Ranking the U.S. Health-Care System
The World Health Organization’s 2000 World Health Report Uses Flawed Inputs to Produce Distorted Results
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Tags: Commonwealth Fund • government-supplied health care • Gro Harlem Brundtland • health care • health insurance • Michael Moore • Sicko • socialized medicine • universal health care • WHO • World Health Organization • World Health Report
It is curious that the United States ranked below Europe in the World Health Organization’s 2000 World Health Report, which rated 191 countries’ medical systems. In his documentary Sicko, socialist Michael Moore makes hay out of the fact that the United States placed 37th, behind even Morocco, Cyprus, and Costa Rica. This ranking is used to “prove” that state-controlled health care is superior to the “free market.”
This ranking is curious because the actual life expectancy of the average American differs very little from that of the average European. At birth, average life expectancy in the European Union is 78.7. For the average American it is 78. And this doesn’t adjust for factors that can affect the averages which are unrelated to health care, such as lifestyle choices, accident rates, crime rates, and immigration. Health isn’t entirely about longevity but it certainly is a major component.
What is not mentioned by Moore, or others citing the WHO report, are the measures being used to rate the various countries and who is doing the measuring. There are many ways to nudge ratings in one direction or another that are not directly related to the actual item being measured.
For instance, one might produce a study on transportation. The purpose of transportation is to get people from where they are to where they wish to be. You might rate how quickly people can move, how cheaply they can move relative to their income, how conveniently they can move, and how free they are to move.
You would think the United States would rate high in such a study. Americans tend to be wealthier than the rest of the world. There is widespread ownership of cars. Gasoline prices are lower than in most other countries. On average, the typical American can travel quicker, cheaper, and more conveniently than people in most parts of the world. But what if this index included other factors as well? For instance, if a major component was the percentage of commuters who use public transportation, that would push the United States far down in the ranking. A larger percentage of the people in other countries have no other option but public transportation.
In 2000, when the report was issued, WHO was run by Gro Harlem Brundtland, a former prime minister of Norway and a socialist. She doesn’t think the results of a health system alone are important. Rather, she wants to know if the system is “fair.” In introducing the WHO report she wrote that while the goal of a health system “is to improve and protect health,” it also has “other intrinsic goals [that] are concerned with fairness in the way people pay for health care.” She is clear about the ideological factors she thinks are important: “Where health and responsiveness are concerned, achieving a high average level is not good enough: the goals of a health system must also include reducing inequalities, in ways that improve the situation of the worst-off. In this report attainment in relation to these goals provides the basis for measuring the performance of health systems.”
True to her ideological roots, Brundtland prefers socialized medicine over private care. Drawing her first conclusion about what makes a good medical system, she declares: “Ultimate responsibility for the performance of a country’s health system lies with government. The careful and responsible management of the well-being of the population—stewardship—is the very essence of good government. The health of people is always a national priority: government responsibility for it is continuous and permanent.”
One WHO discussion paper states, regarding “fairness” in financing, “we consider only the distribution, not the level, as there is no consensus on what the level of health spending should be.” Equal results, not necessarily good results, are the focus.
When Moore or others refer to the WHO index as proof that private health care doesn’t work, they aren’t being totally honest because they fail to disclose that the index lowers the scores of systems that don’t satisfy socialist presumptions.
A Second Rigged Study
The New York Times in August editorialized that American health care “lags well behind other advanced nations.” The newspaper relied in part on the WHO rankings as proof. For the rest, it relied on a more recent study by the Commonwealth Fund. But that study, which compared the United States to five other wealthy countries, has weaknesses similar to the WHO study.
The Commonwealth Fund marked down the United States partly because “All other major industrialized nations provide universal health coverage, and most of them have comprehensive benefits packages with no cost-sharing by the patients.” Again the American system loses points because it doesn’t provide socialized medicine. And the Times neglected to note that “no cost-sharing” means the people have paid through taxes whether they receive the care or not.
Non-Emergency Visits
The United States also was penalized because seeing a physician for non-emergency reasons is harder to do on nights and weekends than in the other five nations. The Fund said “many report having to wait six days or more for an appointment with their own doctors.”
The survey didn’t look at the treatment of serious conditions. Waiting weeks or months for chemotherapy is not held against a health-care system, but waiting a few days to have a check up is. Waiting time for “elective” surgery is counted (the United States was a close second to Germany), but waiting time for non-elective, serious surgery did not count, though that is precisely where socialist systems do the worst.
This issue is not unknown to the Commonwealth Fund. In 1999 it published The Elderly’s Experiences with Health Care in Five Nations, which found significant delays for “serious surgery.” Only 4 percent of the American seniors reported long waits for serious surgery. The rate was 11 percent in Canada and 13 percent in Britain. For non-serious surgery the differences were more obvious: 7 percent in the United States, 40 percent in Canada, and 51 percent in Britain.
In the latest survey, the United States came in dead last for health “safety,” but many of the scores were only a few points apart. For instance, 15 percent of American patients said they “believed a medical mistake” had been made in their treatment within the last two years. Notice this is merely patient perception and nothing objective. But the best score was in Britain, where 12 percent said this.
The United States is also marked down because 23 percent of patients report delayed or incorrect results on medical tests they took. That is far worse than the best country, Germany, at 9 percent. But what constitutes a delay? If a result is expected in a week but takes two, that is a delay. But if it is expected in three weeks and arrives then, that isn’t a delay. Thus what constitutes a delay depends on expectations, leading to counter-intuitive results.
The United States also lost credit because fewer Americans report having a regular doctor for five years or more. But Americans are more mobile than many other people. CNN reports that Americans move every five years on average. In comparison, Britain has a moving rate of 10 percent a year, or an average of once a decade. And 60 percent of those move about three miles.
Freer to Change Doctors
Americans are also freer to change doctors if they wish. Britain requires patients to sign up with physicians, and once they do so, they are pretty much stuck unless they want to end up on the waiting list of another physician. Patients often have to wait to get on the books of a physician and only then can they be treated; that is, they wait to get on a wait list. This is true even for heart transplants. The inevitable waiting is a disincentive to change doctors.
Another measure used by the Commonwealth Fund is centralization of medical records. If a country has a system that allows doctors anywhere to tap into the patients’ records, it is rated higher. The United States has no centralized database and so is rated lower. Many Americans may prefer to have their records private and dispersed. When the Clinton plan was proposed in 1993, one of the rallying points that helped defeat it was the centralization of health records.
Out-of-pocket expenses were counted against a system as well. In socialized health care these expenses are zero or very low but are replaced with taxes. Taxes, however, don’t lower a country’s score because the care “is free.”
Countries were also judged on the number of patient complaints. But different cultures have different attitudes toward complaining. Jeremy Laurance wrote in the Belfast Telegraph recently that the National Health Service needs “a healthy dose of American belligerence.”
Finally, the United States is ranked last among the six nations surveyed in infant mortality. What is not discussed is that nations define infant mortality differently. Any infant, regardless of size or weight or premature status, who shows sign of life is counted as a live birth in the United States. Germany, which ranks number one in the Commonwealth Fund survey, doesn’t count as a live birth any infant with a birth weight under 500 grams (one pound). How valuable is a comparison under those circumstances?
One could easily design a survey that would rank American health care high and other nations low. But this does not mean the American system is what it should be. Its successes and innovation can be attributed to the vestiges of freedom, but government has saddled the system with so much intervention that it is far from market oriented. Instead of worrying about irrelevant international rankings, we should be working toward freeing the medical market.
Comment by Matis on 15 April 2009:
Free health care market, free wall street… yeah, right…
Comment by Jaime on 4 May 2009:
Why don’t we just rig a study so that we can win?
We have a socialist system too in case you didn’t realize. It’s just hidden so that we can claim we aren’t socialist. The uninsured are covered by our higher insurance premiums on both individuals and corporations and higher govermental taxes.
The only real difference is that now the insurance companies get to raise our rates at will in order to increase their profit margin, and there are numerous people dying because they can’t afford care (unlike Europe).
People come to the United States to get care because we have the most technologically advance medical care. It’s not our system of medical payment but our education system people flock to. If you have the flu, you’d much, much rather be in Canada. If you have lung Cancer, the U.S. is the place to be. Once other countries catch us in education and technology, our system will be exposed as the burden it is.
If you want to criticize the WHO, do a real analysis of the topic like the WHO. Don’t just pump rhetoric and point fingers.
Comment by Gerard on 5 May 2009:
Interesting. We do not have a socialist system though. We have a Fascist one, though that is not meant to be inflammatory. We have each state regulating health insurance, what can be covered, what must be covered, etc. You cannot buy the health insurance of your own choosing, so it is a bit ridiculous to say we either have a free-market or socialist system of health care payments.
If a national health insurance system is the way to go, I say, let the free market build that system. Close down the various Departments of Insurance, let Health Insurance companies sell policies nationwide, and end the tax break for having it through your employer. Let people choose.
If that doesn’t work, than at least you have the national networks in place to proceed with your socialization plans.
Also, I very much enjoyed the comment about if you have the flu, you would be better off in Canada but if you have cancer, you are better off in the US. Than was pretty funny. You couldn’t have undermined your own argument more thoroughly. Good job.
G-
Comment by John Anello on 30 June 2009:
If we had true insurance instead of pseudo-subsidies we would have ranked even lower on the WHO list, which would have been even better for us. I like the WHO acronym too, but I feel it is incomplete. It should be followed by WHOM. That would describe their vision for healthcare quite well.
Comment by Steve on 30 June 2009:
As a 60 year old evil physician I hope I live another 15 years to watch those of you who want government medical care complain once that is the only care option you have. I’ve seen medicare deny effective treatment and diagnostic options for years while they were available to those with private insurance or paying cash( yes that is possible) if you are not a captive senior citizen. Do be careful what you wish for, it might come true.
Comment by James Madison Fan on 1 July 2009:
I don\’t think health care in the US is as broken as some would like us to think. You don\’t see people flying to Canada, France, or Morocco to get state-of-the-art treatment. So we must be doing something right.
I don\’t think the disparity of the education is much of an issue, except in the case of Morocco obviously. I\’d offer that any study that ranks Morocco ahead of the US in any technology is suspect on a prima facie level.
I don\’t think nationalized health care as proposed by Obama is the \"cure\" for what afflicts the current system but he is correct when he points out it could be better.
It doesn\’t make sense to pay $250 or more in taxes for an emergency room visit that would have cost $50 if the patient had gone to see a GP. There are even more costly scenarios such as a minor injury easily treated with a bandage and antibiotics becoming infected resulting in a hospital stay or amputation costing the tax payer tens-of-thousands of dollars. We’re going to pay for treatment one way or the other so we should be looking for the most cost effective way to do it.
In addition to this people that enter the US illegally quite often bring stunning new communicable diseases or drug resistant versions of old favorites such as Tuberculosis and we don’t want them spreading the plague because they can’t afford to seek treatment.
There is definitely something to be said for putting together some sort of system that allows the uninsured to seek treatment before it becomes a fiscal nightmare requiring thousands or even millions of tax payer dollars to rectify.
Comment by John Anello on 1 July 2009:
James Madison Fan,
As usual, you are right. Illegal immigration and the imperfections in our healthcare system are intimately linked. Illegal aliens generally cannot see a GP, they lack the identification and insurance to do so; instead they use the emergency room for even the most mild of illnesses. The Emergency Medical Treatment and Active Labor Act (EMTALA) requires that every U.S. emergency room treat people regardless of their ability to pay for it. The act is so vague in its definition of an “emergency” that it can be interpreted to mean almost anything.
If our politicians are serious about healthcare reform they would immediately repeal this horrid and unjust law. Don’t hold your breath.
Comment by James Madison Fan on 8 July 2009:
I\’m kind of torn about EMTALA. I\’m against it for the most part but I find the concept of a hospital doing a credit check before they decide if I\’m worth saving or not to be offensive.
\"I\’m sorry Mr. Anello, but you were late on your last mortgage payment and your credit rating is only 567, so we\’re not going to treat your gapping chest wound.\"
I\’d like to limit it to US citizens but what if I get robbed and shot so I don\’t have my Social Security Card? Do they set me off to the side until they check with ICE to find out if I\’m eligible?
So as much as I hate it, I\’m not sure if there is a preferable alternative?
Comment by John Anello on 8 July 2009:
My criticism of EMTALA is it is far too broad in its definition of an emergency. I think all use of ERs by those unable to pay should be prohibited except in cases of life-threatening circumstances.
It is absurd to expect the ER to render services to individuals who are unable to pay for them. Who should pay for them? The statist would say the taxpayer, what do you say?
Comment by James Madison Fan on 9 July 2009:
If I were King EMTALA wouldn\’t exist, at least not in its current format. If given the option between status quo and nothing at all, I\’d go with nothing.
Unfortunately I\’m not King.
So now I\’m faced with the mother of all unfunded mandates. This either raises the cost of an ER visit to offset the bad debt or it bankrupts the ER entirely. Every time an ER closes this puts additional strain on surrounding ER\’s making it more likely they\’ll close too thus reducing emergency services so patients are 5, 10, 15+ minutes further away from life saving treatment. None of this sounds good to me.
I\’m not a Nationalist but I really hate unfunded mandates especially when they screw entire communities. Since someone has to pay, if the government wants these hospitals to treat every little problem like it is an emergency regardless of if the patient can pay or not then the government should pay the tab rather than the hospital.
By setting up an EMTALA fund it takes the burden off of the ER\’s as well as providing concrete numbers as to how much the program costs. The government doesn\’t pay much attention to the scads of money spent on funded programs so the level of apathy and contempt an unfunded program warrants is of Biblical proportions. Until we can nail down how much EMTALA costs and drop this multi-billion-dollar-boondoggle at the foot of some politician, there is exactly zero incentive to change it. As of right now it costs us “nothing” so why change something if it is “free?”
In addition to this there is the potential it could reduce the cost of health care and especially emergency health care since hospitals wouldn’t need to bump prices into the stratosphere to offset the bad debt. I\’m not sure what the percentage would be but in looking at the costs of health care in 1986 and what they are relative to now it would be a pretty good start.
Comment by John Anello on 9 July 2009:
“if the government wants these hospitals to treat every little problem like it is an emergency regardless of if the patient can pay or not then the government should pay the tab rather than the hospital.”
But government can’t pay the tab. The only action the government can take is to compel taxpayers to pay for each other’s healthcare regardless of their individual ability to do so. The government produces nothing; its only source of revenue is taxes. To say that government should pay for the healthcare of its citizens is to say that individual taxpayers should pay for their neighbor’s healthcare regardless of the neighbor’s ability to pay. Another example of why the government should not interfere with healthcare, they just complicate things with their Who…Whom logic.
Comment by James Madison Fan on 9 July 2009:
True but I already admitted I\’m not King so I\’m looking at what is as opposed to what isn\’t and won\’t be.
Vox Populi, Vox Dei.
Unfortuately the gods are stupid.
It is the tax payer\’s responsibility to pay because we, The People, are the ones that voted the idiots into office, continue to support the idiocy, and for some unknown reason want to expand the idiocy into nationalized health care ala Obama. Why? No idea. Ask Nancy Pelosi because I am sans clue.
If \"The People\" want EMTALA they need to pay for it rather than expecting private hospitals to eat the cost. If they don\’t want to pay for EMTALA they need to make it clear to their representatives becaue the status quo is inviolate otherwise.
We either get rid of it or keep it and pay for it. Keeping it an not paying for it seems to be a strange kind of slavery which \"unfunded mandate\" seems inadequate to define.
This is what we\’ve got so how about we try and do it right rather than spending 5, 10, 20, 100 times more money than is necessary and bankrupting ER\’s in the process?
I don\’t like it. You don\’t like. Life sucks. Oh well. Let us, my friend, mitigate the damage as best we can while we weep into the drams of our cups.
Comment by James Madison Fan on 9 July 2009:
Oh hey. A friend of mine just read this and said the last line might sound flippant and dismissive. It was meant to be a jovial sharing of a mutal disgust.
Comment by John Anello on 10 July 2009:
“In every democracy, the people get the government they deserve.”
-de Tocqueville
I suppose with EMTALA we are getting what we deserve for electing these statist to Congress. It does seem unfair though, Nancy Pelosi gets elected by a group of left wing lunatics in San Fransicko and the enitre country has to suffer. But I suppose the benefits of democracy far exceed the drawbacks, although I am begininng to wonder.
Comment by mo on 10 July 2009:
Haha, “Fan of James Madison”. I do have a weird take on what you wrote (which is slightly flippant while being more facetious than dismissive).
The US Government must be trying to teach me to be self-reliant (and to “mitigate the damage as bet [I] can”).
Yes, you most likely read that correctly. For what can be the opinion of any other 26 yrr old of the people who brought about “Social Security”? If I’m not to expect any benefits from that (wonderfully masterful?) plan of theirs while still paying for a few of its beneficiaries how can I expect to receive any benefit from this proposed health care reform? Instead I’ll have to fund my own triple bypass surgery in 24yrs time (once the government tells me that they ran out of funds), while I probably end up paying for the surgeries of a few of my fellow voters.
Comment by James Madison Fan on 10 July 2009:
\\\\&quot;The best arguement against Democracy is a 5 minute conversation with the average voter.\\\\&quot; – W.S. Churchill
If Nancy were a loan voice screaming at the ocean it wouldn\\\\\\\’t be a problem but rather than being in the minority the insanity of a single party system reigns amd Frankin makes if filibuster proof.
I loathed McCain ever since he co-authored the Simpson-Mazzoli Act Revisited but I voted for him because I didn\\\\\\\’t want to see a Democratic rubber stamp committee form but here it is.
I envision a whole bunch of \\\\&quot;free\\\\&quot; programs for those that voted him into office financed by the \\\\&quot;rich.\\\\&quot; Unfortunately the programs aren\\\\\\\’t going to be free and the rich will be defined as anyone that goes to work someplace where you don\\\\\\\’t have to ask, \\\\&quot;Would you like to supersize that meal?\\\\&quot;
Comment by James Madison Fan on 10 July 2009:
Why is it other people don\\\’t seem to have the same problem with quotes and other select punctuation marks that my posts do? Strange.
Comment by Karl Sandberg on 27 July 2009:
In consideration of Obama-care the news media (including Fox, by the way) has allowed the President to dictate the terms of the debate. He is focussing on insurance coverage and the news media is going along with him. “Coverage” is only one aspect of the discussion, and I believe it is a less important aspect than “access.”
We all agree that everywhere universal coverage has been tried, there is insurance coverage but limited access to care.
With our current health care in the US we have access to care, but limited insurance coverage.
We can walk into any hospital and get treatment. We may end up with a bill, but at least we get treated. Under universal coverage such as is in Canada, they don’t get a bill, but their access to the actual health care is markedly limited. Many, many thousands of Canadians come to the U.S. each month for care they cannot get in a timely manner in their own country.
Remember this: ACCESS IS BETTER than insurance coverage. It’s the actual care you want in a timely manner, and we can get it in the US. It is very difficult to get timely health care in Canada even though Canadians never get a bill.
Comment by Dan on 30 July 2009:
The enemy reporting here.
Just like there may be some questions about the WHO study and/or its conclusions, one must question the conclusions and research of the author here.
For example, the author assumes that America has greater freedom of choice of doctors and states that as fact.
“Americans are also freer to change doctors if they wish.”
Where is the supporting evidence? There is none. The closest the author comes to providing any evidence is stating that British patients must sign up to see doctors. So do we! When was the last time you did not sign up to see a doctor? In America you can only see doctors on your insurers approved list, whereas in Britain, they are free to choose without the interference of some bean counter located 3,000 miles away. The author states there is a waiting list to see some doctors in Britain. Same here! Try to get to see a well known and well respected doctor in any city in America. First thing they will tell you is the doctor is not taking new patients. The author does not seem to be making apples to apples comparisons here.
Out of pocket expenses are used because those are what the patients use to determine whether or not they don`t go and risk even worse illness or injury. The point is that access = ability to obtain (physically) treatment and pay for that treatment. If it is there but you cannot afford it, it is worse than meaningless.
Comment by Kleber on 30 July 2009:
Wow, Solomon Islands ranked number 20. Infant mortality and access to all kinds of specialists is more than triple than it is here. I thought that country relied primarily on foreign aid as one of their primaries sources of income. WOW.
Comment by James Madison Fan on 4 August 2009:
Dan,
I do not think you are the \"enemy.\" You have some good points. The thing is that the author is not offering his own health care plan; he is trying to point out that the WHO is skewed and he is right. The WHO cherry picked criteria to make the US system look worse than it actually is so it is no more an “apples to apples” comparison than this article is.
On an intuitive level, do you seriously think the health care in Morocco is better than in the US or do you think that is a function of the standards chosen by the WHO?
The thing is the more I read about Obamacare the more worried I get.
The reason the US is the primary destination for people looking for advanced medical treatment is due to the very \"flaws\" in our system that Obama wants to eradicate.
For instance, technology is driven by dollars. If it were not for \"unnecessary\" and potentially deadly procedures then elder techniques would still be employed. My daughter was born with a heart defect that required a fairly new procedure. In 1995 the survival rate was 5%. In 2000 the survival rate was 50%. In 2005 when she had the operation the survival rate was 95%. If the procedure was not approved in 1995 by some bureaucrat due to the cost relative to the mortality rate then the doctors never would have learned how to do the procedure correctly and my daughter would be dead right now.
That surgery cost a million dollars and was required to keep her alive. Survival without the surgery is 0%. Both my wife and I had insurance so it was not a problem. If Cigna had denied treatment and our daughter died then we could have sued. Under Obamacare we would not have that option due to Sovereign Immunity. So rather than a corporate bureaucrat deciding my daughter\’s fate \"3000 miles away\" I would have had to rely on a governmental bureaucrat \"3000 miles away\" making the same decision without the threat of litigation being held to his head.
If you think this is paranoia I would point out that Obama has already said that it does not make sense to put a pacemaker into a 100-year-old woman so I have to wonder if he would feel the same way for a 3 day old child. Why save her? The parents can always make another one.
I can easily see saving one kid while allowing another to die being contingent on political fallout from hot button issues such as race. \"I am sorry Mr. Dan but we are going to let your kid die but the kid next to him is going to get the operation because we are receiving threats that we will loose the support of La Raza in the next election.\"
Do we want the government having direct access to everyone\’s medical records? They already have too much information about us so I cannot see this as being a good thing.
The thing that bugs me most about \"Obamacare\" is I cannot pay additional money to get better coverage or procedures. Everyone gets the same crappy coverage rather than a tiered approach. Why should I end up visiting Dr. Mediocre because other people do not have a position where they warrant or can afford superior health care? Unless I can afford to hire my own doctors outright I\’m stuck with raw Obamacare and I am not even sure having your own private physician on the payroll would be legal. I find this especially frightening.
I am diabetic and start having problems with my eyes, kidneys, heart, etc. and the government says I do not warrant treatment because they are weight related they can cut me off even though I have been paying into the system my entire life. If Cigna does that I take them to court for breach of contract for failing to provide the service I paid for. The government does not have to worry about providing coverage as long as they find \"legitimate\" reasons to deny coverage while also denying me the right to get my own coverage through a private insurer at my own expense. What do I do then? Fly to Morocco?
The system we currently have works pretty well for the most part so I do not see any reason to reinvent the wheel when we could tweak what we currently have with far less effort, far less money, with far less government control, as well as without having to nationalize a seventh of the US economy.
Comment by Lester Hunt on 11 August 2009:
I first found out about that absurd WHO study just after I had visited a friend of mine, who was in the last stages of terminal cancer and being cared for by Italian medical system. That Italian hospital, and conditions in which he had to live while there, were awful compared with what Americans of the same socio-economic status get. It was an additional shock to see the awful system, that had caused so much suffering for my friend, described as the second best in the world. I later found out it was a big shock to a lot of Italians, too! My first, instinctive reaction was to suppose that the people who did that study, whoever they are, must, quite literally, be insane. Your article offers a much better explanation. Thanks!
Comment by John Murphy on 24 August 2009:
I am a Canadian who, lived in the US for seven years, so I have personal experience with both systems. I concur that the US system being vastly overrated in the minds of Americans. My experience was that, when I looked for health care of the quality I was used to in Canada, I was denied by US Health insurance at every turn. In my 60 years, I have always received quality health care in Canada and found US health care lacking, when I lived there. I have never had the wait times that Americans are so glib to pretend that they \"know\".
I have had two serious surgeries in Canada. One I had all of 4 days between diagnosis and surgery, the other I had 16 days to go from GP to otolarygologist to surgery… a total of 16 days. My mother had bypass surgery at age 72 and had her sugery in under 3 days. She also had cataract surgery at age 77, from diagnosis to cataract surgery was exactly 14 days. This is what wait times in Canada are REALLY like. American myths about Canadian health care are 98% false. The Americans I know who have moved to Canada, once they actually use the Canadian health care, rhey are very pleasantly surprised and most say they would never use the corrupt US system again after having used the Canadian one.
I was disppointed in US health care when I lived there so I fully believe the WHO study to be in line with my evaluation. One main reason the US ranks so low is that 36% of Americans cannot have NEEEDED health care. It is not only the 15% uninsured that everyone talks about. A further 21% of Americans have health care, but not sufficient to cover their NEEDED care. The US is the only industrialized country that does not have universal health care of any kind for its citizens. Americans should be ashamed of leaving 36% of their own citizens to suffer and die from lack of regular health care.
Comment by John Murphy on 24 August 2009:
Typo :
Last paragraph should read:
A further 21% of Americans have health insurance, but not sufficient to cover their NEEDED care.
Comment by WE27 on 24 August 2009:
John Murphy
you are overstating the “suffer and die from lack of regular health care.” The problem with lack of universal health care is the point of entry into care. There are numerous ways to increase the availability of basic care without government run system.
Your experience is great but anecdotal and certainly not universal.
No doubt the US suffers from lack of universal coverage, but no country covers everything, not even Canada. The US cannot cover everything either. Choices will have to be made…..question is…by whom??
Comment by technorebel on 24 August 2009:
It’s absurd to say that anyone in the US isn’t getting needed care. I don’t know of any doctor or hospital that won’t accept
installment payments from a patient. When I was pretty well flat
broke (even though employed) and didn’t have insurance, I paid for
doctor visits by $10 installments.
Furthermore, illegal aliens (or anyone else for that matter), don’t need an ID or insurance to make an appointment with a GP. Only citizens WITH insurance are asked to hand over their ID and insurance card.
Comment by technorebel on 24 August 2009:
John Murphy—
I’m glad you enjoy the healthcare in Canada. But, of all the examples you give, none had anything to do with a serious long-term disease like cancer. That’s where the wait times count.
Comment by James Madison Fan on 25 August 2009:
Mr. Murphy,
I am glad you have had success with the Canadian health care system. The thing you need to understand is that the US government already runs a model of what the universal health care system might look like in the form of Veteran’s Administration (VA) hospitals.
A shining example of the VA system is Walter Reid Medical Center. Once held up as the crown jewel of the VA system, investigations showed it to be toxic-mold infested and vermin ridden lacking even basic security to the point drug deals were taking place in the lobby. It was so bad that patients had to stand watch in shifts so the gravely ill did not have to worry about being victimized. Defense spending in the US is legendary consuming around a third of our annual budget but even with access to such massive resources they couldn’t keep their premiere hospital in reasonable order much less pristine condition.
The problem is that VA health care is hamstrung by a maze of rules and regulations where the doctor spends more time trying to comply with bureaucratic drivel designed to categorize prognosis and compartmentalize treatment than they do attending their patient. The first priority of any doctor should be to the future of the person under his care not some administrative tome.
Perhaps we should be ashamed that every US citizen is not covered by some sort of health care, but this does not mean that we should restart with a completely different system entirely, especially with a system that was rushed and most Congressmen have not read it.
Obamacare nationalizes one seventh of the US economy. I think it deserves far more research and debate before it is implemented because in its current incarnation it is far more likely to do more harm than good.
Comment by Karl Timothy Mantyla on 30 September 2009:
There may be drawbacks with national health insurance, including wait times. No system is perfect. Our current system is extremely flawed, and even barbaric as I’ll demonstrate below.
But the advantages of national health care and a “public option” for most people–especially those with little or no access to health care–far outweigh those drawbacks.
The rich, the well-off or those who are employed can always get their own medical care or insurance, or negotiate it with employers. Trade unions traditionally do this very well for their members.
47 million Americans have no access or very poor access to health care. (These numbers since the recession are now estimated at far higher–and the’re rising.)
Why have American morals and so-called “family values” been ignored in the debate on this issue?
It is absolutely unfair to bankrupt poor and middle-income Americans for health care–then deny them the benefits they’ve paid for!–simply so that CEOs can make billions, collectively, in bonuses and salaries.
In the street that’s called theft. On Wall Street it’s called the “free market.”
In this case, the insurance companies have been allowed the “freedom” to steal from those who can least afford it, as well as leave them to die in some cases. If an ordinary person did that, they’d be imprisoned immediately. It’s not only immoral and un-American, it should be illegal.
Why is anyone defending this unjust, corrupt system? Because they are paid very well to do so, and this includes Congress and lobbyists.
A public option is the best way to keep insurance companies honest–when they have to compete with fairness.
The “free market” is NOT the only or best answer to all problems–unless of course, you’re a CEO in a position to take advantage of others–even when it means they die young and sick while you earn millions, quite literally over their dead bodies.
The public option is not “socialized medicine.” That’s a fear-mongering term used to politicize and galvanize support (on false pretenses) for an issue that is actually about morality, fairness and compassion. And if it is “socialized,” we should be all for it anyway–because it’s the right thing to do.
We support police and fire services, even though most of us rarely use them. That’s a truly socialized aspect of our culture that conservatives and liberals readily support. The same should be true of health insurance.
To further clarify this last point, it’s the insurance that’s being reformed, not the medicine. We need to support fair and quick access to quality medical care for all, no matter how it’s paid for and distributed.
Here’s a stark example of how this works: Would you allow your child, friend or neighbor to bleed to death for lack of insurance? If you were a doctor, would you refuse them treatment unless they paid, and paid up front? If someone gave you millions of dollars to let someone else bleed to death, would you take it?
If you’re an insurance company, you have the option to answer “yes” to all of the above–and you frequently do, just to make more money. This is the pathetic, depraved, barbaric, inhumane–one might say “Roman”–status quo in American health care and health insurance today, 2009.
Not only do we need reform, we desperately need it.
The bottom line: No “public option” leaves out 47 million Americans to bleed to death, stay hurt, die early and painfully like animals in the wild.
Support the humane, public option. Change the corrupt, redundant and cruel American health care system to one that reflects the humane and compassionate values most Americans claim that they support.
Comment by James Madison Fan on 1 October 2009:
Mr. Mantyla,
You are trying to make a case for a socialist intrusion on a Libertarian site. Some posters on here do not think roads, cops, and fire should be socialized much less medical care. In one thread I have people ticked off at me because I had the audacity to offer that Marx was right about wealth pooling in the hands of the rich in a laissez faire market. At the worst this means I am acknowledging a flaw in a system I support but they are acting like I just read a passage from Das Kapital.
Setting aside the political difficulties of the specifics for a moment, I am extremely vexed by the behavior surrounding the issue. The Dems tried to ram this through without anyone noticing. If they were so certain the majority of the nation would support this plan why did they try to implement it covertly? This is no small investment they are asking us to make. In fact it will likely be one of the largest, if not the largest, entitlement programs we have financed or ever will. Trying to sneak a shoddy, incomplete, and reckless bill through Congress in an effort to implement it without legitimate examination of the effects by experts, much less the public, was criminal and undermined confidence in its legitimacy from the very beginning.
A great deal of controversy has been generated by Obama being called a liar when he said that the plan does not cover illegal aliens. President Obama pointed out that the bill specifically prohibits use by illegal aliens while failing to mention that his Democratic brethren have repeatedly fought back Republican efforts to include an enforcement section to the bill. As it stands the only thing an illegal alien has to do to get treatment is say, “I am an American” in his language of choice and he gets free health care out of my wallet.
My next question is out of the 47 million “Americans” that lack health care, what percentage of these are illegal aliens? PEW puts the number at 12 million so that would be around a quarter and some of the more aggressive boarder control sites indicate the number could be as high as 30 million which is more than 60%. So we are going to scrape and redesign our current system so we can cover people that do not belong here in the first place?
In addition to this I have to wonder how many of these uninsured are people that lack insurance intentionally because they do not want to pay the premium or are young adults just breaking into the job market that are unemployed or underemployed in addition to being uninsured or underinsured. Not having cash and benefits is a perpetual state when you are working at the local burger or pizza place. I managed a Little Caesar’s so I could pay for college. Lousy pay. No benefits. If you would have offered me benefits or a raise I would have taken the raise. I didn’t need a doctor. I needed money for gas, books, classes, and chicks.
In addition to this I fail to see the wisdom in completely scrapping something and reinventing the wheel when the current system works for 85% of the nation while providing the best health care on the planet. When someone needs state-of-the-art health care you do not see them flying into England, France, or Germany, they fly to the US.
Even if 15% of the nation is not covered under the current system and we could deal with that by implementing a limited health care system that is based on a valid Social Security Card. All it would take is presenting your SS card or a valid document that proves you are in the country legally to a doctor or hospital and you could get at least limited treatment.
I also have to wonder what sort of health care the US Government is capable of providing. As I pointed out in my previous post the Vet Hospitals are not exactly the apex of medical treatment in this country even with a third of the budget being spent on the military. I have friends that have first hand experience with long drives, long waits, poor care, incompetent doctors, and constant bureaucratic restrictions.
One had a half-ton air conditioning unit dropped on his knee from some sort of artillery unit which left him using a cane. They keep denying him an operation that would allow him full use of his leg because “It is not damaged enough to justify the surgery.” His doctor put his condition at “90%” of what it would take to justify the operation. If this is how we treat someone that put his life on the line for this nation what is going to happen to the average citizen when going to the doctor is like going to the DMV?
In addition to the above I am also concerned about getting approval for a procedure. As it stands if I am denied treatment I can sue the insurance company and force them to pay for legitimate treatment but I cannot do that with the government because they have sovereign immunity. If so bureaucrat at Cigna says no to a multi-million dollar heart procedure for my daughter and she dies then I sue them into Chapter 11. If some Federal Cube Dweller says no and she dies they claim sovereign immunity and I get to pay for the funeral.
These are only a few of the problems I have with universal health care that need to be addressed before I am convinced it is viable alternative to what we currently have. Once they have a realistic plan on a par with the status quo we can debate the socialistic implications of the government competing with or replacing the public sector. For right now that’s the least of my concerns.
Mr. Mantyla,
You are trying to make a case for a socialist intrusion on a Libertarian site. Some posters on here do not think roads, cops, and fire should be socialized much less medical care. In one thread I have people ticked off at me because I had the audacity to offer that Marx was right about wealth pooling in the hands of the rich in a laissez faire market. At the worst this means I am acknowledging a flaw in a system I support but they are acting like I just read a passage from Das Kapital.
Setting aside the political difficulties of the specifics for a moment, I am extremely vexed by the behavior surrounding the issue. The Dems tried to ram this through without anyone noticing. If they were so certain the majority of the nation would support this plan why did they try to implement it covertly? This is no small investment they are asking us to make. In fact it will likely be one of the largest, if not the largest, entitlement programs we have financed or ever will. Trying to sneak a shoddy, incomplete, and reckless bill through Congress in an effort to implement it without legitimate examination of the effects by experts, much less the public, was criminal and undermined confidence in its legitimacy from the very beginning.
A great deal of controversy has been generated by Obama being called a liar when he said that the plan does not cover illegal aliens. President Obama pointed out that the bill specifically prohibits use by illegal aliens while failing to mention that his Democratic brethren have repeatedly fought back Republican efforts to include an enforcement section to the bill. As it stands the only thing an illegal alien has to do to get treatment is say, “I am an American” in his language of choice and he gets free health care out of my wallet.
My next question is out of the 47 million “Americans” that lack health care, what percentage of these are illegal aliens? PEW puts the number at 12 million so that would be around a quarter and some of the more aggressive boarder control sites indicate the number could be as high as 30 million which is more than 60%. So we are going to scrape and redesign our current system so we can cover people that do not belong here in the first place?
In addition to this I have to wonder how many of these uninsured are people that lack insurance intentionally because they do not want to pay the premium or are young adults just breaking into the job market that are unemployed or underemployed in addition to being uninsured or underinsured. Not having cash and benefits is a perpetual state when you are working at the local burger or pizza place. I managed a Little Caesar’s so I could pay for college. Lousy pay. No benefits. If you would have offered me benefits or a raise I would have taken the raise. I didn’t need a doctor. I needed money for gas, books, classes, and chicks.
In addition to this I fail to see the wisdom in completely scrapping something and reinventing the wheel when the current system works for 85% of the nation while providing the best health care on the planet. When someone needs state-of-the-art health care you do not see them flying into England, France, or Germany, they fly to the US.
Even if 15% of the nation is not covered under the current system and we could deal with that by implementing a limited health care system that is based on a valid Social Security Card. All it would take is presenting your SS card or a valid document that proves you are in the country legally to a doctor or hospital and you could get at least limited treatment.
I also have to wonder what sort of health care the US Government is capable of providing. As I pointed out in my previous post the Vet Hospitals are not exactly the apex of medical treatment in this country even with a third of the budget being spent on the military. I have friends that have first hand experience with long drives, long waits, poor care, incompetent doctors, and constant bureaucratic restrictions.
One had a half-ton air conditioning unit dropped on his knee from some sort of artillery unit which left him using a cane. They keep denying him an operation that would allow him full use of his leg because “It is not damaged enough to justify the surgery.” His doctor put his condition at “90%” of what it would take to justify the operation. If this is how we treat someone that put his life on the line for this nation what is going to happen to the average citizen when going to the doctor is like going to the DMV?
In addition to the above I am also concerned about getting approval for a procedure. As it stands if I am denied treatment I can sue the insurance company and force them to pay for legitimate treatment but I cannot do that with the government because they have sovereign immunity. If so bureaucrat at Cigna says no to a multi-million dollar heart procedure for my daughter and she dies then I sue them into Chapter 11. If some Federal Cube Dweller says no and she dies they claim sovereign immunity and I get to pay for the funeral.
These are only a few of the problems I have with universal health care as it stands that need to be addressed before I am convinced it is viable alternative to what we currently have. Once they have a realistic plan on a par with the status quo we can debate the socialistic implications of the government competing with or replacing the public sector. For right now that’s the least of my concerns.
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[...] It might surprise you to learn that these studies rely on the governments to provide data that is then used to create the rankings. Micheal Moore famously announced that Cuba had better health care than the United States, but [...]
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Comment by Dr. Steve on 6 November 2009:
Part of the problem in this is terms. I have a good idea what medical care is, but I do not know what health care is.
Our medical care compared to other nations can best be measured by specific disease or condition treatment outcome. In this we are consistantly at the top. Whether the bang for the buck is worth it I guess in a large part depends if it is your life or someone else’s.
Health care is what ever you want to make it out to be, so stastics don’t really mean much.
As was pointed out, if near birth death stats are not the same in all data, those that do not count premature birth deaths are going to have higher life expectancy at birth. The death of a two day old has a way of screwing up your percentages.
Please judge the medical care as objectively as you can, then decide how much it’s value is to you. Don’t be fooled by “health care”. Your health is largly oyur own responsibility.
Pingback by Why the WHO Country Health Care Ratings are Biased: « Daniel Joseph Smith on 9 November 2009:
[...] http://www.thefreemanonline.org/featured/ranking-the-us-health-care-system/ [...]