Comparing Apples to Apples in Health Care

In the modern health care debate, it is extremely tempting to compare the American system as it exists now to foreign systems that resemble to degrees the universal health care system currently before the American legislature. It's quite a rational way to estimate the influence this new legislation would have if passed.

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. Already, conflict arises. According to Wikipedia, "The WHO [...] placed heavy emphasis on the health disparities between rich and poor, funding for the health care needs of the poor, and the extent to which a country was reaching the potential health care outcomes they believed were possible for that nation." ^[source] Thus, theirs is more a measure of whether health care is universal than whether it is effective.

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, two three examples are insufficient to prove anything. My argument is limited by the comparative difficulty of coming up with comparisons of various nations by cause of death. But the approach is better logic and, so far, seemingly puts the existing US heath care system in a far better light. How sure are we that our health care system is so horribly behind the other industrialized nations of the world?

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.

Obameter #76: Fund Health Care Training

Obama promised to expand the financial support government provides for the training of health care personnel. In the big stimulus bill, he did so to the tune of $500 million. Promise kept.

I am completely unfamiliar with any political issue surrounding this promise or it's fulfillment. Were health care personnel previously under-trained? Did they need that money? Was it enough? Was it too much? Is there any mechanism in place to make sure it's going to the right people and making a difference? It seems to come completely out of the blue.

It's one of the approximately 140 independent items passed as one huge, joint program above and beyond the usual government spending budget in the huge omnibus American Recovery and Reinvestment Act of 2009, unofficially called the Stimulus Bill. One criticism of the big stimulus bill is that you could hide entire programs in the bill and no one would even find and address them before they became law. No oversight. No debate.

I'd say this is a perfect example. It sounds good, sure. Who wants untrained medical personnel? I suppose it's part of a greater emphasis on health in America, but I wasn't aware of any major lack of training problem in the medical field or that this spending has or will actually improve American health. Wikipedia has 6 words on the topic. Google News has seemingly no related search results. Have you heard anything about it? Has there been any debate, consideration, or discussion of this point at all?

I guess it was slipped in completely under the radar. I wonder what else passed that no one noticed.