US Health Care: worse than you think

Nice post from Aaron Carroll yesterday on a study pointing out just how sorry US health care is.  Here’s the nickel summary:

I’m a health services researcher, and I’m obsessed with outcomes. One of the first major projects of this blog was a two-week series on quality in the US health care system. I’ve written numerous times about what kills us. This study specifically looked at the burden of disease, injuries, and risk factors in the US versus other countries. The methods are amazingly detailed.

So how did we do compared to other countries? Not well. Between 1990 and 2010, among the 34 countries in the OECD, the US dropped from 18th to 27th in age-standardized death rate. The US dropped from 23rd to 28th for age-standardized years of life lost. It dropped from 20th to 27th in life expectancy at birth. It dropped from 14th to 26th for healthy life expectancy. The only bit of good news was that the US only dropped from 5th to 6th in years lived with disability.

Anybody who says we have the best health care in the world is absolutely, shamelessly, clueless on the matter.  Anyway, I found his take at the end quite interesting:

What we have here is a prioritization issue. We spend a lot of time worrying about colon cancer. It’s ranked 11th in 2010. We spend a lot of time worrying about breast cancer. We have walks, and ribbons, and whole months dedicated to it. It’s ranked 13th. Prostate Cancer? Men are obsessed with it. It’s ranked 27th. But more years of life are lost to lung cancer than to prostate cancer, colon cancer, and breast cancer combined. Ischemic heart disease causes four times as many years of life to be lost each year as prostate cancer, colon cancer, and breast cancer combined. Stroke is 3rd. COPD is 4th. Traffic accidents are 5th. Suicide is 6th. None of these things get the national attention, or resources, that they deserve.

We could have the best health care system in the world. We’ve got the money and the necessary pieces to get really, really good outcomes. But we need to be much smarter about it if we’re going to do so.

Indeed.  Our health care “system” is just massively, massively inefficient.  And there’s no evidence whatsoever that greater reliance on the marketplace will make it more so.

Advertisements

About Steve Greene
Professor of Political Science at NC State http://faculty.chass.ncsu.edu/shgreene

7 Responses to US Health Care: worse than you think

  1. Mike Barr says:

    This is probably because the health care industry (insurance, hospitals, pharma, equipment) is pursuing profit, not health care outcomes. The business of a health insurance company isn’t to cover medical expenses, it is to make money. Now, outcomes and cost are part of the profit equation, but not the primary objective. Buying an increment of health care isn’t subject to market forces the way buying a cup of coffee or automobile.

    • pino says:

      This is probably because the health care industry (insurance, hospitals, pharma, equipment) is pursuing profit, not health care outcomes.

      A more basic human need that medical care is food. And we allow grocery stores to sell food for profit.

      Buying an increment of health care isn’t subject to market forces the way buying a cup of coffee or automobile.

      I can’t be sure, but I don’t think that you understand the difference between health insurance and health care.

      • Steve Greene says:

        I’m quite confident both Mike and I understand the difference. I’m not sure you see the difference in proposing your libertarian ideology as the solution to everything– even in situations where it clearly fails, like health care policy– than in an honest empirical assessment of the overwhelming facts about health care policy.

      • pino says:

        I’m quite confident both Mike and I understand the difference.

        I do not share your confidence. People refer to health insurance when what they really mean is a pre-paid medical care delivery plan. People are stunned in ways that can only be explained by a lack of understanding when they express outrage that patients can be denied insurance for pre-existing conditions.

        Can you imagine even one person who would express equal disbelief when a home owner is denied a policy when he attempts to purchase it AFTER a fire burned his house down?

        an honest empirical assessment of the overwhelming facts about health care policy.

        I typed “market based medical care” into Google and the very first result:

        http://www.aei-ideas.org/2013/07/markets-in-everything-market-based-low-overhead-medical-care-with-transparent-pricing-as-an-antidote-to-obamacare-2/

        The video above from KFOR-TV in Oklahoma City is an update on the Surgery Center of Oklahoma, which has been so successful that it is now creating something of a bidding/price war for surgery procedures. In the video above, Surgery Center co-founder Dr. Keith Smith “declares war” on the traditional, high-cost medical care industry in the US by saying “Our goal is to start a price war.” And it’s working — other hospitals, both locally and nationally, are being forced to compete with the center’s low-cost surgery fees — which are typically one-sixth to one-eighth less than what most other hospitals and clinics are charging for the same procedures. For example, the Oklahoma University Medical Center charges $23,934 for an ankle arthroscopy, while the procedure will cost only $3,740 at the Surgery Center of Oklahoma.

        Anybody who says we have the best health care in the world is absolutely, shamelessly, clueless on the matter.

        I didn’t comment on this aspect partly due to the tone, but partly because I don’t think the two sides are going to move. With respect to health care, the debate is beginning to resemble guns and abortion – there is little room for swaying the opinion of folks.

        However, I’ll weigh in now.

        These reports that discuss health care rankings don’t take into account other factors that impact health outcomes. For example, it doesn’t normalize for auto accidents or gang murders. Nor does it take into account the fact that the United States has a dramatically more diverse population with a variety of issues.

        Those horribly low birth stats – Infant mortality and Maternal Mortality…Do they ever break it down and discuss numbers that begin to explain the higher proportion of young, sick, single mothers that have dramatically higher diabetic rates commensurate with the fact that dad is not just a married member of the household but is gone, often in jail.

        Problems all to be sure. But none of them speak to the ability of our doctors to treat the medical issues they face. In fact, the United States has higher rates of success when faced with many difficult issues. For example, if you are a low birth weight baby being born in the world today, hope that you are born in the US.

        In fact, I’m sure that the author didn’t even mention the fact that certain nations don’t even count a birth as a birth if the baby isn’t so and so long, or so and so heavy or fails to live the first 24 hours.

        Anyway, i am neither absolutely clueless, nor shamelessly so. I just look at facts and come to different conclusions. I think that my conclusions are superior in the same way that you think yours are. That’s neither shocking or upsetting.

        But yes, one of us is wrong. And I think that history shows the more free a people are, the better off those people are.

        Actually, I think that Libertarians and Liberals agree. When I think that a person needs help, I contribute my own money. And when the liberal thinks that a person needs help, they agree with me – that I should contribute my money 😉

      • Steve Greene says:

        More later, but for now, I would argue you are getting too hung up on “insurance.” Quite obviously health “insurance” works on very different principles from home or auto insurance. Would you really allow us to avoid the whole debate over government role in health care if we talked instead of “pre-paid medical delivery plans.” And, while there is a role for market incentives, I’m not going to let one study from AEI convince me in light of every European health system that out-performs us with more government involvement.

        Okay, I’m also really tired of hearing about lifestyle differences, etc. Aaron Carroll has addressed this. Simply google “mortality amenable to health care.” We’re very weak in this arguably most important of all health care system indicators. E.g., http://www.commonwealthfund.org/Publications/In-the-Literature/2011/Aug/Mortality-Amenable-to-Health-Care-in-the-United-States.aspx

  2. pino says:

    I would argue you are getting too hung up on “insurance.” Quite obviously health “insurance” works on very different principles from home or auto insurance.

    This is not obvious. How exactly is health insurance different than auto insurance? I’ll save you an example – emergent care. However, emergent care is a very small fraction of our care.

    Would you really allow us to avoid the whole debate over government role in health care if we talked instead of “pre-paid medical delivery plans.”

    I think the debate would be much more easily resolved if we all accepted the fact that it is perfectly reasonable to take into account pre-existing conditions. And until the left acknowledges that they are not talking about insurance, we’re talking about two different things.

    Fundamentally, we ARE talking about two different thing. One side feels that individuals are entitled to medical care. The other side thinks that individuals should buy insurance. Two very different concepts.

    I’m not going to let one study from AEI convince me in light of every European health system that out-performs us with more government involvement.

    As I mentioned, that “one study” was the result of one google search and then looking at the first result that displayed.

    And I reject the assumption – Europe doesn’t outperform the US.

    Okay, I’m also really tired of hearing about lifestyle differences

    Well, fatigue aside, there are facts that show Japanese American men live longer than Japanese men. And that Hispanic Americans live longer than citizens in their native country.

    So, if those nations that boast the higher life expectancies had the same ratio of ethnic makeup of America, would it make a difference? In other words, do Swiss, Spanish and Swedish citizens live longer than Swedish-Americans, or the Spanish love longer than Spanish-Americans and the same for Swiss?

    We’re very weak in this arguably most important of all health care system indicators.

    Well, it may depend on how you define health systems. While America may be poor in the things that lead to disease, once diagnosed, we are better at producing outcomes.

    • Steve Greene says:

      Wow, that’s handy. When there are facts you don’t like you can just reject them as “assumptions.” Your ability to simply write off the whole concept of mortality amenable to health care speaks to your weak grasp of health care policy. It’s not an assumption that (Western) Europe out-performs the US. It’s an empirical fact based on pretty much every measure you could use.

      And falling back on “lifestyle issues” (again) is like arguing that American health care is great because Canadians have to wait a long time. These are issues at the margins at best. You can cherry-pick a factoid here and there all you want– oooohh, great prostate cancer survival rates, but in a comprehensive look there’s simply no intellectually honest denying that health care in America as presently constituted falls well short.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: