Report claiming US health care worse than abroad distorts facts but ObamaCare may soon make it a reality
By Jennifer Popik, JD, Robert Powell Center for Medical Ethics
A report released June 16, 2014, by the Commonwealth Fund think tank claims that although the U.S. spends more on health care, we underperform relative to other countries. This often repeated argument was one of the principal justifications for the Obama Heath Care Law. However, looking at the report’s underlying methodology demonstrates the U.S. is, in fact, getting value for its money.
What is the basis for the Commonwealth Fund conclusion that we get poorer health care even though we spend more? The report compared health care in 11 nations, based on “patients’ and physicians’ survey results on care experiences and ratings on various dimensions of care. … It also includes information on health care outcomes featured in The Commonwealth Fund’s most recent (2011) national health system scorecard, and from the World Health Organization (WHO) and the Organization for Economic Cooperation and Development (OECD).”
One major way in which the study authors ranked quality was through a set of surveys. What is surprising is that although the authors note that Americans tend to be far more optimistic and more demanding than European counterparts, they brush the importance aside. They wrote,
“One definition of ‘quality’ care is health services that meet or exceed consumer expectations. Even if the expectations of U.S. patients were higher than patients in other countries, the U.S. health care system should be held to the standard of meeting its consumers’ needs.”
This standard of measuring quality is totally subjective. In effect, if US health care delivers better outcomes than systems abroad, but foreigners expect less of their health care system than Americans, the US health care system is deemed inferior. A worse foreign system is deemed superior just because its participants are resigned to the poorer outcomes! It is not a cancer outcome, or a wait time indicator, or any other measure that would just look at raw data.
Incredibly, the Commonwealth Fund report never independently addresses any outcomes like cancer survival. It pays no attention, for example to the fact that Americans have better survival rates than Europeans for common cancers.  Studies show that breast cancer mortality is 52 percent higher in Germany than in the United States, and is 88 percent higher in the United Kingdom. Prostate cancer mortality is 457 percent higher in Norway, and 604 percent higher in the U.K.
When the study actually looks at objectively measurable outcomes, such as life-expectancy, even these measures tend to be unbalanced. The Commonwealth study purports to look at the following measure of life-expectancy in tandem: mortality amenable to medical care, infant mortality, and healthy life expectancy at age 60.
At first glance, this metric shows the U.S. having the lowest life-expectancy among several first-world nations. However, life expectancy is not dependent exclusively on health care. If one adjusts for two simple factors, deaths from homicide, which are much higher in the U.S. than in other nations, and transportation accidents, the U.S. actually rises to the top! Documentation for these claims can be found here: www.nrlc.org/USHealthCarebetter.pdf
Further, not all countries define birth (and consequently infant mortality) the same way. For example, in the United States, arrivals of all live infants are counted as births. But many European nations have more restrictive definitions. For example, France and the Netherlands report live births only if the infant weighs at least 500 grams — a little more than a pound — or were born at 22 weeks’ gestation or later. They show lower infant mortality than the US because they move the goal posts; deaths among premature infants are not counted, as they are in the U.S.
Sadly, although inaccurate for the time period it covered, the Commonwealth Fund report may be prophetic. As a consequence of Obamacare, America’s hitherto high standard of health care may be declining. Although the data for the 2014 report was collected before the bulk of Obamacare’s provisions took effect, there is reason to believe that due to the health law’s mechanisms of reducing health care spending there will be a very real decline in healthcare available to Americans.
According to the most recent CBO’s report “Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act, from April 2014,” Obamacare will drive U.S. health care spending $104 billion below what had been projected over the next decade. These “savings” will come at tremendous cost in human lives.
The CBO report goes on to describe the reality — that while insurance premiums are being held down, there is solid and growing evidence that these plans restrict access to life-saving medical treatment for ourselves, our family members, and our loved ones.
CBO writes, “The plans being offered through exchanges in 2014 appear to have, in general, lower payment rates for providers, narrower networks of providers, and tighter management of their subscribers’ use of health care than employment-based plans do. Those features allow insurers that offer plans through the exchanges to charge lower premiums (although they also make plans somewhat less attractive to potential enrollees).”
Last year, when hundreds of thousands of Americans lost plans they liked, the administration claimed that the new exchange plans would be better than the old plans. This could not be farther from the truth for tens of thousands.
As millions of Americans are attempting to start using their new Obamacare exchange health insurance plans, stories about denial of treatment keep piling up. You can read more on this at nrlc.cc/QpXbrk. The newly issued CBO report confirms that exchange plans are restrictive. What’s worse, this is by design.
Rarely reported in the mainstream media is an Obamacare provision under which exchange bureaucrats must exclude health insurers who offer policies deemed to allow “excessive or unjustified” health care spending by their policyholders.
Under the Federal health law, state insurance commissioners are to recommend to their state exchanges the exclusion of “particular health insurance issuers … based on a pattern or practice of excessive or unjustified premium increases.” The exchanges not only exclude policies in an exchange when government authorities do not agree with their premiums, but the exchanges must also even exclude insurers whose plans outside the exchange offer consumers the ability to reduce the danger of treatment denial by paying what those government authorities consider an “excessive or unjustified” amount.
This means that insurers who hope to be able to gain customers within the exchanges have a strong disincentive to offer any adequately funded plans that do not drastically limit access to care. So even if you contact insurers directly, outside the exchange, you are likely to find it hard or impossible to find an adequate individual plan. (See documentation at www.nrlc.org/medethics/healthcarerationing.)
When the government limits what can be charged for health insurance, it restricts what people are allowed to pay for medical treatment. While everyone would prefer to pay less–or nothing–for health care (or anything else), government price controls prevent access to lifesaving medical treatment that costs more to supply than the prices set by the government.
While Obamacare continues to roll out in 2014, it is important to continue to educate friends and neighbors about the dangers the law poses in restricting what Americans can spend to save their own lives and the lives of their families. Is also key to point out that when Americans are allowed to spend more, they really do get more for their money. You can follow up-to-date reports here: powellcenterformedicalethics.blogspot.com
 Coleman, Michel P., et al. “Cancer survival in five continents: a worldwide population-based study (CONCORD).” The lancet oncology 9.8 (2008): 730-756; Verdecchia, Arduino, et al. “Recent cancer survival in Europe: a 2000–02 period analysis of EUROCARE-4 data.” The lancet oncology 8.9 (2007): 784-796.