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August 4, 2009
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The facts about single payer care
There's a lot of myth and a lot of misunderstanding surrounding the ideal of universal health care. It sounds good in principle--I won't argue with that. But it's just unworkable in practice--and the folks who claim it works better are just cooking the truth, hoping you are too dumb or lazy or complicit to notice or care.
Scott Atlas is a professor of medicine at Stanford's med center, and a Hoover Institution fellow (please, those of you whose knees jerk at that--give the reflexive umbrage a rest). He's assembled a list of ten key facts about American health care, especially as compared to the socialized health care systems that get held up as models of how we should be doing better.
Check them out:
Medical care in the United States is derided as miserable compared to health care systems in the rest of the developed world. Economists, government officials, insurers and academics alike are beating the drum for a far larger government role in health care. Much of the public assumes their arguments are sound because the calls for change are so ubiquitous and the topic so complex. However, before turning to government as the solution, some unheralded facts about America's health care system should be considered.Fact No. 1: Americans have better survival rates than Europeans for common cancers.[1] Breast cancer mortality is 52 percent higher in Germany than in the United States, and 88 percent higher in the United Kingdom. Prostate cancer mortality is 604 percent higher in the U.K. and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher.
Fact No. 2: Americans have lower cancer mortality rates than Canadians.[2] Breast cancer mortality is 9 percent higher, prostate cancer is 184 percent higher and colon cancer mortality among men is about 10 percent higher than in the United States.
Fact No. 3: Americans have better access to treatment for chronic diseases than patients in other developed countries.[3] Some 56 percent of Americans who could benefit are taking statins, which reduce cholesterol and protect against heart disease. By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons and 17 percent of Italians receive them.
Fact No. 4: Americans have better access to preventive cancer screening than Canadians.[4] Take the proportion of the appropriate-age population groups who have received recommended tests for breast, cervical, prostate and colon cancer:
Nine of 10 middle-aged American women (89 percent) have had a mammogram, compared to less than three-fourths of Canadians (72 percent).
Nearly all American women (96 percent) have had a pap smear, compared to less than 90 percent of Canadians.
More than half of American men (54 percent) have had a PSA test, compared to less than 1 in 6 Canadians (16 percent).
Nearly one-third of Americans (30 percent) have had a colonoscopy, compared with less than 1 in 20 Canadians (5 percent).
Fact No. 5: Lower income Americans are in better health than comparable Canadians. Twice as many American seniors with below-median incomes self-report "excellent" health compared to Canadian seniors (11.7 percent versus 5.8 percent). Conversely, white Canadian young adults with below-median incomes are 20 percent more likely than lower income Americans to describe their health as "fair or poor."[5]
Fact No. 6: Americans spend less time waiting for care than patients in Canada and the U.K. Canadian and British patients wait about twice as long - sometimes more than a year - to see a specialist, to have elective surgery like hip replacements or to get radiation treatment for cancer.[6] All told, 827,429 people are waiting for some type of procedure in Canada.[7] In England, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.[8]
Fact No. 7: People in countries with more government control of health care are highly dissatisfied and believe reform is needed. More than 70 percent of German, Canadian, Australian, New Zealand and British adults say their health system needs either "fundamental change" or "complete rebuilding."[9]
Fact No. 8: Americans are more satisfied with the care they receive than Canadians. When asked about their own health care instead of the "health care system," more than half of Americans (51.3 percent) are very satisfied with their health care services, compared to only 41.5 percent of Canadians; a lower proportion of Americans are dissatisfied (6.8 percent) than Canadians (8.5 percent).[10]
Fact No. 9: Americans have much better access to important new technologies like medical imaging than patients in Canada or the U.K. Maligned as a waste by economists and policymakers naive to actual medical practice, an overwhelming majority of leading American physicians identified computerized tomography (CT) and magnetic resonance imaging (MRI) as the most important medical innovations for improving patient care during the previous decade.[11] [See the table.] The United States has 34 CT scanners per million Americans, compared to 12 in Canada and eight in Britain. The United States has nearly 27 MRI machines per million compared to about 6 per million in Canada and Britain.[12]
Fact No. 10: Americans are responsible for the vast majority of all health care innovations.[13] The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other single developed country.[14] Since the mid-1970s, the Nobel Prize in medicine or physiology has gone to American residents more often than recipients from all other countries combined.[15] In only five of the past 34 years did a scientist living in America not win or share in the prize. Most important recent medical innovations were developed in the United States.[16] [See the table.]
Conclusion. Despite serious challenges, such as escalating costs and the uninsured, the U.S. health care system compares favorably to those in other developed countries.
These are not just talking points. They are facts. If you want the source material, click on the link above, and follow his footnotes through.
People from all over the world come to the US to get the best care available. That's because of our incredible academic medical centers and the premium we place on research and innovation. It's also because truly smart, creative, caring people have an incentive to go into medicine as a profession (less than they used to, given the burdens of insurance companies, malpractice insurance, etc., but still enough to attract good people). Nationalizing health care will kill that. All you have to do is look at the quality of research (when there is any) and the quality of physicians in countries with socialized health care systems, and you'll see the truth of that. And if we kill innovation and incentives, we'll also be killing people.
Yes, we need health care reform. No, the government is not the answer. Nationalized health care is not a magic bullet--though it is a bullet.
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Comments:
There are a lot of important points here. I find it interesting, however, that the author focuses on Canada and Britain, who spend a lot less than we do on health care, rather than France, which has a relatively "deluxe" single-payer system, with reasonable wait times, good outcomes, etc. In some categories (female colon/rectal), French cancer survival rates are the best in the world. Japan (with a national health insurance system, price controls, etc) tops the list in certain categories as well.
The statistics on technology, moreover, cut both ways. I remember reading somewhere that there are more MRI machines (or maybe it was CT machines) in Orange County, CA than in all of Canada. You can interpret that to mean that Canada doesn't have enough machines. But doesn't it also suggest, maybe, that Orange County may have too much excess capacity (which makes healthcare there very expensive).
A real debate on healthcare, which I agree that we desperately need, is going to require more than pundits cherry-picking facts.
Of course, Peter, you just cherry-picked some facts to support your argument . . .
I find it curious that there are two kinds of claims in the quoted material:
1) Nonfactual, feel-good claims about perceptions -- i.e., what those who receive medical care think about it.
2) Factual claims that are concerned with issues concentrated in the latter end of life, such as cancer... and it's in the end of life where we DO have a single-payer system, called Medicare. This doesn't strike me as a good argument against a single-payer system (though I think it's easily possible to have good medical insurance reform without a single-payer system).
Finally, I don't think the reference to the PSA test is persuasive one whit: what research reviews conclude that PSA tests promote longevity?
I'd like to be convinced that a single payer system is the best for us, but there are several things I'd like to happen first. For starters:
1. Tort reform. That would decrease the rationale for defensive medicine, if not the actual costs — though I think it would significantly decrease costs. Even if it didn't reduce costs substantially, it would be one heck of a good-will gesture. And good gestures are an important part of Hope and Change.
2. Allowing people to shop for insurance out of state. Put a thumb in the eye of the insurance companies, and let them compete with one another for business. No more state by state monopolies.
3. Deny services to illegal immigrants. Send them back from whence they came.
Or, for humanitarian purposes, don't limit services to just those illegal aliens within our borders. If we're going to cover their healthcare needs, why not cover the needs of Mexicans and Canadians who've chosen not to cross the border illegally? Why should they be deprived of care just because of a silly, arbitrary border?
4. Improving the second-rate government-run VA system. Anyone want to send a loved one to a hospital offering the standard of care typical of the VA? I didn't think so.
5. A pledge by legislators and politicians that they'll accept no better treatment for themselves and their families than they want to impose on the rest of us. No special treatment for Ted Kennedy, or President Obama or his family. They cue up like the rest of us.
6. A pledge by legislators that they will read and understand the healthcare legislation — and actually debate its provisions — before voting it into law. I know that's a lot to ask, but it does seem reasonable to me that the greatest deliberative body in the world should . . . well . . . deliberate. You know . . . talk about its provisions for a couple of months before voting on it, so that we can know what the pros and cons are.
If they can't understand it or don't have the time to read it . . . how can they vote for it?
7. Proof that the government plans can be better thought out than the Cash for Cars fiasco (intended to run until November, it ran out of funds in 5 days; computers clogged and crashing for volume; $1B up to $3 B; the EPA changing what cars qualified for what rebate midway through the first week, etc.)
I could go on, but I'll spare you.
Of course, Peter, you just cherry-picked some facts to support your argument.
Yes, that was the point. Was it not clear?
No, it wasn't clear, at least not in the context of your posting history as a whole.
John,
If you had read what I had written, rather than shadow-boxing with my "posting history," you might have noted that I acknowledged the validity of many of Mr. Atlas's points. I was simply pointing out, by citing a few facts of my own, that matters are rather more complex than his analysis would suggest. The problem with "talking points," generally, is not that they are not factual (sorry for the double negative), but rather that they represent a partial and often misleading slant on issues that are often very complex. Proponents and opponents of Obama's plan have both been guilty of gross simplification and misrepresentation.
As for the French example, it is important not because it represents some kind of socialist holy grail, but rather because it is a much better point of comparison for the US than the National Health Service in the UK. France is one of the few countries in the world that comes close to spending the kind of money we do on health care. An American single-payer system (which is of course NOT what Obama is proposing) would presumably be much closer to the French system that the British NHS. But citing the horrors of the NHS is much more politically effective, I guess.
Peter -- A point of clarification: A single payer system is Obama's goal. He's been explicit about this in the past, and it's clear that this is the intended goal of the sort of health care reform that he envisions. See http://www.youtube.com/watch?v=fpAyan1fXCE&feature=player_embedded. And while Obama does claim that the present plan is not a "Trojan horse for a single payer system," that contradicts his past statements and also the intentions of Congressional supporters of the bill who see it as the foot in the door to single payer care. See Barney Frank: http://www.youtube.com/watch?v=f3BS4C9el98&feature=player_embedded.
Peter, since you have proven once again that you don't know what you're talking about, I'll take all of your rhetoric for what it is: empty ideology.
Obama does want a single-payer system. So does Barney Frank. If you try and get your news from sources other than those approved by the DNC, you might know this.
So Peter — do you believe what President Obama says about a single payer system now that he is in the limelight and public opinion is so strongly against single payerism, or what he said in prior talks when he wasn't center-stage and wasn't worried about the public paying much attention to his views?
Did you believe him when he said no lobbyists would participate in his administration? How about the promise to post each piece of legislation for five days on the White House web site before he signed it? What about his promise to close Gitmo NOW (you know — the fierce moral urgency of it all . . .)? And then, there's all that transparency stuff . . .
I could go on, but modesty prevents.
On the other hand, I have this lovely bridge I'd like to sell . . .
Interesting-sounding new book by T R Reid called "the healing of America," which surveys healthcare systems & practices throughout the world. Jacob Weisberg, reviewing the book in Slate, argues that national culture--not just policy--has a very significant effect on how healthcare works or doesn't work. The review is worth reading for anyone interested in this subject.
David,
We have vigorously disagreed in the past, but I don't remember ever impugning your intelligence. Frankly, your ad hominem attack was cheap and intellectually dishonest.
Minerva, Erin,
I can't read Obama's mind. I'm simply trying to focus the debate on the actual proposal on the table.
Peter,
It's not clear to me where David has been out of line. I don't think he has.
Because the thread has become a bit heated, I'll issue a general reminder to all to keep it civil and to stay on point.
Many thanks in advance -- I know it can be tough to do with hot button issues, but if we can all keep the tone good, the content will be better for it.
If the accusation of ad hominem was directed at me rather than David, I was not insulting Peter's intelligence so much as suggesting that his daily reading material, so far as said material informs his comments on this blog, reveals itself to be severely one-sided.
I rarely see an indication that he is aware of anything outside of the DNC spin zone, and when he is, he tends to assume that the information is inaccurate.
This does not speak well to the ability of the academy to deal with issues in a non-ideological manner, if Peter is indeed employed in the academy--I'm not sure if he is or not.
Peter...what are you referring to? Unless something disappeared, my only comment on this thread is a recommendation for a book review.
David,
My apologies. It was indeed John to whom I was referring. Sorry.
I recommend everyone gives the references listed in the original article a good read. Asides from the original articles strong insistence on comparing the US to only single countries rather than international standards, the references are quite revealing.
It rests heavily on the O'Neil report. In fact, that single small work, is referenced in 25 % of the citations.
The O'Neil report was a comparison between the US and Canadian health care systems performed for an economy think-tank. The writers were economists, and it was slated by health care reviewers.
For example, it eliminated the lowest 1/3 of the US population from its numbers before making any comparisons. It cited screening rates comparisons between the US and Canada without knowing or caring that Canadian screening numbers were screenings targeted at risk groups while the US numbers were from screening everyone. Cancer survival rates did not take into account that the US diagnoses more growths as cancers. Etc, etc.
Reference for point 7 is particularly amusing, as the paper cited concludes the exact opposite from what the author of the essay claims it does.
Real research on the subject can be found here:
http://www.commonwealthfund.org/~/media/Files/Publications/In%20the%20Literature/2006/Sep/U%20S%20%20Health%20System%20Performance%20%20A%20National%20Scorecard/951_Commission_why_not_the_best%20pdf.pdf
I love how your "facts" do not even mention the FACT that there are more than 40 million UNINSURED citizens in the United States! Private insurance is the reason for this and is the major culprit in denying health insurance to citizens. It disgusts me that you see health care as a commodity instead of as a universal right. Capitalism has no place in the delivery of health care.
Byron, Maybe that's because it's not a fact that there are 40 million uninsured people in the US. That's not even a figure Obama uses anymore, though he's still exaggerating the number as much as he can. We need health care reform urgently. But what we need are things like allowing insurance companies to compete across state lines, tort reform, and requirements that companies cannot deny insurance to people with pre-existing conditions. We do not need the government swooping in and bolloxing up our ability to care for ourselves the way it has bolloxed up everything else. Setting aside the specific issue of health care, let's talk about costs. Americans have a right to live in a country that is not a whore to debt. That right has been held in contempt by Congress and the administration, and the trillion dollar price tag on the bills before Congress will only mortgage our futures--and intrude on our freedom--that much more. That's what *I* find disgusting.
