The most common comparison along these lines is life expectancy. That comparison is not rational at all. Medical care availability, it's effectiveness, and that of medical insurance affects life expectancy in ways deeply clouded by causes of death that cannot possibly be altered by medical attention. Americans drive more and further than citizens of other nations, increasing our vehicular accidents and, thus, on-the-scene deaths from that cause. We have radically more firearm deaths to the same effect. We are culturally more likely to try to personally, physically stop violent crime or armed robbery, which again decreases our life expectancy in ways unrelated to medical insurance, care, and science.
How do we measure up on direct comparisons of specific causes of death? That is a far better comparison of effectiveness of medical care. Of 100 patients for a given disease, what percentage are alive one year, five years, ten years later? That is a level scale.
So how do we compare? There are thousands of causes of death that could potentially be covered, and information for uncommon approach is less readily available. The full answer is beyond the scope of a blog post and of my own capability as a researcher. But I'll address what few examples I have found.
Of 31 countries statistically analyzed by one recent CDC-funded study (as reported by WebMD, for those without subscriptions to medical research websites), the U.S. has the highest 5-year survival rate for breast and prostate cancer. France and Japan beat us out for the other two cancer types covered, colon and rectal cancers.
If this factor alone were all to consider, it would put the USA tied or ahead of both France and Japan. World Health Organization declared France to have the best health care system in the world [source]. By the same WHO source, Japan ranked 6th and the USA ranked 37th.
The USA also leads the world in gunshot wound survival rates. With all our extra practice, does anyone doubt that claim? The effect on life expectancy would be neutralized by our far greater frequency of occurrence of gunshot wounds, yet it testifies of the effectiveness of our medical capability.
According to Wikipedia's coverage of a international cardiac study, "Canadian patients [...] had a 17% higher risk of dying from heart attacks than did U.S. patients." It is further suggested that that the American culture of cardiac treatment is more effective at saving heart attack victims' lives because of "the greater use of invasive procedures in the U.S." and that "specialized procedures are only available in central hospitals" in Canada but are more abundant in the USA. This suggests that more advanced care is less available under a universal health care system, and that the difference is responsible for a significant number of people's lives. [source]
(If I have not said so previously, let me say so now: I don't believe universal health care creates "death panels" who decide whether you live or die, but rather that financial realities will create shortages of certain advanced and expensive care options. Previously I considered some hospital accountant encouraging against certain procedures, but after reading the previous example my views are altered to say "Exactly like that.")
Of course,
If we can't be sure it's broken, why are we striving to fix it?
Updated at 11:45 am on 24 Sept 2009.
(Incidentally, I'm looking forward to your full site with forums etc... this current comment section doesn't have an easy quoting tool, which makes things tricky).
ReplyDeleteI don't think we're quite coming at this issue from the same direction, and I would agree with you on some of your points. In fact, I use some of the same arguments in discussion with fellow Canadians (many of whom have a *very* twisted view of US health care), in defence of the American system. I should point out that I'm the type of person who enjoys debate, and will often take a contrarian view to encourage new ideas. So while I might defend the Canadian system to you, I could easily turn around and discuss it's faults with another Canadian.
The main thrust of your comments (and I don't want to make a strawman here) seems to be that the US system has a greater degree of efficacy, even if the best treatments may be limited to those with the means to pay for them. The Canadian system strives for universal care, regardless of individual means or income, at the expense of possibly the very best of care not being available everywhere (or at all, in rare cases). I would probably agree with those statements to a large extent.
I work in MRI research, and I recall my graduate supervisor saying that a few years back that Canada had about 150 or so clinical/research MR scanners country-wide. Boston had roughly the same number. So I can definitely see the advantage at the leading edge of health care research of the US system, and it probably explains why most of the world's experts in specific medical areas tend to do their research in the US.
Canada strives to provide universal (and, in my more cynical moments, I would add the adjective 'mediocre') care to every citizen. There's really no effective way to get 'better' care, short of paying out of your own pocket and hightailing to the US. Buffalo (close to where I live in southern Ontario) has MRI/CT imaging clinics which advertise on the side of the highway (!) -- unheard of in Canada, and I can only assume these are partly meant to garner business from Canucks who don't want to wait 6 weeks for a scan on their blown knee.
However, there's a point which I think is important in this debate, and it really struck home after I watch 'Sicko' (please bear with me). Yes, it's a Michael Moore film, so it should be taken with a *very* large grain of salt. However, the point that he makes with regards to private health care insurance companies was interesting, and oddly had never really registered with me before. They are for-profit companies, and therefore have a huge financial incentive to deny coverage/treatment for people that actually need it - more denials means more profits, means bonuses to higher-level execs. I do take your point though that if they consistently pay out more than they take in via premimums, they go out of business. But still - isn't that for-profit scheme somehow wrong, if not from a capitalist sense then certainly from a moral/ethical one?
I appreciate your contrarian tactics. Debate is healthy, and it promotes debate.
ReplyDeleteMy mom works for a dental office (as did I, doing clerical work one summer in my teens). I'm completely aware that medical insurance companies are an ugly mess. Most deny coverage the first time you ask no matter what in hopes the patient will just go away. Her dental office applies twice on consecutive days, mailing out the second request before the first one is even denied. That is clearly a broken system.
From a capitalism purists' viewpoint the current health insurance system in the USA is an utter wreck. It is one of the most heavily regulated industries in the country and awash with unionization, certifications, and other restrictions. By capitalist theory, the efforts of compliance with these rules drives the cost of the service skyward without any improvement to the services performed. In other words, it grows the cap between what you pay in insurance and what you get out of it.
Removing those restrictions would not eliminate the gap, but it'd be better than the current system. I'd probably still rely on savings rather than insurance, but fewer people would be without insurance.
On the other hand, her office refers all Medicare patients to other dentists. The prices Medicare pays (and that dentists are required by law to accept) are almost always lower and often half or less of the cost her office needs to charge in order to stay in business. That's no better.
The fact that for-profit insurance is an epic mess does not change the sorry state of government insurance. Private charities are the best systems for providing health care to the needy (apart from personal savings, the method I personally use).
There's a hospital near here called Primary Children's Medical Center. For nearly a century they have provided medical care for children in five US states regardless of their ability to pay. It's not a terribly large facility (252 beds), but it is an excellent example of top-of-the-line care regardless of income class. I challenge either insurance companies or governments to provide better service. Charitable hospitals are the way to go.
Some related links:
Top 1000 Hospitals in the world (31 of the top 50 are in the USA)
Graphic of the national and regional distribution of the 200 best hospitals in the world. Note that the USA and Canada have more of the best hospitals than all of Europe combined, and that the USA has 9 times as many of those top hospitals as Canada. Sure, there's a population difference to consider, but that's strong evidence that the American system should not change.
My post finished, I'll go work on my full site for a while. This ready-made blogging system is a lot easier to set up, but not nearly as functional as I'd like.