American Health Care System is Atrocious

Kevin Drum links to a cross-country study of health outcomes undertaken by the Commonwealth Fund. Basically, in a detailed study of six countries-- Australia, Canada, Germany, New Zealand, the UK, and the US-- America ranks last along an array of indicators, including: quality care, access, efficiency, equity, and healthy lives. And while the US spends far more on healthcare than elsewhere, it is the only country in the sample not to guarantee universal health insurance, which explains the poor outcomes along the access and equity dimensions. But the US falls down in other areas too.

Let's start with quality. The US scores poorly when it comes to chronic care management and safe, coordinated, and patient-centered care. As Kevin Drum notes, "when it comes to various sorts of preventable medical errors, we're absolutely terrible." It lags in the adaption of information technology.

In terms of access, the US is at the bottom of the heap, even though those with insurance can easily access specialists. The problem is not that access is denied by long waiting lists, but (more insidiously), by costs.

How about efficiency? Still at the bottom. Given the huge outlays and poor outcomes, the US receives an appalling return on its healthcare investment. Of course, much is eaten up in insurance company administrative costs, costs that single payer systems (think Medicare) can avoid. And in the US, patients tend to end up in the emergency room for cases that should be dealt with by a primary care physician.

Equity. Here I will quote directly from the executive summary: "Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick, not getting a recommended test, treatment or follow-up care, not filling a prescription, or not seeing a dentist when needed because of costs." A staggering 40 percent of lower-income Americans reported avoiding seeing a doctor when sick during the past year for cost reasons.

And finally, healthy lives. Death rates in the US from "conditions amenable to medical care" are 25-50 percent higher than elsewhere in the study. Appalling.

You know, John Edwards is one of the few national politicians talking about the need for universal health insurance. And yet the Republicans can only babble on about his haircuts. Talk about Nero...