Tuesday, June 17, 2014

Five Ways America's Health Care System is the Worst

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While constantly deriding the Affordable Health Care Act, the Congressional Republicans have provided no viable alternative to it and, instead want to go back to leaving the uninsured with hospital emergency rooms as their sole source of treatment.  Meanwhile, here in Virginia, the GOP is running ads claiming that Virginia cannot afford to expand Medicaid  conveniently ignoring the reality that (i) the state will be losing two billion in taxes paid to the federal government that will not return to Virginia and (ii) the 400,000 Virginians kicked to the curb will put further strain on the state's non-profit hospital systems and drive costs higher for everyone else.  Throughout all of this, the Republicans boast about America having the best health care system in the world - something that is patently not true.  At least not if one does not belong to the top 1% of the wealthiest Americans.  A piece in Vox looks at 5 ways in which America's health care system is literally the worst.  Here are highlights:
The United States comes in dead last in a new, international ranking of health care systems from a top health-care non-profit.

This doesn't mean that we're the worst in the world; there are plenty of less-developed countries that have worse systems than America's. But when the United States is compared against peer countries like France and Canada it does not come out well. It comes out the very worst.

A new Commonwealth Fund report looks at how the United States stacks up against other countries on things like access to doctors and quality of care. It pulls from three separate surveys conducted over the past three years: a 2011 survey of sicker patients, a 2012 survey of doctors and a 2013 survey of adults over 18. It also uses health outcome data from the OECD and World Health Organization. This means it captures the experience of the medical system from the people who use it a lot, those who use it a little and the doctors treating them.

The American health care system came in last both in the overall rankings, which pull together data on 11 specific measures of success for a health care system. This includes metrics like how easily residents can access health care, if that medical care is affordable and if its effective.

There was no measure where the United States came in first place — our best ranking was coming in third in the effectiveness of our medicine (more on what this means later).

In addition to coming in last overall, there were four specific measures where the United States came in last: cost-related problems, efficiency, equity and health outcomes.

Americans have the most trouble affording medical services; a higher percentage of Americans go without needed care because of cost than people surveyed in any other nation. 

Americans were almost most likely to report out-of-pocket expenses above $1,000 and to have serious problems paying their medical bills. The challenges that Americans have paying their medical bills likely stem from two unique characteristics of the health care system. First, American health care is expensive: the United States spends way more per person on health care than other industrialized nations. We have higher prices for drugs and imaging scans than other countries. 

The other part of the explanation: the United States is the only country in this study without universal coverage. 

[W]e have thousands of health insurance companies who negotiate individually with hospitals and doctors. Every knee replacement in the United States has a different price depending on what deal the insurer has set up with the provider.

This means we end up spending more than other country on the business of getting bills paid. The United States, for example, devotes 7.1 percent of total health care spending on administrative costs.  That's more than twice as much as the United Kingdom and three times as much as Australia.

The Institute of Medicine defines equity as "providing care that does not vary in quality because of personal characteristics" like income or location. The United States does not do a very good job of this. There are big gaps in how Americans with different incomes use the health-care system, with lower-earning Americans being more likely to skip recommended care. Like other measures, this reflects the high costs and insurance gaps of the American system.  

The whole goal of a health care system is to help people get healthier. The United States does spend a lot more money on health care than any other country in this survey. That could make sense if all that additional spending was leading to a better quality of life for Americans, if we lived longer, for example, or had healthier lives.
Unfortunately, the United States comes in dead last when ranked on healthy lives. This metric includes three basic indicators (the only ones available for cross-country comparisons). They are deaths that could have been prevented with care (we have more of those), infant mortality and life expectancy.
The take away?  Just like conservatives like to blather about imagined "American exceptionalism" so to do they ascribe to the nation's health care system characteristics that simply do not exist or which in reality fail to match the health care services available in other advanced industrial nations.  Claiming loudly that something is the best does not make it the best.

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