This post is a response to
a post by Scott Atlas about US healthcare. He raises ten interesting points. I am going to deal with many of the posts he refers to. After the reference section, I will also mention a few other things that this does not deal with.
Breast cancer mortality is 52 percent higher in Germany than in the United States, and 88 percent higher in the United Kingdom. Prostate cancer mortality is 604 percent higher in the U.K. and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher.
This fact forgets two things. The uninsured in the USA have worse survival rates than those with insurance, and this fact does not mention those cancers that have similar survival rates.
Fact No. 2: Americans have lower cancer mortality rates than Canadians.[2] Breast cancer mortality is 9 percent higher, prostate cancer is 184 percent higher and colon cancer mortality among men is about 10 percent higher than in the United States.
As noted above, look at the rates for those who can not affor insurance.
Fact No. 3: Americans have better access to treatment for chronic diseases than patients in other developed countries.[3] Some 56 percent of Americans who could benefit are taking statins, which reduce cholesterol and protect against heart disease. By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons and 17 percent of Italians receive them.
Now this is a fascinating fact. Mainly because when you look at the complication rates for chronic illnesses, the USA actually is worse than other developed nations. In addition to this (and these are facts I will repeat) the US scores worst amongst developed nations when it comes to deaths due to preventable causes.
Fact No. 4: Americans have better access to preventive cancer screening than Canadians.[4] Take the proportion of the appropriate-age population groups who have received recommended tests for breast, cervical, prostate and colon cancer:
- Nine of 10 middle-aged American women (89 percent) have had a mammogram, compared to less than three-fourths of Canadians (72 percent).
- Nearly all American women (96 percent) have had a pap smear, compared to less than 90 percent of Canadians.
- More than half of American men (54 percent) have had a PSA test, compared to less than 1 in 6 Canadians (16 percent).
- Nearly one-third of Americans (30 percent) have had a colonoscopy, compared with less than 1 in 20 Canadians (5 percent).
Fact No. 5: Lower income Americans are in better health than comparable Canadians. Twice as many American seniors with below-median incomes self-report "excellent" health compared to Canadian seniors (11.7 percent versus 5.8 percent). Conversely, white Canadian young adults with below-median incomes are 20 percent more likely than lower income Americans to describe their health as "fair or poor."
[5]
This 'fact' refers to health perception, not to actual health. Again, look at the survival rates of lower income Americans compared to the survival rates of those in other developed nations.
Fact No. 6: Americans spend less time waiting for care than patients in Canada and the U.K. Canadian and British patients wait about twice as long - sometimes more than a year - to see a specialist, to have elective surgery like hip replacements or to get radiation treatment for cancer.
[6] All told, 827,429 people are waiting for some type of procedure in Canada.
[7] In England, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.
[8]
But this does not look at those Americans who never get a chance to wait due to lack of insurance!
Fact No. 7: People in countries with more government control of health care are highly dissatisfied and believe reform is needed. More than 70 percent of German, Canadian, Australian, New Zealand and British adults say their health system needs either "fundamental change" or "complete rebuilding."
[9]
Which is why people in those nations keep those systems! When the conservatives in the UK took power, that was on a promise to protect the NHS! Let alone the fact that people in the UK love the NHS.
Fact No. 8: Americans are more satisfied with the care they receive than Canadians. When asked about their own health care instead of the "health care system," more than half of Americans (51.3 percent) are very satisfied with their health care services, compared to only 41.5 percent of Canadians; a lower proportion of Americans are dissatisfied (6.8 percent) than Canadians (8.5 percent).
[10]
Which is why Obama was elected on a platform to reform the healthcare system...
Fact No. 9: Americans have much better access to important new technologies like medical imaging than patients in Canada or the U.K. Maligned as a waste by economists and policymakers naïve to actual medical practice, an overwhelming majority of leading American physicians identified computerized tomography (CT) and magnetic resonance imaging (MRI) as the most important medical innovations for improving patient care during the previous decade.
[11] The United States has 34 CT scanners per million Americans, compared to 12 in Canada and eight in Britain. The United States has nearly 27 MRI machines per million compared to about 6 per million in Canada and Britain.
[12]
And yet as mentioned, people in the UK are healthier and do better on most chronic conditions when it comes to complication rates than they do in the USA, as well as those who die of preventable causes of death in the USA compared to other developed nations.
Fact No. 10: Americans are responsible for the vast majority of all health care innovations.[13] The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other single developed country.
[14] Since the mid-1970s, the Nobel Prize in medicine or physiology has gone to American residents more often than recipients from all other countries combined.
[15] In only five of the past 34 years did a scientist living in America not win or share in the prize. Most important recent medical innovations were developed in the United States.
[16]
And yet the system fails Americans. Again look at the health of Americans compared to people in the UK and again look at the complication rates for medical conditions which in general is worse in the USA.
[1] Concord Working Group, "Cancer survival in five continents: a worldwide population-based study,.S. abe at responsible for theountries, in s chnologies, "
Lancet Oncology, Vol. 9, No. 8, August 2008, pages 730 - 756; Arduino Verdecchia et al., "Recent Cancer Survival in Europe: A 2000-02 Period Analysis of EUROCARE-4 Data,"
Lancet Oncology, Vol. 8, No. 9, September 2007, pages 784 - 796.
[2] U.S. Cancer Statistics, National Program of Cancer Registries, U.S. Centers for Disease Control; Canadian Cancer Society/National Cancer Institute of Canada; also see June O'Neill and Dave M. O'Neill, "Health Status, Health Care and Inequality: Canada vs. the U.S.," National Bureau of Economic Research, Working Paper No. 13429, September 2007. Available at http://www.nber.org/papers/w13429.
[3] Oliver Schoffski (University of Erlangen-Nuremberg), "Diffusion of Medicines in Europe," European Federation of Pharmaceutical Industries and Associations, 2002. Available at http://www.amchampc.org/showFile.asp?FID=126. See also Michael Tanner, "The Grass is Not Always Greener: A Look at National Health Care Systems around the World," Cato Institute, Policy Analysis No. 613, March 18, 2008. Available at http://www.cato.org/pub_display.php?pub_id=9272.
[4] June O'Neill and Dave M. O'Neill, "Health Status, Health Care and Inequality: Canada vs. the U.S."
[5] Ibid.
[6] Nadeem Esmail, Michael A. Walker with Margaret Bank, "Waiting Your Turn, (17th edition) Hospital Waiting Lists In Canada," Fraser Institute, Critical Issues Bulletin 2007, Studies in Health Care Policy, August 2008; Nadeem Esmail and Dominika Wrona "Medical Technology in Canada," Fraser Institute, August 21, 2008 ; Sharon Willcox et al., "Measuring and Reducing Waiting Times: A Cross-National Comparison Of Strategies,"
Health Affairs, Vol. 26, No. 4, July/August 2007, pages 1,078-87; June O'Neill and Dave M. O'Neill, "Health Status, Health Care and Inequality: Canada vs. the U.S."; M.V. Williams et al., "Radiotherapy Dose Fractionation, Access and Waiting Times in the Countries of the U.K.. in 2005," Royal College of Radiologists,
Clinical Oncology, Vol. 19, No. 5, June 2007, pages 273-286.
[7] Nadeem Esmail and Michael A. Walker with Margaret Bank, "Waiting Your Turn 17th Edition: Hospital Waiting Lists In Canada 2007."
[8] "Hospital Waiting Times and List Statistics," Department of Health, England. Available at http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/HospitalWaitingTimesandListStatistics/index.htm?IdcService=GET_FILE&dID=186979&Rendition=Web.
[9] Cathy Schoen et al., "Toward Higher-Performance Health Systems: Adults' Health Care Experiences In Seven Countries, 2007,"
Health Affairs, Web Exclusive, Vol. 26, No. 6, October 31, 2007, pages w717-w734. Available at http://content.healthaffairs.org/cgi/reprint/26/6/w717.
[10] June O'Neill and Dave M. O'Neill, "Health Status, Health Care and Inequality: Canada vs. the U.S."
[11] Victor R. Fuchs and Harold C. Sox Jr., "Physicians' Views of the Relative Importance of 30 Medical Innovations,"
Health Affairs, Vol. 20, No. 5, September /October 2001, pages 30-42. Available at http://content.healthaffairs.org/cgi/reprint/20/5/30.pdf.
[12] OECD Health Data 2008, Organization for Economic Cooperation and Development. Available at http://www.oecd.org/document/30/0,3343,en_2649_34631_12968734_1_1_1_37407,00.html.
[13] "The U.S. Health Care System as an Engine of Innovation,"
Economic Report of the President (Washington, D.C.: Government Printing Office, 2004), 108th Congress, 2nd Session H. Doc. 108-145, February 2004, Chapter 10, pages 190-193, available at http://www.gpoaccess.gov/usbudget/fy05/pdf/2004_erp.pdf; Tyler Cowen,
New York Times, Oct. 5, 2006; Tom Coburn, Joseph Antos and Grace-Marie Turner, "Competition: A Prescription for Health Care Transformation,"
Heritage Foundation, Lecture No. 1030, April 2007; Thomas Boehm, "How can we explain the American dominance in biomedical research and development?"
Journal of Medical Marketing, Vol. 5, No. 2, 2005, pages 158-66, U.S. Department of Health and Human Services, July 2002. Available at http://fraser.stlouisfed.org/publications/erp/page/8649/download/47455/8649_ERP.pdf .
[14] Nicholas D. Kristof, "Franklin Delano Obama,"
New York Times, February 28, 2009. Available at http://www.nytimes.com/2009/03/01/opinion/01Kristof.html.
[15] The Nobel Prize Internet Archive. Available at http://almaz.com/nobel/medicine/medicine.html.
[16] "The U.S. Health Care System as an Engine of Innovation,"
2004 Economic Report of the President.
Why does no other developed nation have the old US model of healthcare? Because in the US model, before the reforms, insurance companies used death panels to deny care to those they were meant to cover. And then they raised costs. Not only does the USA spend more on healthcare than any other nation, it finds itself bottom of the table when it comes to preventable deaths due to treatable conditions when it comes to developed nations. The sad thing is that rather than focus on these things, the right spreads lies and half truths about the reforms and howhealthcare works abroad. Even sadder is the fact that the reforms are so simple. But I think the saddest things are the number of kids in America who die. I do not like the issue that in the UK, we have a high death rate of kids aged under five compared to other nations, but the USA, the most developed nation in the world have an even higher death rate for kids aged under five. And in addition to that, look at the maternal mortality rate for the USA. In English it means the number of women who die when they are pregnant (or soon after) which are due to problems related to the pregnancy. It is higher in the USA than it is in other developed nations.
I do not know which facts you will find of more interest. But please do click on at least a few of the links that I have provided which back up my statements.
