Wednesday, August 22, 2007

Stossel on U.S. Health-Care Rankings

The always well-informed John Stossel at

The New York Times recently declared "the disturbing truth ... that ... the United States is a laggard not a leader in providing good medical care."

As usual, the Times editors get it wrong.

They find evidence in a 2000 World Health Organization (WHO) rating of 191 nations and a Commonwealth Fund study of wealthy nations published last May.

In the WHO rankings, the United States finished 37th, behind nations like Morocco, Cyprus and Costa Rica. Finishing first and second were France and Italy. Michael Moore makes much of this in his movie "Sicko."

The Commonwealth Fund looked at Australia, Canada, Germany, New Zealand, the United Kingdom and the United States -- and ranked the U.S. last or next to last on all but one criterion.

So the verdict is in. The vaunted U.S. medical system is one of the worst.

But there's less to these studies than meets the eye. They measure something other than quality of medical care. So saying that the U.S. finished behind those other countries is misleading.

First let's acknowledge that the U.S. medical system has serious problems. But the problems stem from departures from free-market principles. The system is riddled with tax manipulation, costly insurance mandates and bureaucratic interference.

Most important, six out of seven health-care dollars are spent by third parties, which means that most consumers exercise no cost-consciousness. As Milton Friedman always pointed out, no one spends other people's money as carefully as he spends his own.

Even with all that, it strains credulity to hear that the U.S. ranks far from the top. Sick people come to the United States for treatment. When was the last time you heard of someone leaving this country to get medical care?

The last famous case I can remember is Rock Hudson, who went to France in the 1980s to seek treatment for AIDS.

So what's wrong with the WHO and Commonwealth Fund studies? Let me count the ways.
Folks, what you’re about to read illustrates the difference between those rare journalists like Stossel who “dig” and “read the documents” and most MSM reporters who simply base their stories on “the handouts.”
The WHO judged a country's quality of health on life expectancy.

But that's a lousy measure of a health-care system. Many things that cause premature death have nothing do with medical care. We have far more fatal transportation accidents than other countries. That's not a health-care problem.

Similarly, our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada.

When you adjust for these "fatal injury" rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation.

Diet and lack of exercise also bring down average life expectancy.

Another reason the U.S. didn't score high in the WHO rankings is that we are less socialistic than other nations.

What has that got to do with the quality of health care?

For the authors of the study, it's crucial. The WHO judged countries not on the absolute quality of health care, but on how "fairly" health care of any quality is "distributed."

The problem here is obvious. By that criterion, a country with high-quality care overall but "unequal distribution" would rank below a country with lower quality care but equal distribution.
The rest of Stossel’s column is here.

It’s a pity more MSM reporters aren’t as smart and hard-working as Stossel. With more information and better analysis of health-care statistics, Americans could lead healthier lives.


Anonymous said...

John - Great review of Stossel's article. Two points to note. I do not think the UN report on life expectancy was adjusted for demographics. White populations, as found in Europe, have higher life expectancies than non-white populations. Secondly, the murder rates Stoessel cite for the US relative to UK seems to be out of date. The US rate as of 2003 was only 3.5 times the UK rate, and not 10 times the UK rate. Historically, the relative rates are of an order of magnitude of about 5 times. See
Finally, you mention how the MSM media in general and the New York Times in particular have handled the story. It is not wonder they are losing readership. As Abe Lincoln said, you can fool some of the people all the time and all the people some of the time, you can't fool all the people all the time. People are figuring out that what is true is not in the MSM and what is in the MSM is not tru.e

Anonymous said...

Do I really have to posit that the US healthcare system has serious problems? I think that is true only if you can measure a gap between the existing system and a possible system that could exist at the same moment in time if everything worked, somehow, perfectly.

So, by that measure, Wal-Mart would have a Supply Chain with serious problems. Uh, huh.

Anyway, when was the last time that the UN got their numbers right? Oil-for-food? The peace keeping force required to actually keep the peace in Rwanda?

Count me out.


locomotive Breath said...

Tell me again what's so great about Canadian healthcare? A city of 1 million can't handle 4 neos?

No room at the inn

Don Surber

The Dionne quintuplets were born on May 28, 1934, to a humble, French-speaking couple in a farmhouse outside of Callander, Ontario, Canada. They were identical sisters and for the first 10 years of their lives, the five girls were the No. 1 tourism attraction in Canada.

Then came free health care for all Canadians. Which is why the four identical Jepp sisters were born in Great Falls, Mont., instead of Calgary this weekend. The Canadian parents flew 325 miles to get to an American hospital.


Locomotive breath said...

UK cancer survival rate lowest in Europe

By Nicole Martin

Cancer survival rates in Britain are among the lowest in Europe, according to the most comprehensive analysis of the issue yet produced.

England is on a par with Poland despite the NHS spending three times more on health care.

kbp said...

Thanks John

A bit OT, but I wished to point it out.

...When was the last time you heard of someone leaving this country to get medical care?"

Micheal J. Fox

Of course that results from the slower process in approval of drugs and procedures here, but he did leave this country for treatment of Parkinson's. A slip in the research in the article.

Anonymous said...

I suspect a moderately high number of people (1k?) leave the US every year to get drugs unavailable in the US.

Some of what they go after is Laetrile (remember that?) and some is stuff that *should* be available here but it isn't.

Note that these are drugs not on the formulary, not drugs that are unavailable due to money/training issues.

I suspect the number of in-migration folks coming after drugs they aren't *allowed* to have in their countries is much higher. Witness the Canadian quints, et. al.

We can talk about Medical Tourists and India if you want, but that is a whole 'nother subject.


Anonymous said...

Having lived both in the US, and UK, I believe I can attempt to offer a frank assessment of both.

I'm in the UK now. For basic care and preventative care, the UK is tops. I pay nothing beyond taxes and get to see a GP immediately. For specialist care, socialized medicine is not very good. Getting to see a specialist varies by region and problem.

However, it should be noted that you can buy private health insurance in the UK, something that essentially allows you to jump first into line. Because of socialized medicine (people willing to take the government's program), private healthcare is pretty cheap. One thing I don't miss is the co-payments, the payments before co-payments, etc. Also, if I need emergency care, there will be no 10% co-pay bill that could cost upwards of 25,000 in the US.

So there are pros and cons.

Anonymous said...

Anon - "I pay nothing beyond taxes".

Yeah, well, I have paid taxes in the UK (44% of my paycheck if I recall) and Australia (48.9% of my paycheck). Oh, and runious GST (12.5% in Oz) and other taxes on everything purchased.

My total payroll taxes in the US are around 34%. Any my 'regular' purchase taxes are 5% or so.

So, in Oz I can pay 49% on my gross and 12.5% on my net and get "Free" healthcare.

In the US I can pay 34% on my gross and 5% on my net and buy healthcare.

The last time I bought healthcare on the open market (5 years ago) for a family of 5 it cost me 3% of my gross.

So, under the American system I can get good healthcare and have more take home and more spend.


Also, I will note that the wait for a dentist in Brisbane is 7 years for non-emergency and in Sydney it has recently been "improved" to 4-5 years. Not to make British dental jokes, but how long to get on a regular 6 month preventative dental care regime in the UK these days?


Anonymous said...

I'm actually taking more home in the UK (about 69%) than I was in the US (about 65%). Both include healthcare and pension deductions. In the UK it comes through taxes, and in the US it comes through buying an overpriced healthcare plan sponsored by your employer. I was able to see a dentist right away off the NHS in the UK. Costs were much lower. In terms of VAT, yes they're higher, but I'm saving by not having to own a car because public transport is much better. Some things are good, some aren't--I'm not one for blanket statements.

Jestak said...

When you adjust for these "fatal injury" rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation.

I posted a comment over at Mankiw's blog on this issue. Stossel is flat-out wrong in this factual claim. If homicides and traffic accidents (the "fatal injuries" Stossel refers to) were zero in the US, there would still be at least 16 countries with life expectancies higher than in the US.

Anonymous said...

good to know are health care dosen't suck just are poor transpotation system, lack of understanding in each other, and that we are fat and not so happy. i feel much better now!