The Myth of Lousy Healthcare in the U.S.

Few complaints about the U.S. healthcare system are as common as the claim that we spend too much on healthcare and get too little in return, especially compared with other industrialized nations. A new Commonwealth Fund report is the latest to indict U.S. healthcare. It pegs the American system dead last in a survey of 11 developed countries. But, like virtually every other study that trashes the U.S. healthcare system, Commonwealth’s rankings rely on questionable assumptions, like giving weight to those systems that treat people equally rather than well. At the same time, Commonwealth ignores the problems that countries with socialized healthcare systems have with treating people once they’re sick. And on that metric — that is, actually delivering care to those who need it — the U.S. is without peer. The Commonwealth Fund report begins by asserting that the U.S. healthcare system “is the most expensive in the world.” It’s true that the U.S. spends a larger share of its gross domestic product — 18%, or almost $3 trillion – on healthcare than other countries do. But by itself that statistic means nothing. The U.S. also happens to be one of the richest countries in the world. Once basic needs are taken care of, an increasing share of each extra dollar will go to what were once considered luxuries. You can only spend so much on food, after all. That assertion is borne out by national spending data. Between 1990 and 2012, for example, spending on healthcare climbed 290%, significantly faster than GDP growth of 171%. But household spending on pets climbed 353% over those same years; on live entertainment, it went up more than 500%. Americans spend 639% more on telephones and 900% more on computers. By the Commonwealth Fund’s logic, America also faces a pet-care spending crisis. In contrast, spending on staples like food, clothing, housing and furnishings all climbed more slowly than GDP. The Commonwealth Fund concludes that the U.S. “underperforms relative to most other countries on most other dimensions of performance” despite having the most expensive healthcare system in the world. But a closer look at those “dimensions” calls that claim into question. Take infant mortality rates, where the U.S. typically places far down the list behind France, Greece, Italy, Hungary, even Cuba. This comparison is notoriously unreliable because countries either use different definitions of a live birth — or fudge their numbers. The U.S. counts every live birth in its infant mortality statistics. But France only includes babies born after 22 weeks of gestation. In Poland, a baby has to weigh more than 1 pound, 2 ounces to count as a live birth. The World Health Organization notes that it’s common practice in several countries, including Belgium, France and Spain, “to register as live births only those infants who survived for a specified period beyond birth.” What’s more, the U.S. has significantly more pre-term births than other countries. That fact alone accounts for “much of the high infant mortality rate in the U.S.,” according to a report from the Centers for Disease Control and Prevention (CDC). The CDC found that if the U.S. had the same pre-term birth rate as Sweden, our infant mortality rate would be cut nearly in half. What about life expectancy, where the U.S. ranks below its peers, as well? International measures of longevity typically fail to account for differences in obesity, accidental deaths, car accidents, murders and the like, all of which shorten lives no matter how good a nation’s healthcare system is. The U.S. murder rate, for example, is more than four times the United Kingdom’s — and far higher than all the other countries in the Commonwealth Fund study. The U.S. has a worse highway death rate than all but one of them. And U.S. obesity rates are more than double Canada’s and more than four times Switzerland’s. A far more meaningful comparison of international health systems would take stock of how people afflicted with diseases such as cancer fare in different countries. And on this measure, there’s no question the U.S. stands above the rest. Five-year survival rates for breast cancer are higher in the U.S. than in England, Denmark, Germany and Spain, according to the American Cancer Society. In the U.S., the survival rate for prostate cancer is 99%. In Denmark, it’s 48%. For kidney cancer patients, the survival rate here is 68%. It’s just 46% in England — which the Commonwealth Fund ranked as the No. 1 healthcare system in the world. Finally, the Commonwealth Fund study also ignores massive problems with actual access to care in the countries it heralds. Every citizen of a country with socialized medicine may have insurance. But that doesn’t mean they can get the care they need. Treatment delays were so chronic in the United Kingdom, for example, that the government had to issue a formal requirement that patients shouldn’t have to wait more than four months for treatments authorized by their general practitioner. The Royal College of Physicians found that poor care — including doctors trying to keep costs down — caused nearly two-thirds of asthma deaths in the U.K. in 2012. In Canada, the average patient seeking an elective medical service has to wait four-and-a-half months between being recommended for treatment by their primary care physician and actually receiving it. Waiting for care is the norm in Canada, even though Madam Chief Justice Beverley McLachlin of the Canadian Supreme Court declared nine years ago, in a ruling holding a ban on private health insurance in Quebec illegal, “Access to a waiting list is not access to healthcare.” The Commonwealth Fund is right about one thing — the U.S. healthcare system is too expensive. But rationing care — as Commonwealth’s favored systems do — is not the answer.