amount with private insurance.

3) Public hospital safety net. Feds sets a small but significant budget - say 4%-5% of GDP - to run a large version of the VA system, perhaps with state wide systems and encourages the state systems to complete on outcomes. Most healthcare spending is deregulated and remains outside of this system, but the safety net is there.

4) Health insurance voucher option. Government sets a budget (say 10% of GDP) and gives health/age conditioned vouchers to indiviudals to purcahse private health insurance. Could also use a strategy where the government sets a per capita budget (say $5,000 pp per year) and gives people vouchers for that amount to take to HMOs - HMOs must accept all vouchers if they accept any.

5) Single payer.

6) National Health Service - nearly all healthcare run through here.

Posted by: justin84 | June 24, 2010 1:42 PM | Report abuse

"I have never known anyone who has not been able to get treatment in the USA. No one."

Then you need to read the very beginning of T.R. Reid's book. A woman with lupus lost her job (due to side effects from the drugs she was taking), then lost her insurance, and didn't qualify for state aid. Sure, she got "treatment" through the ER when her symptoms got even worse, but she died because ER treatment was inadequate for what she had. She died because she couldn't get coverage for the ongoing care she needed. So just because you have "never known anyone" who was not able to get adequate treatment doesn't mean they don't exist. And I can tell you that no one in Europe goes bankrupt because they got sick--and that does happen here.

"No one is denied care in the US. No one."

Insurance companies never deny care?

"This is not simple matter and my research - and it's been extensive - clearly shows USA is the place you want to get sick in. "

Yes, you want to get sick here IF you can pay for it. But there are people who go abroad because it's cheaper to travel and get care there than to pay for the care here.

"Since I post on this liberal site I clearly read all media and research all sides...."

"The newyorker? Liberal. T.R. Reid? Kaiser family foundation. About as progressive socialist as you can get. "

But it doesn't matter what people read if they pick and choose who to believe based on the speakers and not on the fundamentals of the studies. That's a cop-out. I don't think something is wrong just because Newt Gingrich says it's right. If he's wrong, I need to point out why, or admit that maybe he's right.

Arguments and studies stand on their own merits, not on who funds it or who says it. I provided cites on 5-year survival rates, and they haven't been refuted. If you can't refute the study on its own terms, then just maybe it's not biased; maybe it's correct and some views need to be adjusted.

There's a danger here of "epistemic closure": the forming of a view that is reinforced by those who agree and where any evidence to the contrary is dismissed as the product of a biased media. People who fall into that trap will continue to believe what they want to believe, even if the evidence to the contrary happens to be right.

The New Yorker piece gets its numbers from the Dartmouth Study on the subject, which I understand is very highly regarded. You can look at it if you want at http://dartmed.dartmouth.edu/spring07/html/atlas.php.

Posted by: dasimon | June 24, 2010 2:58 PM | Report abuse

"I have never known anyone who has not been able to get treatment in the USA. No one."

Then you need to read the very beginning of T.R. Reid's book. A woman with lupus lost her job (due to side effects from the drugs she was taking), then lost her insurance, and didn't qualify for state aid. Sure, she got "treatment" through the ER when her symptoms got even worse, but she died because ER treatment was inadequate for what she had.

First of all TR Reid's book is backed by Kaiser Foundation or in other words George Soros or in other words Moveon.org or Obama's administration.

You cite a sad story. How about the women in England who cannot get cancer treatment because it's too expensive. Then you made my point - she was denied MEDICAID or gov't run healthcare in USA!

A co-worker's dad just had quadruple bypass - no insurance at the Cleveland Clinic. Another person I know had suspected cancer - pre bono next week hystercomy. A friend's 18 yr old daughter saw her doctor on a Sat. morning for the flu and he noticed her stomach was enlarged - ovarian cancer - removed by TUES the next week.
100% guarantee these stories do not happen in England or Canada. Our gov't is our biggest problem with healthcare. Again go read some real info - not liberal progressive Soros propaganda.

Posted by: debmries | June 24, 2010 3:38 PM | Report abuse

"You cite a sad story. How about the women in England who cannot get cancer treatment because it's too expensive. Then you made my point - she was denied MEDICAID or gov't run healthcare in USA!"

As I wrote above, every system has its horror stories. That's why we have to look at studies. And that's why our personal experiences about who we know and don't know are not enough and don't constitute sound data. I can throw back at you T.R. Reid's experiences in France, Germany, and Japan where he could have elective shoulder surgery as fast or faster than in the US (and at far lower cost).

Once again, you decry studies that conflict with your worldview as "liberal" instead of considering the possibility that they may be right. That approach will not lead to accurate results but only reinforces one's preexisting assumptions.

Finally, as to why health care is so expensive here: look at the Gawande article in The New Yorker. It says Medicare costs (which is our best proxy for costs in general) are twice as high in McAllen as in El Paso, both in Texas. If you buy that (and I find it hard to believe that even if the numbers are off, that they're off so much to account for such a huge disparity), what accounts for the discrepancy? They have similar demographics, the same federal and state regulations and laws, the same taxes, the malpractice tort rules, the same everything that you listed above. The only remaining factors seem to be the way the doctors practice medicine and the way health services are delivered. So it would seem that there's a lot of waste in our system unrelated to the list that you provided.

If you can come up with other explanations, you're welcome to do so. Or explain why the article is in error, other than just labeling it "liberal"--which is not an argument and fails to show whether it's accurate or not.

Posted by: dasimon | June 24, 2010 5:22 PM | Report abuse

debmries: an addendum to my prior post.

You wrote that the US should only be compared with Canada because of urban/rural concerns. But Canada has about 1/9th of the US population and an even larger area, so is that a fair comparison if rural residency drives up costs? Or are you going to throw out the areas of Canada where just about no one lives? But then wouldn't you have to do the same for the US?

By the way, according to Wikipedia, the US "is a very urbanized population, with 81% residing in cities and suburbs as of mid-2005 (the worldwide urban rate was 49%)." http://en.wikipedia.org/wiki/United_States_Population

I'd recommend some research first on these issues; it came up previously with the claim that the population of The Netherlands was smaller than New York, as you may recall.

Posted by: dasimon | June 24, 2010 5:28 PM | Report abuse

Just a side note: the population of the Netherlands is smaller than the population of the New York City metropolitan area. Not that that matters to the argument.

Posted by: AnonymousBE1 | June 24, 2010 7:14 PM | Report abuse

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Posted by: Rosana4065 | June 25, 2010 1:05 AM | Report abuse

It seems to me that a lot of money could be saved with a few simple employee boosting strategies. I saw a great white paper called 5 Strategies for Improving Employee Satisfaction in Healthcare that I think is worth looking at in lieu of our health care crisis.

Posted by: sara1994 | June 29, 2010 6:40 PM | Report abuse

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