Map of life expectancy at birth from Global Education Project.

Thursday, June 18, 2009

Who da bomb?

So Whisker wants to know, if the U.S. health care system is, contrary to our usual narcissistic self-perception, a major fail, what country has the best?

There isn't really any single answer to that, because you can compare countries' sysems on various measures and people will value them differently. And, the research just hasn't been done that compares every candidate country on every measure that you might put forward.

Nevertheless, people have tried. One way that seems fairly straightforward is to look at results. I said seems straightforward because it isn't. Medical intervention accounts for only a fraction of population longevity and health status -- and what fraction presumably varies from country to country, making it even tougher. Nolte and McKee have tried to cut this knot by isolating deaths considered amenable to health care, that occur in people younger than age 75. They include bacterial infections, treatable cancers, diabetes, and complications of surgery. They only count half of ischemic heart disease deaths because those seem only partially "amenable" to health care. They also set younger age limits for diabetes (50) and common infections (15). Read the article if you want to see all their arguments. Anyhow . . . .

From 1997-98 through 2002-2002, "amenable" mortality fell in all 19 countries for which they did the comparison, but it fell more slowly in the U.S. than anywhere else. We started off not looking good, and ended up looking even worse. The rankings are slightly different for males and females, but we're number last for both sexes. The winners? France for males, Japan for females. France comes in #2 for females, making it best overall. Japan is 8th best for males. The final ranking for both sexes combined is (may I have the drumroll please): France, Japan, Australia, Spain, Italy, Canada, Norway, Netherlands, Sweden, Greece, Austria, Germany, Finalnad, New Zealand, Denmark, United Kingdom, Ireland, Portugal, United States.

Yup, the cheese eating surrender monkeys win. However, not all countries are included in the research, obviously. I got an e-mail yesterday from something called The Israel Project, claiming that Israel has the world's best health care. I won't take their word for it -- among other reasons because they appear to be big boosters of Netanyahu, of whom I am not, as you might imagine, a big admirer -- but you never know, there are reasons why that might be true.

Another way to look at international comparisons is by what we call "process" indicators - do the right things happen under given circumstances. These aren't collected consistently and universally across systems, or even necessarily within systems, particularly in the U.S. given our extreme fragmentation. So, the Commonwealth Fund depends on surveys of patients and doctors. In 2007 report, they compared Australia, Canada, Germany, New Zealand, the UK and the US. Overall, the UK won this one hands down, with big wins on quality, right care, patient-centered care, efficiency, and "healthy lives." So, on this comparison, it's the hard core, flat out socialized medicine that triumphs. Not only that, but they're very close to the cheapest, which means the Brits have more money left over for tea and crumpets. (What he hell is a crumpet, anyway?) Oh yeah -- we're number last on this one too. We always are, no matter how you do it. And we spend the most.

That basically seals the deal, as far as I'm concerned. All this wailing about how we can't allow ourselves to become like the Europeans, with their "socialism" and "rationing" and "restrictions on individual rights" is manifestly nonsensical because all you have to do is look at the bottom line: they pay less, a lot less; and they get more, a lot more. So yes, we should be like them.

QED

4 comments:

kathy a. said...

and everyone's covered by national health care, you left that part out. when my sister was visiting the UK and had a grand mal seizure, that was totally covered.

so, reading between the lines, the critical question seems to be, is anyone expecting to get fabulously wealthy off of their country's health system? and if the answer is yes, go to the end of the line.

roger said...

today's news...76 effing % of us want single payer, public option health care. what percent of our 535 elected fools want it? maybe 5? less than 1%!!

too irate to comment any more calmly or rationally.

and f you tom daschle (he lost his last election!), you too max baucus. you too ron wyden.

kathy a. said...

roger, don't hold back!

but seriously, there is a gap between what people want on the ground and what might be politically possible.

C. Corax said...

I got an e-mail yesterday from something called The Israel Project, claiming that Israel has the world's best health care. I won't take their word for it -- among other reasons because they appear to be big boosters of Netanyahu, of whom I am not, as you might imagine, a big admirer -- but you never know, there are reasons why that might be true.

Is war considered a preventable cause of death?

As for 76% wanting single payer, there are folks out there who honestly don't know what "single payer" means (my mother and my brother both said people asked them what it meant), so once those folks are enlightened, we can add them to that number.

We can have it if we insist on it. If Bolivia's poor can send Bechtel fleeing with its tail tucked between its legs, we can get single payer. We just have to stop being so pathetically passive.