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Tilting at Windmills

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May 16, 2007
By: Kevin Drum

HEALTHCARE IN AMERICA....The Commonwealth Fund has released its latest comparison of healthcare performance among various countries, and you can read all about it here. However, since I know you're all busy people, I'll just cut to the chase: we suck. Despite the fact that we see doctors less often, go to the hospital less often, and stay in the hospital for shorter times than any of the other countries in the report, we still spend by far the most money. In return for this we get lousier care. As the summary chart below shows, we score last or close to last on five out of five measures — though we do manage to eke out a first place finish in one subcategory. Go team!

If you want a quick and dirty look at the data, download the chartpack and page through the charts. My favorites are 21, 28, 50, and 56. There are a few areas where the United States does well (preventive care, for example), but for the most part we're either average or below average. And when it comes to various sorts of preventible medical errors, we're absolutely terrible. It almost makes you want to just stay home the next time you feel a pain in your chest.

Kevin Drum 1:40 AM Permalink | Trackbacks | Comments (61)

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I have to question the validity of a report that ranks the UK as number 1. Perhaps it didn't look at hospital cleanliness and likelihood of catching MRSA.

Where are the French?

Posted by: KathyF on May 16, 2007 at 1:45 AM | PERMALINK

I don't think this report necessarily says that the care one can get in the US is bad per se. I think, for those of us lucky enough, care is on the level of the other countries, if not better in cases where cutting-edge medicine is needed. I think *all* judgements in the survey are affected by the absence of proper health care for a vast amount of people. Many people won't be able to follow up properly after the have become permanently afflicted with diabetes or other diseases; many people simply cannot afford to have a nurse looking after them for longer periods, and so they simply don't; and those people will probably be the people who drag down the right care score.

It seems superficially logical that the other countries' health systems are much better placed for advances in information technology: this requires coordination, which is easier if the system is hierarchical to begin with --as opposed to all-out competitive.

In the end there are two important questions: how much can the US system improve in the "good" dimensions of the other countries' systems without sacrificing much. There is some slack in the system (Information Technology for example) that could make it possible to improve without much negative effect. But how much...

And, how should one look at the trade-off between a centralized, more egalitarian, health system versus a decentralized system where some people can get the best care of the world, and others no care.

Posted by: me on May 16, 2007 at 2:04 AM | PERMALINK

Despite the fact that we see doctors less often

Probably because Americans are healthier and not as sick as non-Americans.

go to the hospital less often

Because Americans are healthier and not as sick, we don't need to go to the hospital as much.

and stay in the hospital for shorter times than any of the other countries in the report,

Due to our superior medical staff, American doctors can cure patients more efficiently and at a faster pace than non-American doctors. So we don't have to stay in the hospital as long.

we still spend by far the most money.

Americans have to pay more for their health care because our doctors are better and work faster than non-American doctors.

In return for this we get lousier care.

It appears to me we get the best health care in the world.

Posted by: Al on May 16, 2007 at 2:11 AM | PERMALINK

Kevin knows the political problem here. It's the same one presented to people who favor tax reform. Taxpayers don't really care about the tax system being equitable; they care about their own taxes being lower.

In the health care area they care about gettng the best care if they get really sick or badly injured -- which Americans with insurance, a majority and a large majority of Americans who vote, pretty much do. I have to wonder whether comparisons of this kind that emphasize things Americans do not value highly do that much good for the cause of improving the health care system here.

Posted by: Zathras on May 16, 2007 at 2:14 AM | PERMALINK

how should one look at the trade-off between a centralized, more egalitarian, health system versus a decentralized system where some people can get the best care of the world, and others no care.

That's not the tradeoff; the tradeoff is between decentralized system that performs half as well and costs twice as much as other country's systems.

The "best medical care" is hard to measure; lately it's been the Europeans in the headlines with groundbreaking hand-transplants and face transplants.

Posted by: Max Power on May 16, 2007 at 2:24 AM | PERMALINK

Chart 77 points out non-existance of a trade-off; the US government spends more per capita for health care than the foreign government-funded single-payer systems.

So whoever rolls out universal health care can pay for it with a tax cut - AND a cut in out-of-pocket and private spending of well over $3000K per person, per year.

Posted by: Max Power on May 16, 2007 at 2:36 AM | PERMALINK

The original webpage now (04.30 AM EST) shows Germany 1 and UK 2. But does anyone really believe any of these surveys anyway? For one thing they use an arbitrary scoring system. For another, it's hard to properly do cross-country comparisons. And for a third, pretty much everybody in pretty much every country always thinks their health system sucks and that every other country does it better. Just the same as with transport.

Posted by: guest on May 16, 2007 at 4:30 AM | PERMALINK

Al: "Probably because Americans are healthier and not as sick as non-Americans. ... It appears to me we get the best health care in the world."

Once again, your rank inability to expound beyond the political cliche proves you to be a fool.

But, hey, I'm just sayin' what everyone else here's thinkin' -- knowutahmean?

OK, that's probably not true -- but only because everyone else here thinks you're a fuckin' moron. I was just trying to be polite.

Posted by: Donald from Hawaii on May 16, 2007 at 6:04 AM | PERMALINK

But of course, the Republican Party and conservative groups like the AMA, will spend millions on propaganda campaigns to hornswaggle Americans into believing that we actually have the best medical care in the world and those poor Canadians with their socialistic health care wait months to see a doctor for a hangnail.

And also of course, a large percentage of Americans will buy into this horseshit. People like egbert and Norman Rogers and ex-liberal and on and on. And the downward spiral of idiocy continues...

Posted by: The Conservative Deflator on May 16, 2007 at 6:34 AM | PERMALINK

And for a third, pretty much everybody in pretty much every country always thinks their health system sucks and that every other country does it better

Well, yeah, pretty much everybody, I guess — except for the UK and Germany. And the New Zealanders. But everybody else, for sure.

Probably the sheep and the beer.

Posted by: Mike on May 16, 2007 at 6:39 AM | PERMALINK

This is what you get when a society tolerates consenting adults having a private sexual relationship.

Posted by: Gore/Edwards 08 on May 16, 2007 at 6:59 AM | PERMALINK

Al, if we are so healthy, why do all these countries have longer life expectancies?

Posted by: Gore/Edwards 08 on May 16, 2007 at 7:06 AM | PERMALINK

This doesn't measure the US's strengths.

No other system pays for as many experimental therapies that are life-changing for the patient. (Granted it's not a system in the US as much as a patchwork of systems ... nevertheless.)

Posted by: N on May 16, 2007 at 7:14 AM | PERMALINK

This doesn't measure the US's strengths.

No other system pays for as many experimental therapies that are life-changing for the patient. (Granted it's not a system in the US as much as a patchwork of systems ... nevertheless.)

Posted by: N on May 16, 2007 at 7:14 AM | PERMALINK

Both US and Canada really have one thing going against both countries in comparison to the other countries in this survey.

They're big and have lots of population spread out (Australia is big too but its population is more centralized).

Both suffer from a lack of doctors in more rural areas. I'd be willing to bet that in urban areas in both countries, those numbers, with the exception of spending per capita in the US, are competitve.

One solution to both problems, is more doctors. But the supply of doctors is artifically constrained.

The other solution, at least to the economic drain the health care sector is on the economy, is to cut the red tape. But the red tape is not put on by government, it's put on by the insurance industry. That's where the difference is. In Canada, a doctor's office consists of a doctor and his receptionist. In the US, a doctor's office consists of a doctor, and his receptionist, and a team of insurance billing specialists.

That's the added overhead.

Posted by: Karmakin on May 16, 2007 at 7:35 AM | PERMALINK

Anyone interested in a second source for medical statistics should visit nationmaster.com -- the guy who runs it seems to spend all his time collecting statistics, both weird and non-weird, about the various nations. All those other countries you might wonder about are there. This should be reassuring to some, because we don't actually deliver the worst standard of care -- there's plenty of appallingly poor countries and banana republics that do much worse than us.

But otherwise, yeah, we suck. Go USA! We're #20!

Posted by: dr2chase on May 16, 2007 at 7:41 AM | PERMALINK

And for a third, pretty much everybody in pretty much every country always thinks their health system sucks and that every other country does it better. Just the same as with transport.

With transport? Really? I kind of find it hard to believe that Americans think that their transportation system is done better in the USA than in other countries.

No other system pays for as many experimental therapies that are life-changing for the patient.

That's a very tiny sliver of the population. There's no reason we'd have to sacrifice that in order to provide better health care for the problems that just about everyone is confronted with.

Posted by: Constantine on May 16, 2007 at 7:43 AM | PERMALINK

With transport? Really? I kind of find it hard to believe that Americans think that their transportation system is done better in the USA than in other countries.

Whoops. I reversed your statement. What I meant was: I find it hard to believe that people in say Germany think that their transportation system is worse than, say, the UK's or the USA's.

Posted by: Constantine on May 16, 2007 at 7:53 AM | PERMALINK

Go New Zealand! Yay!

Posted by: Tony on May 16, 2007 at 8:06 AM | PERMALINK

This study is arrant nonsense. How do I know? Because in addition to the US, I have lived in and been forced to use the healthcare services of the UK, Sweden, and France. They provide good cheap basic service for cuts, bone-breaks, and wide-spread diseases; their record with more exotic illnesses, dentistry, and elder-care is woeful. Waiting-times at crowded ERs are scandalous, and if you need a kidney you can face a three-year wait, since everything is done by lists.

Because these are socialized systems, all the statistics used in the study are from these governments themselves--the UK ignores the epidemics of clostridium killing off old folks in state-run homes, as well as the brain-drain crisis that has left their psych sector relying on 'shamen' and 'alternative healers'. By contrast, the US stats include the minimal care afforded our 12 million+ undocumented immigrants. This should have been pointed out in your blurb above.

Thos who point out that our life expectancy ranks behind others, should look to the example of Costa Rica, whose health care is far more primitive than ours and whose life exectancy is roughly equivalent--the lesson seems to be that often 'less is more'. Thus, there is a strong argument for staying away from doctors altogether. In conclusion, let me also point out that when wealthy Gulf-state patients go abroad for treatment, they almost always come here to the 'sheik-wings' of modern American hospitals.

Posted by: Kierkegaard on May 16, 2007 at 8:29 AM | PERMALINK

It looks like we are paying 2 or 3 times as much and getting less. Why am I not surprised.

Posted by: Ron Byers on May 16, 2007 at 8:29 AM | PERMALINK

It looks like we are paying 2 or 3 times as much and getting less. Why am I not surprised.

Posted by: Ron Byers on May 16, 2007 at 8:29 AM | PERMALINK

You can thank tort reform and a conservative refusal to regulate for the high number of preventable errors.

There simply is no incentive for hospitals to employ and require practices designed to minimize preventable errors.

Posted by: anonymous on May 16, 2007 at 9:27 AM | PERMALINK

I have to agree with Kathy M at the top. I'm a product of the UK system, I have relatives who still wrestle with it, and there's no way it could rank so high. The German ranking - had some experience of it - is very believable. They do a good job.

Posted by: Jim on May 16, 2007 at 9:30 AM | PERMALINK

I work at a hospital that just received an award for being in the top 5% of all hospital and here's my advise: Don't get sick and don't go to the hospital. Healthcare stopped being about health sometime around 1972. It's weird, but this was also around the time the average wage raises fell flat and CEO's pay started being 125% of their workers they employed.

Posted by: Kstan on May 16, 2007 at 9:36 AM | PERMALINK

After reading this, I've decided to quit getting sick.

And according to the last 5 TV commercials I've seen pushing drugs that control everything from highway merging anxiety to bad hair distress disorder, I should have no trouble.

(Are those prescriptions covered by Medica?)

Posted by: wishIwuz2 on May 16, 2007 at 9:46 AM | PERMALINK


Kierkegard:

You should read your own post more carefully.

"Because in addition to the US, I have lived in and been forced to use the healthcare services of the UK, Sweden, and France. They provide good cheap basic service for cuts, bone-breaks, and wide-spread diseases; their record with more exotic illnesses, dentistry, and elder-care is woeful...In conclusion, let me also point out that when wealthy Gulf-state patients go abroad for treatment, they almost always come here to the 'sheik-wings' of modern American hospitals."

So the other countries are good at providing basic medical care (which is 99% of all medical care) to everyone at low cost.

The U.S. is good at providing super-exotic healthcare to the very wealthy at very high cost.

On the elder care issue. If an old person is very wealthy or has good insurance, in the U.S. we will pay vast sums to extend their life a few months while millions of poor kids go without healthcare entirely.

Posted by: Jose Padilla on May 16, 2007 at 9:47 AM | PERMALINK

Was France left out just to spare us total humiliation?

Posted by: keptsimple on May 16, 2007 at 10:06 AM | PERMALINK

Waiting-times at crowded ERs [in non-US countries] are scandalous

I look forward to hearing from any Americans who declare how their wait times in crowded ERs were of no problem whatsoever.

Posted by: Constantine on May 16, 2007 at 10:06 AM | PERMALINK

One thing makes no sense in the post, Kevin.

The US is especially good at preventative care?

(I thought it was the US LACK of preventative care that was considered one of the US' big weaknesses.)

Posted by: SamChevre on May 16, 2007 at 10:08 AM | PERMALINK

Kevin, you surely are aware of the problematic nature of a study which lists the United Kingdom as being number 1 in health care. I suspect that if another pundit trotted out this sort of "evidence" in support of a policy you opposed, you'd heap scorn and derision on it.

To head off the typical invective in this forum, no, I'm not really a supporter of the current health care delivery system in the U.S..

Posted by: Will Allen on May 16, 2007 at 10:27 AM | PERMALINK

The weirdest thing to me - the last 3 times I've been to see medical professionals (at different locations, different problems), they've done tests on my blood. Each time, they promised they would send the results in the mail. I have never received any of the results, despite calling numerous times. I have received bills for the visits and treatment though.

No other industry provides me such poor service with such regularity.

Posted by: MDtoMN on May 16, 2007 at 10:40 AM | PERMALINK

Waiting-times at crowded ERs [in non-US countries] are scandalous . . .

As has been repeatedly pointed out in rebuttal to this inane point, it is better to wait for service than to get none at all.

Some commentors apparently believe that having no health care at all is much preferrable to having to wait in line to receive some health care.

US: kid dies because his parents couldn't afford health insurance or a necessary vaccine.

Other: kid lives because nation provided affordable health care and the necessary vaccine, but kid and parent had to wait in line 3 hours to get the vaccination.

Conservative: kid from US is better off - kid and parent never had to wait in line for 3 hours, a fate much worse than death.

And conservatives wonder why they get booted out of Congress and nobody but authoritarian lemmings believe anything they say about Iraq or other major issues.

Posted by: anonymous on May 16, 2007 at 10:54 AM | PERMALINK

'Right care', I take it, means correct diagnosis, which means the problem isn't with the doctors themselves, but with everything around them.

Posted by: cld on May 16, 2007 at 10:55 AM | PERMALINK

I have to question the validity of a report that ranks the UK as number 1. Perhaps it didn't look at hospital cleanliness and likelihood of catching MRSA.

True. Bizarrely, the study did not include a "number of hysterical tabloid stories about supposed catastrophe in health care system" category.

This study is arrant nonsense. How do I know? Because in addition to the US, I have lived in and been forced to use the healthcare services of the UK, Sweden, and France.

Oh, well, that's convinced me. Discard the controlled experiments, everyone: an anecdote on the Internet from a guy called Kierkegaard is far more rigorous!

Posted by: ajay on May 16, 2007 at 11:12 AM | PERMALINK

>if you need a kidney you can face a three-year wait, since everything is done by lists.

Uh, how, exactly do you think transplants are managed in the US?

Posted by: Jaye on May 16, 2007 at 11:19 AM | PERMALINK

Jaye: Uh, how, exactly do you think transplants are managed in the US?

There are privately operated kidney stores where you can pick up a new kidney in less than 30 minutes for only a few dollars.

This is how the free market works, Jaye.

If it wasn't for all those guv'mint regalations, that is.

Supply and demand allowed to operate freely is the answer to all of society's woes and if you liberal jokers would just quit interfering and assuming guv'mint is the answer to all things we would all be able to get new kidneys as described above!

Heil, Bush!

Posted by: Snazzy Conservative Doofus on May 16, 2007 at 12:16 PM | PERMALINK

Most medical innovations happen in the U.S. Do you think perhaps we pay more overall for our healthcare because we are subsidizing healthcare advancements for the rest of the world?

Why do so many wealthy people from other countries come here for healthcare? I have several friends from other industrialized ountries whose entire families line up doctor's appointments while they are visiting because they prefer our medical system. Why do you think that people who can afford to pay completely out of pocket would choose to come here?

I know of two people personally (one with private insurance, one without) who within two weeks of discovering an alarming symptom had been seen by the doctor, X-rayed, MRIed, biopsied, diagnosed, in one case received multiple opinions on treatment and then began their cancer treatments. Compare that to months long waits in places with government run healthcare.

But that kind of expediency costs money - you must have plenty of expensive diagnostic machines available, plenty of technicians to do all the tests. Nurses and support staff to help the doctor schedule appointments, line up treatments, etc. All of these people need to eat and feed their children so we have to pay them. It all adds up.

There are plenty of places where US Healthcare could improve, especially in the further use of technology, but overall we are much better than these kinds of surveys indicate.

Posted by: Patel on May 16, 2007 at 1:11 PM | PERMALINK

I still think this claim about 'spending more for healthcare' is a joke. Here are some comparative tax data

Corporate Individual VAT
Italy 33% 23%-43% 20%
France 33.33% 10%-48.09% 19.6%
U.S.A. 35% 0-35%
Canada 36.1% 15-29%* 7%*

* That's for federal. Provincial income and VAT taxes could double those figures.

Posted by: mishu on May 16, 2007 at 1:20 PM | PERMALINK

Patel - read the rest of the thread. Just because very rich people get good care in the US does not mean that the US system is overall the best. British cars are not the best in the world just because some of them happen to be Rolls-Royces.

And, if you look at the survey, it's not just saying that US healthcare is the most expensive; it's also saying that it's the worst.

Posted by: ajay on May 16, 2007 at 1:22 PM | PERMALINK

Sweet jumping Jesus Al,

Can you spare a nanosecond to compare our lifespan, infant mortality rate, obesity rate, asthma rate, diabetes rate, cardiovascular disease rate and cancer rate versus those inferior commie-plan states and reconsider your sweeping assertions about our "best health care in the world"?

Didn't think so.

I do appreciate the immense stretching that was required to come up with the assertion that our better, faster doctors should cost more. Bravo. My corporate overlords are always saying that we need to be better and faster to lower our price to the customer. I shall inform them that we should be charging more.

Al-Bot expelled:

Despite the fact that we see doctors less often

Probably because Americans are healthier and not as sick as non-Americans.

go to the hospital less often

Because Americans are healthier and not as sick, we don't need to go to the hospital as much.

and stay in the hospital for shorter times than any of the other countries in the report,

Due to our superior medical staff, American doctors can cure patients more efficiently and at a faster pace than non-American doctors. So we don't have to stay in the hospital as long.

we still spend by far the most money.

Americans have to pay more for their health care because our doctors are better and work faster than non-American doctors.

In return for this we get lousier care.

It appears to me we get the best health care in the world.

Posted by: Trollhattan on May 16, 2007 at 1:27 PM | PERMALINK

I'm pretty skeptical of a ratings system that rates the UK's system, which has major flaws, over Canada's (which has flaws, but a lot less than the UKs).

Posted by: cf on May 16, 2007 at 1:37 PM | PERMALINK

How many other countries would tolerate this?
Patient dies in ER
Officials meet to discuss death at King-Harbor
By Susannah Rosenblatt, Times Staff Writer
May 16, 2007
Los Angeles County supervisors met in an emergency closed session Tuesday to discuss how a woman who had complained of severe abdominal pain at Martin Luther King Jr.-Harbor Hospital died last week after reportedly going untreated by medical staff.
The county investigation into the woman's death, reported by The Times on Tuesday, comes as county health officials are readying the recently downsized, long-troubled hospital for a crucial federal inspection in July that will determine its fate.
Edith Isabel Rodriguez, 43, lay down on the floor of the hospital's emergency room lobby in severe pain during a May 8 visit. Earlier that day, hospital employees had prescribed pain medication and released her.
Rodriguez's boyfriend pleaded with hospital security officers for help. The hospital's security officers discovered an outstanding arrest warrant for Rodriguez for a parole violation. As they took her into custody, she became unresponsive. Rodriguez died May 9....

Posted by: Mike on May 16, 2007 at 1:59 PM | PERMALINK

I recently spoke with two well-educated friends. The issue of health care came up and they both said our capitalist system ensures we have the best health care in the world. I repeated the facts that I read here a bit ago about how the preponderous of evidence indicates Canada's system is better and less expensive. No surprise, but they threw out the old story of Canadians coming here for knee replacements. I don't think they really cared until I started explaining how the health care crisis is impacting our industrial sector. Sad.

Posted by: objective dem on May 16, 2007 at 2:19 PM | PERMALINK

Well, yeah, pretty much everybody, I guess — except for the UK and Germany. And the New Zealanders. But everybody else, for sure.

No, no - we suck too.

Posted by: Phoenician in a time of Romans on May 16, 2007 at 2:20 PM | PERMALINK

I know of two people personally (one with private insurance, one without) who within two weeks of discovering an alarming symptom had been seen by the doctor, X-rayed, MRIed, biopsied, diagnosed, in one case received multiple opinions on treatment and then began their cancer treatments. Compare that to months long waits in places with government run healthcare.

Well, I suppose two anecdotes does trump reams of statistical data, but I'll still ask: how exactly was the health care of the person without insurance paid for? The treatment described above will run into the hundreds of thousands of dollars -- so who paid?

Posted by: Stefan on May 16, 2007 at 2:22 PM | PERMALINK

Patel,

Many wealthy people come to the US for health care, however, many AVERAGE citizens travel to other countries for health care that they can not afford here.

Two Examples:

I know a man who traveled to Thailand for throat cancer, he's still alive shy of five years. Note, doctors here said nothing could be done...he did not have health insurance, he could not afford 380.00 USD/month.

I know a lady who traveled to INDIA for hip surgery, she's doing fine. She had the same problem with insurance...she could not afford the monthly.

So...if your wealthy and insured, medical care in the US is fine, otherwise your 'effed. Is that good? For some, however, not so good for the majority.

>>>>>>>>>>>>>>>>>>>>>>>>>

Posted by: S Brennan on May 16, 2007 at 2:41 PM | PERMALINK

Why do so many wealthy people from other countries come here for healthcare? I have several friends from other industrialized ountries whose entire families line up doctor's appointments while they are visiting because they prefer our medical system. Why do you think that people who can afford to pay completely out of pocket would choose to come here?

Um, because we do a good job of catering to a hyper-wealthy elite and not so good a job for everybody else who isn't a Saudi prince?

Why exactly do you think the above argument is a selling point rather than a condemnation of the American medical system? Why should the American taxpayer, through their support of medical resarch, subsidize wealthy foreigners' medical care at the expense of ordinary Americans?

Posted by: Stefan on May 16, 2007 at 3:13 PM | PERMALINK

I know of two people personally (one with private insurance, one without) who within two weeks of discovering an alarming symptom had been seen by the doctor, X-rayed, MRIed, biopsied, diagnosed, in one case received multiple opinions on treatment and then began their cancer treatments. Compare that to months long waits in places with government run healthcare.

Actually, compare the months long wait in places with government run healthcare (actually, most often government subsidized, not government run) to the wait of eternity in this country for people without healthcare.

Average waiting times are longer overseas because those countries cover everybody, and so the stats account for 100% of the population. Here, however, about 15% of the population lacks insurance and so their waiting time of effectively infinity is never even counted -- in essence, we're massaging the stats in our favor by not counting the lowest performing. It's like if I decided to get an average of how wealthy everyone in the country was but never counted the bottom 15% of income earners.

Posted by: Stefan on May 16, 2007 at 3:18 PM | PERMALINK

Posted by: Zathras on May 16, 2007 at 2:14 AM | PERMALINK

In the health care area they care about gettng the best care if they get really sick or badly injured -- which Americans with insurance, a majority and a large majority of Americans who vote, pretty much do. ...

However, people also care about changes to the quality of care that they are accustomed to, and as increasing numbers experience treatment decisions being made by insurance firms rather than doctors, this is perceived as a reduction in quality of care.

Posted by: BruceMcF on May 16, 2007 at 3:29 PM | PERMALINK

Ajay, the NHS DOES have a problem with MRSA and other superbugs. It's not hysterical tabloid reporting.

I suspect it's due to cultural differences. (No, not those cultures.)

People here are not in the habit of complaining, or asking for special treatment, such as requesting that their health attendant wear gloves or use alcohol swabs before taking blood. Such a request would be unseemly. An individual's needs are not as important as the team's, so to speak, so while everyone wants everyone to have access to health care, people aren't comfortable asking for better, cleaner care for themselves.

That also explains why cancer survival rates are worse here than in any European country--and that there is less access to cutting edge cancer drugs. Why spend money on extending the life of one individual when hundreds could receive care for the same cost?

That's just my observation. I personally am on the Don't Get Sick plan too.

Posted by: KathyF on May 16, 2007 at 4:43 PM | PERMALINK

ajay: Patel . . . [j]ust because very rich people get good care in the US does not mean that the US system is overall the best.

But it does mean that the US system is overall the best because only rich people count in Patel's world (or Bush's).

If being rich doesn't get you better care than the poor folks who clearly don't deserve good medical care (if they were deserving, they'd be rich!), then what good is being rich?

The whole point to being rich is being able to lord it over the masses, while watching htem suffer and assuring yourself that being rich proves you are better than they are.

Posted by: Patel Hell on May 16, 2007 at 4:50 PM | PERMALINK

Why do so many wealthy people from other countries come here for healthcare? I have several friends from other industrialized ountries whose entire families line up doctor's appointments while they are visiting because they prefer our medical system. Why do you think that people who can afford to pay completely out of pocket would choose to come here?

In point of fact, many Americans are now traveling to India, Thailand, and Singapore to get affordable health care.

But more fundamentally, who cares? What is your program for universal healthcare and - if you do not have one - why should you get any?

Posted by: Thinker on May 16, 2007 at 5:10 PM | PERMALINK

I am an American from Los Angeles who has been living in New Zealand for a couple of years now. I used to have very good insurance in the US. My experience is the NZ health system is better overall wtih some exceptions, dental care is not really covered and comes out of pocket and there are waits for some things. However, we have insurance that lets us go to a private hospital to skip the wait. The insurance for a family of four is about US$60 a month. There are some things you pay for here but overall our out of pocket is much less than when we had insurance in the US, a US 1,100 a month policy.

It is faster/easier to see a GP here and they will actually talk to you, listen to you and remember you. With a new baby we had people come to our house for the first couple of months instead of having to take the baby out, same thing before the baby was born they came to us.

Posted by: CLG on May 16, 2007 at 5:53 PM | PERMALINK

Health care is pretty darn good for the elderly but it pretty much suck for everyone else unless that have great health insurance. When I was in my 20's without insurance, I walked around for weeks with a finger oozing blood that needed stiches and should have been really cheap and easy to take care off, but I couldn't because I had no insurance and not enough money to pay for what would have ended up being close to a thousand dollars. Similiarly my husband when a young man with no insurance walked around with a broken bone in his foot until the pain drove him to a doctor where he got to go into hock to pay for a proceedure that took a nurses aide about 10 minutes (setting the bone and putting his foot into a cast). I now carry for my family very exspensive insurance that I pay out of my own pocket because I'm self-employed and I still can't afford to go to the doctor for routine things because the co-pays on most things are prohibitive. Example, last year my daughter had to go to the ER because she was severly dehydrated from the Flu and it ended up costing us close to $2000 and that's with the $700 month insurance premimiums! Now contrast this with my 96 year grandmother who recently passed. She was a very wealthy woman but Medcare picked up everything from her 2 week in the hospital to another 2 weeks in rehab, plus twice a week visits from a RN and weekly visits from a therapist. They even payed for wheelchair, bedside comode and hospital bed! Too bad you have to be on your death bed to actual get decent government health care.

Posted by: puddlejumepr on May 16, 2007 at 8:02 PM | PERMALINK

The study was done by people who want a collectivist universal gov't-paid system like Canada's. You'll notice Canada ranks #5 (out of 6) for access (due to extreme waits for everything but emergency care or routine checkups; did you know the wait for an MRI is usually 6 - 24 months and cancer patients even must wait for treatment). The U.S. ranks #1 in the most important category (the ONLY reason for healthcare) - EFFECTIVENESS, including preventiveness. Canada was last in this category. It's extremely common for Canadians with money to just pay out-of-pocket, beyond their high taxes, to get healthcare in the U.S. (and not vice-versa). Canada had no #1 rankings. Overall, Canada was almost as bad, according to this group's propaganda, as the U.S. except Canada was last in effectiveness while the U.S. was first. The healthy lives category is dependent on many factors beyond the healthcare system, including race, lifestyle choices, etc. Canada ranks #5 in the equity category, while it is actually almost perfect in treating all citizens equally poorly, whether a productive contributing responsible citizen or a drug-addicted self-abusing welfare bum. They both get the same quality of care and the decent person must wait alongside (or behind) the bums. Take the study however you want. By the way, I'm Canadian and know how our system works. Regardless of any of this, healthcare is not a right! It's a personalized service (unlike a public utility such as the sewage system) provided through the labor and property of others (like a haircut, but of course more important). Therefore there's no right to it unless you believe one person has a right to the labor or property of another (i.e. you're a collectivist/small-c communist). If you believe this, when can I call you to get my free room & board in your house (food & shelter are more fundamental to life than healthcare), the use of your car whenever I need it, and I want you to scratch my back too!

Posted by: Terry on May 17, 2007 at 2:33 PM | PERMALINK

While the Commonwealth Report is imperfect, it serves as yet another notice, and a harbinger of our healthcare future.

As part of the launch of the book "Patients Beyond Borders" last March (following nearly three years of research), I took 20-hospital tour through Singapore, Thailand and Malaysia. The cost- and service disparities are mind-boggling. It's nearly unimaginable that in return for a 30-80% savings, American patients can travel to one of 20 countries, to receive equal or better care than they can find on their own soil.

While our hospitals and clinics crumble, particularly inner city public institutions, SE Asia, India, Costa Rica and the Middle East are building large, impressive new hospital complexes that specifically cater to medical travelers--including American accreditation (JCI) and partnerships with Harvard Medical, Cleveland Clinic, Johns Hopkins, et al.

Informed US patients have long since abandoned the wailing wall of our deteriorating healthcare services, and instead are headed overseas for treatment. More than 150,000 Americans did so last year--and the trend is growing at an estimated 20% clip.

While contemporary medical tourism will by no means resolve our healthcare challenges, perhaps the implications of its increasing popularity will serve as a wake-up call to those who posess power to change.

Posted by: Josef Woodman on May 17, 2007 at 6:27 PM | PERMALINK

Well, medical care is the most regulated business in America. It does not surprise me that at some point this can drive prices above the ones for the government run medical care in other Western countries, while gaining little in quality.

In any case, the best way would be to have different systems compete. I am curious to see whether the government medical care would be able to compete ting with private care in the Western countries, if people were allowed to completely opt out of the government system and take their money with them. But all know the answer, don't we?

Posted by: gringo on May 17, 2007 at 6:32 PM | PERMALINK

Very complex issue - encompassing many complex issues.

But we have 46+ million without insurance;
2/5 poor have gone without care or significantly delayed seeking basic care;
another 75 million are vulnerable to financial bankruptcy with ONE significant health problem; health costs are the leading cause of personal bankruptcy;
millions of service workers have no paid sick time benefit and are one unpaid day away from termination and loss of income - they are also unlikely to have health insurance employer-based benefits;
administrative costs from insurance, claims management, denials and appeals account from between 30 and 40% of all healthcare dollars spent.
patient care institutions use a for-profit business model to compete for market share of profitable services - instead of basing services on patient need and use
There is a growing critical shortage of physicians and nurses, and many cost cutting measures are aimed at curtailing reimbursement for their services, thus perpetuating the shortage

Posted by: N=1 on May 18, 2007 at 1:07 PM | PERMALINK

I am an expat living in Germany. When I was in the US a couple years ago, I had a heart attack (at 35 years old (but i'm very athletic and eat well... blah blah blah)... family genetics). I waited 90 minutes in the ER.... until they finally told me I had a heart attack. They put in two stents that I don't need. This is what the doctor's here in Germany told me. It was unnecessary. What was diagnosed (here) was severe sleep apnea... they never noticed this in the hospital when i was in the ICU in the states. Never decided to test for the cause. Anyway, it was treated here, among many other little issues. I find it astounding that my doctor here wants to promote my health care so intensely. I see him every month, and I have no co-pays except for 10 euro every quarter... for both meds and and any doctor I see. There are many things I don't like about living here, but, friends ask ask me what do I like better... It's very easy; health care, hands down. Doctors are knowledgeable and efficient. It's easy to get in to see someone as long as you go through the correct channels. Oh, My BlueCross bill (after deductibles) for my hopspital stay in the states was about 4500. Of course, I was paying about 350/month for my health care premium. Here, because I am legally married, I am on his insurance. I pay nothing extra. It's just fair. There are so many problems with the US system.... It has to change. Health care should not be 100% competitive. It's a racket.

I give you some details only because I was in the American system and am now in this system. I have first hand experience!

Posted by: jd on May 29, 2007 at 11:03 AM | PERMALINK

According to an article in the latest TLS, 70% more women die in childbirth in the U.S. than in Europe. SEVENTY PER CENT.

I know where I'm going to have my babies.

.

Posted by: Raya on May 31, 2007 at 7:53 PM | PERMALINK




 

 

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