NRL News
Page 22
June-July 2011
Volume 38
Issue 6-7

American Health Care Leads the World

By Roger Stenson

With all the criticism of health care in America, one might think we’ve become a third-world country. Prominent figures extol as virtuous the health care systems in Europe and Canada and other parts where government runs medicine. Is it an example of a preferential option for more government? Is America really as bad as they say? Are the nationalized systems truly better?

Why WHO Statistics Are Misleading

Michael Moore eagerly points out in Sicko that the World Health Organization (WHO) ranks the U.S. 37th in health care. The statistic is often repeated by proponents of a Canadian-style program for us.

The WHO ranking system is based on subjective criteria and preferred political measurements, not health care quality. Some of these measurements are of perceived “fairness” (the U.S. is ranked 54th here), the extent to which the populace smokes, the income tax system (the more progressive—i.e., escalating rates on increasing levels of earnings—the better), whether or not the government runs health care, and if a nation allows Health Savings Accounts (for WHO, that’s a bad thing).

These have nothing to do with health care. Smoking, for example, is certainly related to health, but not health care. One does not go to one’s doctor to get a pack of cigarettes (a lifestyle choice affecting health), but to get treatment for lung cancer (a disease requiring health care).

Michael Tanner of the Cato Institute points out WHO’s contradiction. Guess what country is rated number ONE in “responsiveness to patients’ needs in choice of provider, dignity, autonomy, timely care, and confidentiality”? The United States. These are measurements of health care, not ideology.

WHO based their rating on subjective criteria reflecting a particular ideology. When rating countries in terms of outcomes, WHO ranked the U.S. number one.

Why Infant Mortality Statistics Are Misleading

Infant mortality is another factor that critics of private health care in America like to mention. Again, it is a matter of how tabulating is done.

The Organisation for Economic Co-operation and Development (OECD) is comprised of 34 world democracies “committed to democracy and the market economy.” It publishes 250 new titles each year, including reports on health care and health care statistics.

Data from OECD, the U.S. Department of Health and Human Services, and WHO show a higher infant mortality rate in America than countries like Canada or Germany or Japan—or Cuba.

However, several discrepancies between countries influence these findings, such as relative definitions of live birth. When a preemie dies at birth or shortly afterwards in the U.S. and some other countries, his or her death may be counted as a live birth and an infant death. In other countries this fits the definition of “fetal death,” and thus, not infant mortality. It can be readily seen that this also drives down life expectancy numbers for the U.S.

Moreover, neonatal care for preemies in the U.S. is intense. A baby born 20 weeks after conception receives a mountain of medical intervention in his or her behalf in a U.S. hospital. The survival rate for these and other low birthweight infants is significantly less than that of nine-month babies. To the doctors and nurses in American neonatal units these are infants. When one dies, they’ve lost a patient, an “infant mortality.” In other countries, little or no intervention is attempted. When the untreated baby expires, the occasion is considered a “fetal death,” a huge factor reducing the tabulations and reporting of infant mortality.

Why Life Expectancy Has To Be Adjusted

Another criticism of the United States is its life expectancy of 75.3 years, lower than countries such as Canada, Sweden, and Japan. However, the homicide rate in the U.S. is outrageously high, resulting in premature deaths. This lowers life expectancy.

Our deaths from vehicle accidents are similarly off the charts at 15.3 deaths per thousand. This, too, lowers life expectancy. So, correcting or adjusting for these variables, the United States ends up having the highest life expectancy of all 29 OECD nations measured between 1980 and 1999.

Imagine how the United States would compare if obesity were to be factored in as well. We are the fattest population in the world with an obesity rate of 31 percent, according to 2003 data. Remembering that incidence of a disease is not an indicator of health care (excepting medical preventive interventions like vaccines), but of a population’s health. U.S. health care is bolstered again by examining lifestyle factors and how life expectancy may be adjusted upwards were it not for deleterious habits.

How Is Health Care Properly Measured

Health care is best measured by how a system treats the sick. For example, even though Americans have a very high incidence of prostate cancer, the death rate is lower than in other countries. The ubiquity of prostate cancer among men provides a useful metric. So does breast cancer among women. OECD statistics show that the proportionate mortality associated with these prevalent cancers “is among the lowest of any industrial country.”

In addition, access to advanced medical technology such as MRI machines and CT scanners is a very strong indicator of how well a health care system serves the population. The United States compares favorably against Canada and the United Kingdom in this and in other areas of high-tech medical procedures.

“For premature babies, for children born with spina bifida or for people who have cancer, heart disease, chronic renal failure or almost any other serious illness, the chances of survival are best in the United States, where modern medical technology is most available and accessible,” according to Lives at Risk, a National Center for Policy Analysis publication.

Self Assessment

We are constantly bombarded by critics of health care in America on how bad our system is, and those critics are eager to claim that health care in countries with government-run programs are superior to the United States in the delivery of health care services. It’s enough to make one feel “not so good.” Nevertheless, according to the OECD, 72.6% of Americans over the age of 65 report their health as “good,” compared to only 56.5% in Britain and 47.4% in Germany, for example.

But it’s not just the elderly Americans who are more optimistic about their health. Of those aged 45 to 64, 85.4% of Americans say their health is “good”—more than the 71% in the United Kingdom and 58.2% in Germany.

Value: Cost and What You Get

Obviously, the United States spends more per capita on health care than any of the OECD countries. That’s a good thing, despite the protestations in the pro-nationalized health care polemic. Even Sherry Glied, President Obama’s assistant secretary of health for planning and evaluation, confirmed, “The evidence suggests that rising health spending has accompanied improvements in Americans’ well-being and has not impoverished the nation.”

In addition, the Commonwealth Fund points out that the United States is below the median in the rate, adjusted for cost of living, of increasing health care spending. The median for the average annual growth rate of real health care spending per capita from 1997 to 2007 is 4.0 percent. The United States is at 3.7 percent. So, while we do spend more, we are controlling the rate at which our spending increases better than more than half the OECD nations, and still delivering the best health care in the world. Again, one need only check with WHO’s ratings of that delivery: USA, Number One.

Of course our health care system is more expensive than other countries. We get what we pay for. We get the best value. The Obamacare plan is to lower cost and access—ration. But health care spending growth in America has been below Australia, Canada, the United Kingdom, New Zealand, the Netherlands, and Sweden for the period 1997 to 2007.

People who can afford it come to America for important health care. Where did Silvio Berlusconi go for heart surgery last year? Where did Canadian MP Belinda Stronach go for breast cancer surgery? Tens of thousands of patients from around the world come to America every year. The Mayo Clinic treats 7,200 foreign patients per year. Johns Hopkins treats more than 6,000 foreigners every year. The Cleveland Clinic treats 5,000. One out of three Canadian doctors sends a patient to U.S. each year.

Conclusion

In some countries, like Canada and the United Kingdom, patients are not allowed to spend, or are severely penalized for spending, their own money to get the health care they need but is not approved by the state. Can you imagine living under those restrictions in America?

Start imagining, because that is precisely what Obamacare is scheduled to enforce in 2014.

The model of broken industries that everybody acknowledges are in need of restructuring is precisely what exists in countries that have nationalized health care where often $10,000 is allocated to pay for $12,000 of expenses. In the world of government health care, this means musical chairs, and some are left without a seat at the health care table—rationed out. Bad decisions at the top, allocating less than what services cost, and manufacturing too many family practice doctors when specialists are needed all contribute to the stifling of innovation, proliferation of inefficiency, and a dearth of quality. The pain of socialized medicine has impelled almost all of them to move toward greater and greater privatization.

Countries with nationalized insurance strictly control the number of doctors who can be specialists. That results in rationing.

Countries with nationalized health insurance end up with a paucity of diagnostic technology. That results in rationing.

Countries with nationalized health insurance have unbearably long wait times imposed on patients. That results in rationing.

Countries with nationalized health insurance, because their systems are economically defective, efficiency defective, and service defective, deny life-saving health care to patients. That is rationing.

Rationing results in involuntary euthanasia.