Our big health care blind spot

By
Houston Chronicle
January 2, 2007

There's a strange assumption underlying most discussions of health care in the United States: that we've got the world's best care. The obvious question is, "What does 'best' mean?" But that question is rarely asked.
 
This New York Times article raises this very issue, pointing out that our system is far more expensive than anybody else's... but leaves us with shorter lifespans and higher infant mortality rates than many other modern nations, and of course covers a much smaller proportion of our population:

"The story never changes," said Gerard F. Anderson, a professor at the Johns Hopkins Bloomberg School of Public Health. "The United States is twice as expensive with about the same outcome.

"As a consumer, I don't mind paying more if I'm getting more, but that's just not the case in the U.S.," said Professor Anderson, who publishes an annual review comparing the American health care system with those of its peers.

What may be less well known is the level of administrative waste in the United States health care system, versus that of well-designed systems elsewhere. Although Americans tend to equate efficiency with private enterprise, that's not the case with the current system.

The American system, based on multiple insurers, builds in more unnecessary costs. Duplicate processing of claims, large numbers of insurance products, complicated bill-paying systems and high marketing costs add up to huge administrative expenses.

Then there's an enormous amount of paperwork required of American doctors and hospitals that simply doesn't exist in countries like Canada or Britain.

The Times article argues for a single-payer system, but points out that the biggest obstacle to it is our belief that it just can't work - despite examples in other nations of single payer systems producing healthier citizens at a lower cost.

There's only one catch. Most Americans just don't believe it can be done. The health care crisis may turn out to be more of a problem of ideology than economics.

The economic case for a single-payer system is surprisingly strong. Start with what we already know. Countries with single-payer systems have long records of spending less on health care than the United States does. The United States spent an average of $6,102 a person on it in 2004, according to the Organization for Economic Cooperation and Development, while Canada spent $3,165 a person, France $3,159, Australia $3,120 and Britain just $2,508.

At the same time, life expectancy in the United States, a broad measure of health, was slightly lower than it was in those other countries in 2004, the latest year for which complete figures are available. And the United States had a higher rate of infant mortality.

Whether you like the idea of single-payer system or not, it seems reasonable to agree that a discussion of our health care system should start with an honest accounting of its costs, the amount of money that goes into overhead (such as the insurance industry), and the actual patient outcomes.

So why are we, as a nation, convinced that our healthcare is the best when by most objective standards, it's not? Why are we convinced that a single-payer system would lead to a government bureaucracy, when our privatized insurance industry bureaucracy eats up more health care expenditures than the government systems of other countries? Why are we convinced that private insurers must be more efficient, when the most efficient health systems in the US are those run by the government?

As economist Dean Baker points out on his Beat the Press blog, some of the blame falls squarely on the New York Times and the rest of the American media:

The New York Times had a column Sunday that pointed out that other wealthy countries have better health care outcomes than the United States, at a much lower per person cost. While the column included much useful information, it concluded that the main obstacle to reform in the United States is that the public does not have confidence in a government managed health care system.

I would suggest an alternative hypothesis -- the vast majority of the public has no idea how inefficient the U.S. health care system is relative to the systems elsewhere in the world. I have been reading the NYT almost every day for more than 30 years; this is one of the few times I can recall any mention of the relative inefficiency of the U.S. health care system. On the rare occasions when the NYT talks about the health care system in another wealthy country (e.g. Canada, Sweden, England), the article is usually focused on the system's problems, and generally implies that its demise is imminent. I would be very surprised if even 10 percent of the NYT's readers knew that per person health care expenses in the U.S. are more than 60 percent higher than in Canada and more than twice as high as in England, and that both countries enjoy longer life expectancies.

Furthermore, the NYT has a policy of either ridiculing or ignoring politicians who propose reorganizing the U.S. system along the lines that have proven successful in other countries. Remember the extensive coverage given to 2004 Democratic presidential candidate Dennis Kucinich's plan for a universal Medicare system? No one else does either. It was barely mentioned in the media.

Baker is right; our media do a horrible job on providing context for health care stories. While many countries with single-payer systems are experiencing problems, there's one crucial factor that usually isn't mentioned: many of the problems are caused by limited resources, and these countries are putting significantly fewer resources into health care than we are.
If Canada or the United Kingdom funded their health care systems at American rates, I suspect that many of those problems would vanish: nearly doubling the money you're spending can pay for a lot of doctors, a lot of facilities in geographically remote areas (a particular problem in Canada), a lot of dentists (a particular problem in the UK), and so on.

If they spent the money (per citizen) that we do, they'd also be way ahead of us - because nearly a big chunk of it wouldn't be vanishing into the bottom lines of insurance companies.

The American system is a great system if you're part of the industry that feeds off of it, sucking up health care dollars like a tapeworm in somebody's stomach. The question we should be asking is whether we want to spend our money supporting a for-profit industry while enormous numbers of Americans go without routine care, our infants are more likely to die, and our adults are less healthy... or if we might want to rethink the whole proposition.

It's nice to see the New York Times finally talking about financial and patient outcome data that's been around for years. Perhaps they'll start to do their job as a news organization on this topic. I suspect, however, that this is just a blip, and before long we'll be back to stories about how the lack of hospitals in the Yukon or a shortage of dentists in the Isle of Wight proves that single-payer systems can't ever work.