Health Care: Where Do We Rank? [Hint: Not High]
Now that the ‘debate’ over health care has calmed somewhat from the ludicrous to the merely ridiculous I thought it might be timely to inject a little actual research into it. You know, like, facts.
The problem with the ‘debate’ is that it is not a ‘debate’ at all. On one side we have reformers like myself who want to change the current system for one reason or another. And on the other are arrayed a goodly number of folks who want no reform at all. So there is no ‘debate’. When one side’s position is simply ‘no’, you can’t make subtle concessions or search for a middle ground. There is none. Within the reformist camp there are a wide range of positions from the ‘tinkerers’ to the ‘complete overhaulers’, so it’s possible to have a debate within that camp. But with the opposition: not a hope. They’ve dug in and are willing to use every slur and epithet in the book to prevent sense or calm dominating.
Why?
Maybe they understand the situation.
Maybe they see just how rotten the current set up is and are comfortable with its rottenness. Like an old shoe: we need to replace it but this one fits so well …
Frankly I am sick and tired of people telling me that our system is the world’s best without being able to back that statement up. By what criterion?
Rating health care systems comparatively is a complex task. Different societies value different things. So there is no easy way of looking at all the world’s health care systems and producing a score card for us to check where we stand.
But the World Health Organization has done exactly that. They examined the different systems of all its members – pretty much all the nations of the world – and came up with a classification method so that we can see where we rank.
The WHO is much less concerned whether someone in Manhattan can get immediate face lifts than whether a country’s population at large has access to basic care. After all the idea is not to compare the care available to just the wealthy, it is to evaluate the entire system and its delivery of care to the entire population.
In other words the efficacy of the system as a whole is what matters not just its highlights.
And the US falls flat. Horribly flat.
The WHO report dates from 2000, so there may have been some movement in the rankings since. Even so I doubt wheteher any of us would have expected that the US ranks as low as it does. Especially given the amount of money we spend.
We rank 37th.
Right underneath Costa Rica, but just ahead of Slovenia. The French are top.
How can this be?
We spend twice as much per person as the French and we rank 37th? After Costa Rica?
The answer has to be that we spend a disproportionate amount on non-care things within the system. Things like insurance company administration. Duplication of effort is rife because our system is so fragmented. Paperwork is everywhere absorbing huge amounts of money that never flows to actual care. Our system is relies on market forces to keep it efficient, but it has been co-opted by the big insurance companies and the big businesses who supply care as a benefit – the effect is that competition is severely reduced. We have a state driven system too: a small business cannot shop across state lines to get a better deal. The system reeks of oligopoly and price fixing. And it is not comprehensive: millions of our fellow citizens are not covered, which raises the cost to the rest of us when they turn up in the emergency ward.
In fact our system is the poster child for failure.
And yet I keep hearing this story about it being the best.
Is that simply denial? Is it malicious? Is it driven by an obsessive ideology?
It doesn’t matter: the fact is that in the only credible comparative analysis available at the moment we rank 37th. Right after Costa Rica. Just ahead of Slovenia.
That just sucks.
We have created the world’s least efficient, most expensive, Rube Goldberg, junk heap of a system in a haphazard, ad hoc way. And it is a failure.
Time to fix it. Before it sweeps us away in a sea of red ink and ineffectiveness.
