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POLICY/INTERNATIONAL: The best health care system in the world!

God Bless America.

Zeke Emmanuel is a pretty prominent ethicist and with my former economics teacher/prof Vic Fuchs author of a not bad proposal for universal health care. He’s more famous as the least famous Emmanuel brother—the one who’s not in The West Wing or Entourage. And he thinks that the health care system is a mess. Now you’d assume that if he was fired one of his two very, very rich brothers could step in to keep his family out of the workhouse. But apparently not.

President Bush frequently has said Americans have the world’s best health care system, but Emanuel stopped short of calling Bush clueless in his essay (behind JAMA firewall)and during an interview with The Associated Press. “I work for the federal government. You can’t possibly get me to make that statement,” Emanuel said in the interview.

But don’t worry, the AP found a rent-a-quote to make the article fair and balanced:

David Hogberg, senior policy analyst at the National Center for Public Policy Research, said a strong case can be made that the U.S. health care system is the best. “It depends on what measures you use,” Hogberg said. Life expectancy is influenced by many factors other than health care, he said, and nations measure infant death rates inconsistently. Other measures show the United States performing well, he said.

Just in case you wondered the National Center for Public Policy Research may sound like its some official well respected non-partisan body  but its header title describes it as a  “A Conservative Think Tank” (an oxymoron perhaps). Yeah, those guys know all about health care, I’m sure.

However the reason for this fuss is the latest edition of the Commonwealth Fund’s six-nations report. What does it say? Same thing it’s said for ages. (Shorter version here) The US system costs more and is no better—nay, it’s worse. But Karen Davis and pals have this little zinger in the tail

Findings in this report confirm many of the findings from the earlier two editions of “Mirror, Mirror”. The U.S. ranks last of six nations overall. As in the earlier editions, the U.S. ranks last on indicators of patient safety, efficiency, and equity. New Zealand, Australia, and the U.K. continue to demonstrate superior performance, with Germany joining their ranks of top performers. The U.S. is first on preventive care, and second only to Germany on waiting times for specialist care and non-emergency surgical care, but weak on access to needed services and ability to obtain prompt attention from physicians.

Did you notice that? We’re not even Number One in shortest waiting times for elective surgery. Want to get your hip replaced most quickly? Move to FrankFurt!! I assume that David Gratzer and Sally Pipes are brushing up on their Deutsch right now.

And in other news…apparently Michael Moore isn’t a thorough fact checking reporter and according to his supporters(!) leaves behind a “trail of broken promises to colleagues, exaggerations of facts, and footage used out of context.  Hmm, I’d never have guessed that (actually I’ve read one of his books and yup his “research” is incredibly sloppy. In fact so sloppy that apparently PhRMA and AHIP are on to him:

The Pharmaceutical Research and Manufacturers of America issued a statement attacking Moore’s record. "A review of America’s health care system should be balanced, thoughtful and well-researched," the statement said. "You won’t get that from Michael Moore.

And given the quality of “research” from those two organizations, do I have to add the next sentence for you?

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RobertJohn R. GrahamStuart BrowningBarry CarolMatthew Holt Recent comment authors
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Robert
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Robert

As an American living overseas – at 57 I looked for a system that was better than the US in providing quality – affordable healthcare in my latter years of Life – Hello America – It’s NOT YOU – – Money Hungry Insurance Companies – Pharmacuetical Companies – Doctors – Hospitals – the whole system is based on PROFIT – Not LIFE and providing Quality Care. I recently had Kidney Surgery in China – Yes Communist China – 9 days in a private room with my wife – MRI – Color Ultra-Sound – X-Rays ( all on the latest –… Read more »

Matthew Holt
Guest

Well in that case, Mr Browning, the US didn’t exist as a nation until 1959

Barry Carol
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Barry Carol

Peter, Thank you for asking about my father and end of life utilization of healthcare. Here’s the story. He had congestive heart failure, diabetes and end stage renal disease (ESRD). However, his mind was sharp and he had lots of intellectual curiosity. In 2000, he fell in his home and broke his hip. After surgery, he was discharged to a nursing home. He had physical therapy and periodic trips to the hospital, usually to pump out fluid built up due to his failing kidneys. After a few months, he could no longer walk even with a walker (which really aggravated… Read more »

Stuart Browning
Guest

Yes, I was ignoring 2000 years of history – as Germany did not exist as a nation until 1871.

Peter
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Peter

Barry, your father aside, do you really believe that phone and TV charges are what concerns patients for out-of-pocket charges? I would think realistically it’s the bankruptcy issue – insured or not. As for your father, would he have fit into your vision of end of life/utilization management?

Matthew Holt
Guest

Hmm…I’m glad Mr Browning was attentive enough to notice the joke, even if he didn’t find it as funny as the average English football fan would. But his history is lacking. He seems to be ignoring roughly 2000 years of German history outside 1933-45, or was the Ostro- and Visigoths invasion of Rome, the Saxon’s invasion of England, the 30 Years war, the Franco Prussian war, the invasion of Russia in WW1 all done by the Nazis too? I didn’t know they’d invented time travel as well.
As for John Graham. Too clever by half. No wonder Sally hired him!

John R. Graham
Guest

Ja, aber in Deutschland gibt’s private Krankheitsversicherung fuer Leute, die nicht under den oeffentlichen Systeme liegen wollen. Und, unter das oeffentliche Systeme, konkurrieren viele Krankheitsfonds. Die Regierung druckt Leute night zu eiem Staatsmonopol wan man 65 Jahre alt sei, wie in den Vereinigten Staaten.
(So, you see, David Gratzer & Sally Pipes do not need to learn German: I’ve got it covered.)

Stuart Browning
Guest

You just have to appreciate Mr. Holt’s comparison of the U.S. with Nazi Germany. I think it speaks volumes about his objectivity.

Matthew Holt
Guest

Barry–I basically agree. I don’t think Commonwealth is measuring all the things that American’s care about and I wouldn’t suggest the UK system circa 1949 as the solution to America’s 2008 problems. BUT much of what Commonwealth thinks is good (IT in health care, care coordination, P4P) IS done rather well in the UK. Which is why it shows up so well in the study. I’m far more interested in how the Germans manage to beat us on elective surgery waiting time–far closer to the issues you raise about accessibility to care that’s good from a patient point of view.… Read more »

Barry Carol
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Barry Carol

Peter, The hospital setting is where electronic records can add the most value. In academic medical centers especially, there are likely to be multiple doctors involved in a patient’s care and most will not know the patient. It is important for them to know what each other is doing, and often they don’t. I’m not as impressed with the out-of-pocket cost discussion. I think people generally expect a lot more insulation from out-of-pocket costs than they should. I’m reminded of when my father had heart bypass surgery in 1997 at age 77. Including a couple of weeks in a rehabilitation… Read more »

Peter
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Peter

Barry, I found this survey result done by asking system users. Relevent for you?
http://www.washingtonpost.com/wp-dyn/content/article/2005/11/03/AR2005110301143.html

Peter
Guest
Peter

Barry, maybe a good comparison of world wide single pay systems and the U.S. system would come from the people using the system. I know that on my visits to Canada when healthcare is discussed, no one wants the U.S. system. Many do want improvements in the way Canada’s system is managed/financed, always a struggle. I wonder what type of opinion exists in other countries when asked if going to the U.S. model is the way to solve their healthcare issues? I know your experience has been positive, probably because you are well financed and covered.

Barry Carol
Guest
Barry Carol

Matthew, No offense to you and your fellow Brits, but I find it hard to assign much credibility to a study that ranks the UK system #1 overall. I think you would be hard pressed to find many single payer advocates who propose replacing our current system with the UK approach. I think it is important in comparative studies like this to separate the health insurance financing system from the provision of healthcare. Even I would rank the U.S. last on health insurance financing because it doesn’t achieve universal coverage. For a system financed largely by payroll taxes, however, employers… Read more »

David Hogberg
Guest

Matt,
Ok, challenge accepted. I’ve got a lot to get off my plate this week, but I will get to it no later than this weekend. I’ll even see if I can get the American Spectator to run my response as an article.
Fair enough?

Matthew Holt
Guest

David. Sorry but your argument that “care is better here because I found two metrics on which we win” is illogical crap & I’ve dealt with it over at Spot-on. Go over there and when you’re ready to answer those questions, I’ll gladly run your piece on THCB. Not ONE of your colleagues on the right has been prepared to do so. Will you be the first?