American Health Care

Some perspective on American health care.

Last week, the British Medical Journal ran the triumphant headline "US comes last in international comparison on health care", based on a survey by the US-based Commonwealth Fund. However, the notorious anti-American bias of this publication actually buried the real shock, which was that:

The United Kingdom was ranked first overall, scoring highest on quality, efficiency, and equity.

The other countries in the list are Australia, Canada, Germany and New Zealand. It is crucial to remember that studies like this (using highly aggregated data) tend to compare apples with pears. For example, key health data like infant deaths and live births are recorded differently with the US counting extremely low-weight infants as live births. This led to false accusations on poor US standards regarding infant mortality.

The editors of The Australian Private Doctor recently provided some revealing figures, confirming that socialized NHS style systems ration services not by price but by waiting times:

While only about 5 per cent of Americans have a wait of more than four months for surgery, the figure for Australians, New Zealanders, Canadians and Britons ranges from 23 per cent to 36 percent.

The American system is more expensive because it delivers premium healthcare with high cost technology and pharmaceuticals, as well as super-specialist physicians and treatments. Most of those are rarely elsewhere available. The US also pays for the bulk of clinical research and is pivotal to medical innovation.

Much is made of the 40 million uninsured in the US, but they should really be labelled free-riders – they obtain health care on an emergency basis and others pay (roughly $1000 per year). Even more important, thanks to a range of State and Federal programmes for low-income individuals and families, "The per capita spending rate (on health care) for individuals is the same for those above and below the poverty line."

We have to be careful that in an effort to improve access to health care we don't ruin the really good parts.