So the verdict is in. The vaunted U.S. medical system is one of the worst.
But there's less to these studies than meets the eye. They measure something other than quality of medical care. So saying that the U.S. finished behind those other countries is misleading.
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First let's acknowledge that the U.S. medical system has serious problems. But the problems stem from departures from free-market principles.
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It's when this so-called "fairness," a highly subjective standard, is factored in that the U.S. scores go south.
The U.S. ranking is influenced heavily by the number of people -- 45 million -- without medical insurance. As I reported in previous columns, our government aggravates that problem by making insurance artificially expensive with, for example, mandates for coverage that many people would not choose and forbidding us to buy policies from companies in another state.
Even with these interventions, the 45 million figure is misleading. Thirty-seven percent of that group live in households making more than $50,000 a year, says the U.S. Census Bureau. Nineteen percent are in households making more than $75,000 a year; 20 percent are not citizens, and 33 percent are eligible for existing government programs but are not enrolled.
For all its problems, the U.S. ranks at the top for development of life-saving drugs. It "falters" only when the criterion is proximity to socialized medicine. r quality of care and innovation, including
. REF. I believe this to be true and accurate. Please try to comment without insults.
Posts: 3165 | Location: From the Mountains to the Sea. | Registered: 06-08-02
[QUOTE] [/QThe WHO rankings of 191 health systems worldwide placed the United States 37th, trailing countries like Malta and Oman and barely edging out dilapidated Cuba. Predictably, "ClintonCare" champions are using the report in their battle cry for reviving the movement toward government-controlled medicine. But the WHO study is much like the annual magazine rankings of colleges: It grabs plenty of headlines but rests on questionable analysis. A closer look at the WHO health care study reveals startling assumptions, critical lapses in statistical judgment, and a clearly predetermined political agenda. UOTE]
This paper suggests that the WHO study might be skewed to rank the US (and other relatively high GDP per capita countries) too highly in terms of health care efficiency in some ways:
'The results of our paper point to the fundamental problem that plagues every effort to analyze health production: while many products, such as steel, are largely produced within reasonably well-defined industries, health is produced both inside and outside the health care industry...
...The complexity of the issues at hand are illustrated by the fact that GDP per capita may be positively correlated with health system output measures for three distinct reasons. First, high GDP per capita facilitates provision of public health measures (such as clean water, improved nutrition, sanitation and vaccinations) and personal consumption patterns (such as adequate diet) that are inputs into the public and household production of health..."
The article you quote seems to misunderstand the purpose of the WHO report. It was not designed to measure specific examples of absolute quality of care regardless of cost (which the US would undoubtedly score highly on), but overall efficiency throughout a country. For various reasons, discussed elsewhere on this board, the US has a pretty inefficient system.
(Expensive "life-saving drugs" for example, which your article says the US leads the world in, although technically impressive, can be inefficient. Often it would be a lot cheaper and better to have people eat, smoke or drink less and take more exercise in the first place. But that doesn't fit the capitalist model, I guess)
Having said that, of course the WHO report has problems. It's trying to measure a vague and complex thing. The paper linked to concludes -
'An international aid allocation strategy designed to reward countries with efficient health care systems, as measured by the WHR methodology, would channel aid to countries with low reported HIV/AIDs infection rates, low fertility rates, and high GDP per capita...'
That's not good, but it's not evidence of politically motivated US-bashing either.
Adding the total number of annual traffic fatalities (43,000), to the total numbers of annual murders (17,000), gives us 60,000, or 0.02% of the 300,000,000 in the US. (Someone please check my math.) Scotty, one-fifth of one percent is not going to change the life expectancy much at all. Picking 78 as the life expectancy, and multiplying it by 1.00002 raises the life expectancy to 78.016.
Of course, if we are going to do that, we must do it to the figures for other countries, so the figures for them will also go up, admittedly, not as much as .016 (2 months).
Sorry, that theory for raising the US life expectancy figures just doesn't hold water.
Regarding the other factors -
It may come as a surprise to you, but other countries also have illegal aliens. They must have counted in their numbers just as they did in ours.
How many states require people to have health insurance, as your article states?
The practice of not allowing residents of one state to buy insurance from another may be due to insurance lobbying, since rates vary from state-to-state. Surely everyone, given the chance, would buy from the cheapest state. But if state laws disallow that, then state laws disallow that. You aren't suggesting that the federal government take away some of the rights reserved for the individual states, are you?
Your article does point out that the figures for the US would rise slightly if all things were considered. But it somehow manages to point out that other countries' figures would also rise. In any case, the adjust figures would not be significantly higher than the ones WHO puts out. Further, however many millions without adequate health care is that many too much in a country as concerned about its citizens as the US claims to be.
We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America. Preamble to the Constitution of the United States (Bold mine - DG)
What could be more in line with promoting the general welfare for ourselves and our posterity than to provide all of them with decent health care?
Posts: 17549 | Location: Lincoln Place, Granite City, IL, USA | Registered: 06-03-02
Of course, America's health care may be the very best in the world. Let's assume it is. What use is that, Scotty, to those of your citizens, including children, who don't have access to it (for any reason)?
I take it you have free education, regardless of means, for all children though children may be educated privately. What's the difference between that and free healthcare for them, regardless of means ?
Scotty, could you please enlighten me as to the following, from your cited source.
"But the problems stem from departures from free-market principles. " What does that mean, exactly??
"It's when this so-called "fairness," a highly subjective standard, is factored in that the U.S. scores go south." Is it only subjective when considered desirable but not when disparaged??
"The U.S. ranking is influenced heavily by the number of people -- 45 million -- without medical insurance" Is that a desireable goal for the richest country in the world? Or is that not one measure of national wealth and health?? .
"As I reported in previous columns, our government aggravates that problem by making insurance artificially expensive with, for example, mandates for coverage that many people would not choose" Why would anyone prefer to go without insurance for reasons other than that they can't afford it. If a person making $50,000/year is raising a couple of kids, some paying college tuition, etc. and has to choose between eating and buying too costly insurance, that doesn't speakl to highly of the government that, by your source, 'aggravates the problem" by making insurance 'artificially expensive'
"For all its problems, the U.S. ranks at the top for development of life-saving drugs" . Big deal! Many of the serious ailments that only affect a very small population receive short shrift in favor of millions spent on r&d of things like acid reflux and erectile dysfunction, because there's more profit to make from them. Is that what the free market deems "fairness"?
"For all its problems, the U.S. ranks at the top for development of life-saving drugs" . Big deal! Many of the serious ailments that only affect a very small population receive short shrift in favor of millions spent on r&d of things like acid reflux and erectile dysfunction, because there's more profit to make from them. Is that what the free market deems "fairness"?
Thanks anyway. After all, we in Britain buy them for use in our National Health Service Most of the big drug companies are European but we are happy that the US has corporations which are developing drugs too.
We can talk about statistics all night long. We can discuss how many Americans really have no access to health care until we are blue in the face. We could argue the merits of rich Canadians coming down to the Mayo Clinic, Johns Hopkins, or Duke University Medical Center when they have something really wrong with them.
IMHO, the problem isn't the quality of health care delivered in the United States. It is simply that we have become a nation of lazy lard butts with crappy processed food diets. Until we eat properly, exercise more and get a handle on obesity we will continue to lag many nations in life expectancy.
Posts: 8101 | Location: in the backwoods of North Carolina | Registered: 06-07-02
We can talk about statistics all night long. We can discuss how many Americans really have no access to health care until we are blue in the face. We could argue the merits of rich Canadians coming down to the Mayo Clinic, Johns Hopkins, or Duke University Medical Center when they have something really wrong with them.
Canadians certainly are accessing services in the US, Fuse. As I understand it, a lot of the treatments they come to the US for, are not available in Canada. However, not all the Canadians that do this are wealthy. Many end up mortgaging their homes, and taking huge loans to afford potentially lifesaving, innovative treatments, that are only available in the US.
Heck, wouldn't you do the same thing, if you, or a loved one, needed a medical procedure that wasn't available in your country?
Where you have a publicly funded health care system, there is inevitably a lag between the introduction of new treatments, and government approval for universal availability.
Under a private system, there's a push to get the treatments out there, because some can afford to pay for them, whether it be the citizens of that country, or those willing to travel. The bottom line is, the same medical care isn't available to all in either country, but at least in Canada, everyone is getting basic medical care.
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It is simply that we have become a nation of lazy lard butts with crappy processed food diets. Until we eat properly, exercise more and get a handle on obesity we will continue to lag many nations in life expectancy.
That may well be part of the problem, but it's a generalisation to put lower life expectancy simply down to obesity. The bottom line is, that many people get sick in the US, and can't afford basic health care. Often their illness has nothing to do with eating habits.
...it is simply that we have become a nation of lazy lard butts with crappy processed food diets...
I don't know if it's actually been proved or not, but many have said that the British population was never healthier than under World War Two rationing, when they had to eat sensibly. Planning an efficient health care system - including prevention as well as cure - could be pretty straightforward; it's the balancing of it with individual freedoms and so on that gets tricky.
'It is generally accepted that food rationing improved the nation’s health through the imposition of a balanced diet with essential vitamins.'www.history.ac.uk
Why did the WHO conduct its survey? Was it to help decisions about allocation of aid money? If so, why were nations never likely to ask for aid included? As a kind of control?
Imagine if the US were a poor country applying for aid to subsidise its health care; wouldn't immediate objections be raised about how much of the aid was actually going to go into the pockets of insurers, and how many sick people would never see a cent's worth of it? How inefficient.
Originally posted by newnickname: I don't know if it's actually been proved or not, but many have said that the British population was never healthier than under World War Two rationing, when they had to eat sensibly.
Here is the weekly food allowance per person in 1941
2 oz butter 2 oz cheese 6 oz margarine or cooking fat 2 oz tea 2 oz jam 1/2 oz bacon 8 oz meat 3 pints of milk 2 oz sugar one egg or one packet of dried egg
People were expected to 'dig for victory'(turn all available land into growing land, whatever it was before) and vegetables in general were not rationed. And yes, it's true that the diet was healthier. The 'bad' things in a diet were not readily available, and certainly not in any large amount !
Rationing continued postwar. The last items to be taken 'off ration' did not come off until 1954. One was bacon, I believe
IMHO, the problem isn't the quality of health care delivered in the United States. It is simply that we have become a nation of lazy lard butts with crappy processed food diets. Until we eat properly, exercise more and get a handle on obesity we will continue to lag many nations in life expectancy.
But it isn't ONLY life expectancy that puts the U.S at 37th among the industrialized nations. We do die earlier than Australians, Canadians, French, Germans, Japanese, Swedes, and Brits. But our infant mortality rates are higher, our per capita expenditure is higher, our costs as a percentage of GDP is higher, percentage of government revenue spent on health is higher, and the percentage of health costs paid by governmnent is lower. We just don't get the value for our money, because too many people have to get their cut.
Isn't it obvious that if health needs are taken care of before they become critical, if the emphasis is placed on preventive medicine. if a whole industry of insurers, drug makers, clerks, etc. are not supported by profits, that the taxpaying public might pick up a smaller bill?? And satisfy a more all-inclusive service to the citizenry? IMHO they well might.
"But the problems stem from departures from free-market principles."
What does that mean, exactly??
Provision of health care is surely a good example of the need for 'mechanism design'.
'Under classical economics, markets are supposed to efficiently allocate resources, but these theories rely on rigid premises that, in practice, do not always shape up. One of the most problematic of these assumptions is that individuals have all the information necessary to make rational decisions, which is clearly not true.'A free market of flaws
In an ideologically-pure free-market for health care, would the average person really have the resources to be able to work out how much to pay for what services, or what kind of insurance, covering what eventualities, would be most appropriate? I doubt it. A truly free market in health would actually be ruled by the insurers and providers, in gangs.
Another aspect of mechanism design theory - the provision of public goods - is also relevant to health care. Free markets are not good at providing common property such as clean drinking water and efficient sewage systems.
'...a 2003 study published in The New England Journal of Medicine found that the average overhead of U.S. insurance companies is 11.7 percent, compared with 3.6 percent for Medicare and 1.3 percent for Canada’s national health insurance program. And the waits in Canada are a result of Canada’s low level of health spending - on a per capita basis, about half that in the United States. The efficiency of Canada’s national health insurance program coupled with our current high level of health funding would yield the world’s best health care system...'baltimoresun.com
The WHO itself seems to have questioned the ranking idea shortly after its 2000 report:
'2.7. Ranking performance: The meeting went on to discuss ranking of performance... ...There was a sense that although the exercise had been successful in attracting attention and giving rise to the whole consultation exercise, the use of ranking in further HSPA exercises should be reassessed. Certainly the concerns raised above were added to by questions on the advisability of comparing countries in this way and the alternatives available. The meeting wanted to see any ranking carried out made as useful as possible...'www.who.int (PDF)
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It's when this so-called "fairness," a highly subjective standard, is factored in that the U.S. scores go south.
Actually, it isn't subjective.
'Fairness of financial contribution: When WHO measured the fairness of financial contribution to health systems, countries lined up differently. The measurement is based on the fraction of a household's capacity to spend (income minus food expenditure) that goes on health care (including tax payments, social insurance, private insurance and out of pocket payments). Colombia was the top-rated country in this category...'www.who.int
Americans may be used to what follows. It amazed me ! How much of what follows are American voters likely to accept as sound policy and thinking?
Mr Giuliani has just been explaining on TV that Clinton and others want "socialised medicine". And that, he says, "means worse medicine" because breast cancer survival rates are better in the US than in France or "England"(what, not Scotland ? He really ought to know more about Britain and 'the UK' ). He hastened to say that "if you want statistics you should ask my wife": he hadn't got any .It would be interesting to know what like for like statistics she has, if any . If she has she's done a lot better than expected !
Death rates from breast cancer for African American women are 30 per cent higher than for white American women.This was said to be due to 'socio economic factors'. Their cancers are less likely to be detected early and when they present the cancers are more advanced and tumours larger. Now why would that be?
So what does Mr Giuliani say about those who don't have medical aid because they are not insured? His answer was that the poorest do get medical aid. The rest "are consumers" as he put it. He explained that they buy TVs and cellphones and such. They don't have healthcare "because they can't afford it".So the answer is to make insurance affordable for them.You do that by making big tax incentives, tax breaks,on the purchase of insurance. Hmm. If that works at all it means that the government is paying the bills of insurers It doesn't guarantee 100 per cent healthcare coverage anyway.
Never mind 'England', he should visit the Netherlands ("Holland" to him ?) where everyone is insured by insurance companies, comprehensively, at fixed rates, by law
His answers are utterly incomprehensible to those of us, rich, poor and middling, who have never had the need to wonder whether or not we could afford healthcare or healthcare insurance.
Can anyone tell me why Rudy didn't mention that Finland and Sweden have lower rates than the US? Does anyone know what kind of health care system those two countries have?
Posts: 17549 | Location: Lincoln Place, Granite City, IL, USA | Registered: 06-03-02
A Bogus Cancer Statistic October 30, 2007 Giuliani falsely claims that only 44 percent of prostate cancer patients survive under "socialized medicine" in England. Summary In a new radio ad, Rudy Giuliani falsely claims that under England’s “socialized medicine” system only 44 percent of men with prostate cancer survive.
We tracked down the source of that number, which turns out to be the result of bad math by a Giuliani campaign adviser, who admits to us that his figure isn’t "technically" a survival rate at all. Furthermore, the author of the study on which Giuliani’s man based his calculations tells us his work is being misused, and that the 44 percent figure is both wrong and “misleading.”
It’s true that official survival rates for prostate cancer are higher in the U.S. than in England, but the difference is not nearly as high as Giuliani claims. And even so, the higher survival rates in the U.S. may simply reflect more aggressive diagnosing of non-lethal cancers, according to the American Cancer Society.
Actually, men with prostate cancer are more likely to die sooner if they don’t have health insurance, according to a recent study published in one of the American Medical Association’s journals. Giuliani doesn’t mention that.
Note: This is a summary only. The full article with analysis, images and citations may be viewed on our Web site:
When it comes to prostate cancer specifically, a 2003 study of cancer patients in Kentucky, published by the American Medical Association's Archives of Internal Medicine found: "Among patients with prostate cancer, 3-year relative survival proportion was 98% for the privately insured and 83% for the uninsured."
The study found similar disparities for breast cancer, lung cancer and colorectal cancers. For each type of cancer, those without insurance were more likely to die sooner. The study looked at 35,855 cancer patients in the state, including 6,959 men with prostate cancer.
The authors noted that earlier studies established that cancer patients who lack health insurance tend to be diagnosed later in the course of their disease, and also to receive different treatment, than those who have coverage. Similarly, a 2002 report by the National Academies' Institute of Medicine examined 130 research studies and found that “working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital.”
Posts: 17549 | Location: Lincoln Place, Granite City, IL, USA | Registered: 06-03-02
This demonstrates the problem with gathering health statistics. Wouldn't there be a genetic explanation for Iceland's high incidence of breast cancer, for example? Nothing to do with health care or lifestyles, maybe. There are so many variables.
Another chart from the same site shows the cheery statistic "deaths from cancer" by country:
#1 Netherlands: 433 deaths per 100,000 #2 Italy: 418 deaths per 100,000 #3 Hungary: 411 deaths per 100,000 #4 Luxembourg: 409.7 deaths per 100,000 #5 Slovakia: 405.3 deaths per 100,000 #6 Ireland: 357.6 deaths per 100,000 #7 Czech Republic: 335.4 deaths per 100,000 #8 New Zealand: 327.3 deaths per 100,000 #9 United States: 321.9 deaths per 100,000 #10 Australia: 298.9 deaths per 100,000 #11 Norway: 289.4 deaths per 100,000 #12 France: 286.1 deaths per 100,000 #13 Austria: 280 deaths per 100,000 #14 Sweden: 268.2 deaths per 100,000 #15 Finland: 255.4 deaths per 100,000 #16 United Kingdom: 253.5 deaths per 100,000
And of course, it's obvious from the above that 'socialised medicine' is worse at combating cancer. The US stands out from the others at, er... half way down the table.
AnswerPool.com 
Most of the big drug companies are European but we are happy that the US has corporations which are developing drugs too.
He really ought to know more about Britain and 'the UK' 
). He hastened to say that "if you want statistics you should ask my wife": he hadn't got any .It would be interesting to know what like for like statistics she has, if any . If she has she's done a lot better than expected !
It doesn't guarantee 100 per cent healthcare coverage anyway.