Comparing Apples to Apples in Health Care III

Here are links to the first and second articles in the Apples to Apples series.

FactCheck.org, an institution I greatly support, has gotten into the survival rate issue. Previously I've been criticizing the comparison of health care systems via life expectancy and infant mortality rates while promoting survival rates for specific ailments as a better comparison of systems. FactCheck has taken it upon themselves to criticize straight survival rate numbers.

They start by conceding the obvious difference in the stats: "Across the board, the United States boasts a higher five-year relative survival rate than the European average," they say. "But survival rates also differ within the United States, between insured and uninsured populations. […] survival rates among the uninsured were [&hellip] similar to Europe[.] […] Rates for people on Medicaid were similar to the uninsured."

That initially looks pretty good for the US status quo, but this is a comparison of the USA to Europe, not to socialized medicine. When comparing cancer survival rates from the USA to Canada, Japan, Australia and Cuba (all nations with single-payer government health coverage systems) we come up even or low pretty consistently. (Except with prostate cancer, which is apparently more of a money-maker for doctors than a major harm to public health.)

Also, early detection campaigns can distort a nation's survival rate numbers; catching cancer early rather than waiting for more serious symptoms means you're treating a weaker form of the cancer. Even with identical health care systems, early detection means a better survival rate. Thus, societal differences can distort the comparison of health care systems. Europe isn't big on cancer screenings, and neither are the American uninsured. That explains pretty well why the lower tier of Europe and uninsured Americans doesn't really compare to the higher tier of care enjoyed by socialized medicine and the American insured.

As their dedication to non-partisanship demands, FactCheck.org refuses to take sides on the debate overall. Survival rates do make the USA look much better than life expectancy and infant mortality statistics do -- we have great survival rates overall. Also, it doesn't bode well for the public option when it's current American counterpart, Medicare, is more like being uninsured than well-covered. Thus, these points could be used to argue against the public option before the legislature. On the other hand, insured Americans essentially tie the four socialized medicine nations mentioned suggesting that a socialized medicine system would mean top-tier coverage for all. "There's no way to know!" is the unspoken FactCheck theme.

What would be ideal is a statistical analysis of deeply similar cases in different nations. Great collections of parallel case studies would give a good comparison view of the systems. But I haven't seen any sign that anyone has done that. So the job is to derive what conclusions we can from the information given.

The big thing that strikes me hardest is cancer survival rates: the USA is the worldwide best at surviving breast and prostate cancer ^[source], but FactCheck explains that away as powerful early detection campaigns. Which makes sense. That leaves me without any way to guess which nation has the best cancer treatment.

That leaves the pro-US-system argument heavily relying on a sentence from Wikipedia of all places: "Canadian patients [...] had a 17% higher risk of dying from heart attacks than did U.S. patients." ^[source] Okay, technically it refers to a study in the cardiovascular medicine journal Circulation, but I haven't actually read that article. It's a thin strand to cling to. Maybe, despite my confident facade, I really don't know who has the best health care system.

One of the Wikipedia footnotes links to this article, gives a brief analysis of some of these same points, followed by a great and universal principle that I shall now steal as the beginning this article's conclusion: "The available data often do not provide clear answers." That being the case, isn't a diversity of approaches the best way to determine the best approach? The USA should remain unique until it's system is proven inferior. Since such proof remains elusive, don't fix anything.