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?
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 – most expensive technology available in the World ) – All for US$1500.00 – – – Open your Eyes America – Change the system before the American Health system kills you. Read the Declaration of Independence – – The Document that began this country of America – Read it closely ” We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. — That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, — That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. ” – – – Think about it People of America – Change the Government! It’s your right and obligation for the “Safety and Happiness” of ALL Americans. – – – For those who have not watched Michael Moore’s “SICKO” Rent it and see for yourself – I have known this for over 30 years and that’s why I do not live in the USA – It’s not the best place to live any-longer.
Well in that case, Mr Browning, the US didn’t exist as a nation until 1959
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 him) while his mind remained sharp. He did not have a living will, though I did have POA. The staff at the nursing home recommended kidney dialysis which I gently discouraged given how miserable he was being unable to walk or do much of anything besides read and watch TV. Dialysis would not have changed that. I encouraged him to execute a living will and brought him a copy of my own which my lawyer prepared five years earlier. He finally executed one, as it turned out, about three weeks before he died which called for nothing heroic to be done. He might have survived somewhat longer had he opted for dialysis but I don’t think he, his family or the healthcare system would have been well served had he done so. He died in 2001 at the age of 81.
Yes, I was ignoring 2000 years of history – as Germany did not exist as a nation until 1871.
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?
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!
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.)
You just have to appreciate Mr. Holt’s comparison of the U.S. with Nazi Germany. I think it speaks volumes about his objectivity.
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. And given that culturally we’re closer to the Germans on many points of view (optimism about technology, placing high value on business efficiency, loving cars, high desire to invade foreign countries on a regular basis) than to the Brits or even Canadians, I think that there’s lots to be learned there.
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 center before he could go home (he had other health problems as well), I’m sure his care easily cost over $100K for the episode. He was well insured with both Medicare and federal (retired employee) Blue Cross as supplemental insurance. Yet, while he was in the hospital he was indignant about his out-of-pocket costs. They related to charges for his phone and TV. The total for the stay: $50!
I fully understand that virtually nobody in other countries would trade their health insurance financing system for ours. The issue for them is how much more funding are they prepared to provide to beef up the system they have. So, in Canada, for example, the question might be do we commit another one or two or three percentage points of GDP to fix the aspects of the system that we are not satisfied with, not do we replace the financing system with the U.S. approach.
Barry, I found this survey result done by asking system users. Relevent for you?
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.
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 have the necessary infrastructure to withhold the employee share (if any) of the tax from the paycheck and forward it onto the government. I like payroll taxes (and, perhaps, a dedicated value added tax) because it maximizes health insurance cost transparency rather than hiding the cost in general income tax revenue.
With respect to the U.S. being behind the curve in the adoption and implementation of electronic medical records, this does make the system less efficient than it would be if technology were more widely used. As a patient, however, I view it as a much less significant issue than, say, long wait times, poorly trained doctors,or no access to the most effective drugs, etc.
On the wait time issue, I wonder if the study is measuring the time from diagnosis to surgery but does not include the time between seeing a primary care physician (who is often the gatekeeper in other countries) until a specialist can be seen to determine the diagnosis.
Heart disease and diabetes are much more prevalent in the U.S. than many other countries, mainly because of diet and other lifestyle related choices. I think it is fair to compare healthcare systems on how well they manage and treat these diseases once they are diagnosed but not on how many people per 100,000 of population develop the conditions.
It is also fair to compare survival times and mortality rates for people who need treatment for cancer, heart disease, stroke, etc.
From a patient’s perspective (and I’ve had a lot of experience here), good medical care means timely access to competent doctors, good hospitals, imaging equipment, labs and drugs. It means the doc can spend enough time to figure out what I need and communicate it to me. It also means receiving a treatment protocol that will maximize my chance of being cured or at least surviving for a length of time that compares favorably with likely treatment in other countries. I can live with my doctor not having state of the art electronic records even if it makes him somewhat less efficient than he would otherwise be.
I suppose healthcare system quality may mean different things to different people, but assessing it in a way that can be meaningfully compared across countries is tricky business indeed. The key challenges for the U.S. system are getting to universal coverage and reining in utilization, especially at the end of life. If we could make meaningful headway on the latter, we could probably free up the resources to pay for the former and then some.
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.
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?
Making snide remarks about my being a “conservative”? Wow. Color me impressed.
BTW, on the off chance you are interested, here’s my blog post explaining why I think we are still the best health care system in the world. In fact, you’ll notice that we fare better than many of the countries that have a single-payer system that you prefer.
Don’t discount the ability of Americans to wave the flag and sustain the wrong direction when faced with the truth. “If we just keep doing the same thing long enough it will finally show our system is better.” Sounds like the stragegy for Iraq.