Measuring Health Care Success

As a defense of our current health care system I often see quotes from those on the right about what foreign dignitary / celebrity / personality is coming to America to have their medical procedure. It seems like they think this some how proves our current system is great and that the Patient Protection and Affordable Care Act is awful or at least unnecessary.

Unfortunately, this simplistic correlation is not supported by the reality. In a paper by the Robert Wood Johnson Foundation it was reported that "Among 19 countries included in a recent study of amenable mortality, the United States had the highest rate of deaths from conditions that could have been prevented or treated successfully." and "Many Americans would be surprised by the findings from studies showing that U.S. health care is not clearly superior to that received by Canadians, and that in some respects Canadian care has been shown to be of higher quality."

In part, our failure in health care can be attributed to our free market society. In the United States 70% of our physicians are specialists. This happens because a specialist in the US can make twice that of a general practitioner. This monetary incentive gives us some of the best specialists in the world, so when some one wants the best doctor for a specific aliment the come to the US. The problem is, such a focus on specialized medicine, leads to worse outcomes. An article published in Health Affairs shows "lower mortality rates where there are more primary care physicians, but this is not the case for specialist supply."

If the belief is that higher pay gets us better doctors I wouldn't take an issue with that. I would, however, point out that if more money gets us better doctors then the same is true of teachers, yet many on the right have stated repeatedly that more money will not improve education. Either money is important in hiring the most qualified staff or it isn't. In our current system more money leads to better specialists but worse outcomes.

Another fallacy of the American health care system is the rhetoric surrounding wait times. Bloomberg Businessweek reported "both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems." If wait times are one of the biggest failings of universal health care systems then it is also a failing of our current system.

The worst result of our obsession with specialized medicine, however, is the cost. A paper by the American College of Physicians found that "The evidence for the value of primary care (general practitioners) is clear: better quality of life, more productive longevity, and lower costs as a result of reduced hospitalization improved prevention and better coordination of chronic disease care."

Of course the area where the American health care system is most inferior is coverage. Most other industrialized countries cover close to 100% of the population while the US leaves around 16% uninsured for medical care. Given that having insurance is linked to improved health, a lack of coverage is yet another area that diminishes the claim that "America has the best health care system in the world".

There a plenty of areas where our Health care system is the best but to use anecdotal evidence to support the fallacy of America's health care superiority is counterproductive. There is no reason that our system can't be improved. Rationalizing our health care system failures with foreign dignities proves a lack critical thinking not US dominance in health care.