American healthcare seen from Europe
I live in France and am a beneficiary of socialized healthcare. This is a system that certainly has its own set of problems but the difficulties are not, in my opinion, nearly as severe or widespread as the problems in the US.
I recently sat down with a public health expert in Europe who now works for an international pharmaceutical company. He wishes not to be named but was willing to speak about American healthcare. He has read both Obama's and McCains health care plans. I asked him what he thinks of the American healthcare system and what he thinks of private healthcare. Here is one of three conversations we had on the subject.
Blevins: What shocks you most about the American healthcare system?
The most shocking aspect is the ratio between cost and efficiency. If you look at it from a purely statistical viewpoint, this is quite striking. In 2006 for example, 16 % of your GDP was spent on healthcare, an enormous investment, yet in a recent study that assesses the quality and performance of health systems over time in 19 OECD countries, the US was last. If your automobile industry were this inefficient, the US would probably not even qualify as a G8 country.
Blevins: Does this mean that the quality of healthcare in the US is really that poor? Because Americans are mostly concerned about the cost of their healthcare, but there is a widely held belief that we have the best medical facilities and doctors in the world.
Well Americans are both right and wrong about this. Because it's true, most of the top ten medical centers in the world are in the US. This seems like absolute proof of American healthcare quality. But your ability to perform has not kept up with your technological and medical improvements. For instance, when you compare the first analysis of this report, taken in 1997 with results from 2003, you see a definite trend: other countries have made big improvements in the performance of their healthcare systems, compared with the US, whose system has made only marginal gains. So the US has fallen behind the other OECD countries because it has been unable to move forward and adapt to the changing conditions within your country.
Blevins: Does this mean these facilities are only available to the rich?
Not exactly. The problem is more complex than this. Let me explain this using the previous example: if you take the above report I mentioned and you leave out the US, the curve tracking healthcare system improvement is quite steep. And if you take this curve and you apply it to the US in order to determine how many deaths could have been avoided, you find that no fewer than 75,000 people died needlessly in the US in 2002 and 2003 for instance. That's a staggering number of avoidable deaths.
Blevins: So what are the real differences between healthcare in the US and healthcare in the top ranked countries in this report?
The top countries were France and Japan. They were the first when the tracking started in 1997-98 and they still are the top ones five years later, in 2002-03. What is interesting is that these two countries' healthcare systems are completely different, but they have one thing in common: in both countries, the state intervenes in two key areas, in the cost of medicine and in the funding of treatment for serious and prolonged medical conditions (cancer, diabetes and MS for instance)
Blevins: How does the state intervene in these two areas and why is that better than the American system?
Well in the US, the market determines the price of medicine and the price of major medical treatments. In concrete terms this means that new drugs are much more expensive in the US than in Japan and in France. And often a high co-payment is demanded of the patient. It's the same when it comes to treatment for prolonged medical treatment: since the market determines cost, it tends to be quite high and this heavy cost delays access to care, which results in higher mortality. In other words, the market creates impossible conditions for effective and rapid treatment.
This is nothing new of course but the American system is particularly problematic because American capitalistic regulation is based on the idea the individual has a choice and that he or she can at all times exercise this right. But when you're in need of medical attention, your bargaining capacity is radically altered. You have no choice but to seek treatment and this means the individual has very little room for bargaining. In France and in Japan, the state assumes the role of negotiator and acts on behalf of the collectivity to regulate costs.
In the next conversation, I ask our expert why the market is unable to regulate prices effectively.
I recently sat down with a public health expert in Europe who now works for an international pharmaceutical company. He wishes not to be named but was willing to speak about American healthcare. He has read both Obama's and McCains health care plans. I asked him what he thinks of the American healthcare system and what he thinks of private healthcare. Here is one of three conversations we had on the subject.
Blevins: What shocks you most about the American healthcare system?
The most shocking aspect is the ratio between cost and efficiency. If you look at it from a purely statistical viewpoint, this is quite striking. In 2006 for example, 16 % of your GDP was spent on healthcare, an enormous investment, yet in a recent study that assesses the quality and performance of health systems over time in 19 OECD countries, the US was last. If your automobile industry were this inefficient, the US would probably not even qualify as a G8 country.
Blevins: Does this mean that the quality of healthcare in the US is really that poor? Because Americans are mostly concerned about the cost of their healthcare, but there is a widely held belief that we have the best medical facilities and doctors in the world.
Well Americans are both right and wrong about this. Because it's true, most of the top ten medical centers in the world are in the US. This seems like absolute proof of American healthcare quality. But your ability to perform has not kept up with your technological and medical improvements. For instance, when you compare the first analysis of this report, taken in 1997 with results from 2003, you see a definite trend: other countries have made big improvements in the performance of their healthcare systems, compared with the US, whose system has made only marginal gains. So the US has fallen behind the other OECD countries because it has been unable to move forward and adapt to the changing conditions within your country.
Blevins: Does this mean these facilities are only available to the rich?
Not exactly. The problem is more complex than this. Let me explain this using the previous example: if you take the above report I mentioned and you leave out the US, the curve tracking healthcare system improvement is quite steep. And if you take this curve and you apply it to the US in order to determine how many deaths could have been avoided, you find that no fewer than 75,000 people died needlessly in the US in 2002 and 2003 for instance. That's a staggering number of avoidable deaths.
Blevins: So what are the real differences between healthcare in the US and healthcare in the top ranked countries in this report?
The top countries were France and Japan. They were the first when the tracking started in 1997-98 and they still are the top ones five years later, in 2002-03. What is interesting is that these two countries' healthcare systems are completely different, but they have one thing in common: in both countries, the state intervenes in two key areas, in the cost of medicine and in the funding of treatment for serious and prolonged medical conditions (cancer, diabetes and MS for instance)
Blevins: How does the state intervene in these two areas and why is that better than the American system?
Well in the US, the market determines the price of medicine and the price of major medical treatments. In concrete terms this means that new drugs are much more expensive in the US than in Japan and in France. And often a high co-payment is demanded of the patient. It's the same when it comes to treatment for prolonged medical treatment: since the market determines cost, it tends to be quite high and this heavy cost delays access to care, which results in higher mortality. In other words, the market creates impossible conditions for effective and rapid treatment.
This is nothing new of course but the American system is particularly problematic because American capitalistic regulation is based on the idea the individual has a choice and that he or she can at all times exercise this right. But when you're in need of medical attention, your bargaining capacity is radically altered. You have no choice but to seek treatment and this means the individual has very little room for bargaining. In France and in Japan, the state assumes the role of negotiator and acts on behalf of the collectivity to regulate costs.
In the next conversation, I ask our expert why the market is unable to regulate prices effectively.
Advertisement
The US has some of the best medical centers and some of the best univerities but a poor health care system and a poor educational system. So we know how to excel but choose not to do it??
Beyond this election we need to stay involved and actively make changes.
For too long we have accepte the 'notion' that our healthcare system is one of the best in the world. Clearly that is a lie.
75,000 people dying needlessly is outrageous. We should be in a state of emergency about our healthcare system!
I feel the same way about our education systems... they are in a state of emergency!
November 1, 2008 12:45 PM | Reply | Permalink
Dear Jane B,
Thanks for the enlightening post. My family is also covered under the French health care system and we are constantly amazed by its low cost, efficiency and high quality of care. I agree that it is not perfect, but it does provide pre-natal-to-grave service that no sane French person would trade for US coverage.
However, I have but one qualm with your post and that is in the use of the term "socialized healthcare". That indicates to most readers that the French system curtails choice, etc and makes it akin to Britain's vastly inferior National Health Service. France's system, among other advantages, guarantees both 100% choice of doctors and leaves medical decisions solely to the Doctor-Patient perogative.
A 2005 British report says it best:
"the French system is a pragmatic blend of consumer choice, professional autonomy, central regulation and a government-backed guarantee for the poor which exceeds the NHS standard by far... the French in their own way have discovered how to universalise the benefits of a competitive market. The NHS, by comparison, has universalised the drawbacks of public sector monopoly."
To those interested, for more on the report go here and for a full download of the study it's based on you can click for the PDF here
Indeed, the USA does not have a health care system, but a health care industry, and experiencing the benefits of the French system underscore that huge difference in every way.
I look fwd to your next post.
Cheers!
November 1, 2008 1:36 PM | Reply | Permalink
Maybe France's system is great. I can't really say. But overall, US hospitals and clinics treat thousands of foreign patients each year. If nationalized healthcare systems were so fabulous, then why do Canada and Britain send so many patients to the US? It's because the delay in services can be so long that those foreigners aren't comfortable risk their health/lives to wait so long.
According to the Cato Institute, the Mayo Clinic treats 7,000 foreigners each year. Johns Hopkins treats 6,000 foreigners. That implies to me that maybe we're not the best, but we have to have better healthcare than a lot of other places
November 1, 2008 2:31 PM | Reply | Permalink
This is a loose reading of the "facts" and continues to dismiss the vast inequities in our system.
Who are these "foreigners" and what procedures were they undergoing? Were they on vacation or did they specifically seek out a specialist that wasn't available in their home country?
Our system is good at some things, but to say those things make up for everything that is wrong with it is to completely dismiss the real facts and will mean we never fix what's wrong.
According to common sense, unless one is able to look at both the good and the bad, we will never make the necessary changes to our many broken systems, from health care to education to finance. Pretending that nothing is wrong or that what we have is better than it really is can lead to nothing but the continued wasting of a huge portion of our GDP for inferior systems.
I am sick of wasting our money in the interest of pretending we have no problems.
November 1, 2008 3:02 PM | Reply | Permalink
I didn't mean to imply that nothing is wrong. Clearly there are things that need to be fixed. But c'mon, I think you're stretching a bit to suggest that people on vacation just happen to end up at the Mayo Clinic or Johns Hopkins.
The link below goes to the article I was referring to. It's an interesting read
http://www.cato.org/pub_display.php?pub_id=9272
November 1, 2008 3:25 PM | Reply | Permalink
Mayo and Hopkins are great for the wealthy, but how good was American health care for the woman that died on the floor of the emergency room? How good is it for the people that are turned out into the street? The ER has become an underfunded safety net that absorbs the inadequacies of the health care industry.
November 1, 2008 6:52 PM | Reply | Permalink
"75,000 people died needlessly in the US in 2002 and 2003 for instance. That's a staggering number of avoidable deaths."
Well, I would simply call that bullshit.
Comparing the US Healthcare system to the system of Japan and France is meaningless without also comparing the government, the culture, and the genetic makeup of the populations.
If you don't like the US system now, just wait for a few years from now when it gets really bad.
November 2, 2008 12:26 AM | Reply | Permalink
Steevo. It'd be tough to find two largish nations as close in culture, government and genetics as Canada and the US.
Roughly same ethnic mix, same language, both democratic federal systems, pretty much the same educational outcomes and forms, occupational types, same rates of auto ownership, commuting patterns, homeownership, smoking, obesity, air pollutants, etc. Yeah, some differences, but if I blindfolded the average American, they couldn't tell whether they were in Toronto's burbs or Detroits, Calgary's or San Diego's. I know I can't, nor can my sibs. (Tough the birds DO sing more sweetly up here. During the 3 months they're not frozen stiff.)
Yet one spends 10% of GDP and one spends 15%-17%.
The 10% system gets better outcomes.
Other than vested interest, this is no serious debate. This is Change, this is having to let go of the old and look at something new, this is what an Obama should be all about. IMHO.
November 2, 2008 2:13 AM | Reply | Permalink
Of course, it is the inequity of the American healthcare system that is its biggest flaw. Take it from someone who negotiates welfare plans on behalf of unionized employees that are costing employers in excesss of ten dollars per employee for each hour worked. The number of workers with the benefit of a strong union that can continue to negotiate plans with such rates are shrinking and shrinking fast and, if nothing is done, premium healthcare in this country will indeed be a luxury exclusively available to the wealthy.
Pointing out the problem is the easy part. Convincing Americans, those of us who can take our kids to whatever doctor we deem necessary, that we have to accept a more equitable redistribution of healthcare opportunities is the challenge. This father, like many parents who will read this fine post, is prepared to look to what our French friends do (although my experience with the French folks I met while my daughter was living in Paris doesn't corroborate the notion that everything is groovy when it comes to medical care over there). But political reality demands, I submit, that we understand how critical most Americans believe that individual choice in the healthcare realm remains, even when their own choices inevitably shrink. In short, when it comes to healthcare, it's not enough to tell the American people to take a gander across the pond or on the other side of Niagara Falls.
November 2, 2008 1:28 AM | Reply | Permalink
Sometimes I guess I don't really recognize some of the stuff the official "debate" says about health, Bruce. I've had American and British and Canadaian health care, and I gotta say, if the ideologues would just stop barking about this issue and clouding it for Americans, so they could just quietly LOOK, they could make up their own minds.
5 years ago, I moved to a new Canadian city. From out of country. I picked up the phone, got a list of doctors, picked one. When I wanted to change, I changed. When I want to see a specialist, I get a referral, and go. When I got sick a while back, I picked the hospital I wanted to go to, spent 5 minutes answering questions, no insurance company involved - at all - got admitted for 4 days of intensive treatment, signed when I left, no bill, that's it, bye-bye. People talk about "choice," but I sure as heck didn't feel to constrained. And I never spent anything for any of this. Yes, I've had doctors fuck up, dentists too - but on the whole, I know our Med schools a bit from the inside & have family who are Docs, and they're pretty competent.
Some places, some groups, pay for their own glasses or dental stuff (though that's often covered by employers or the provinces.) Sometimes there's waiting lists. But it's the usual. A piece of new equipment that the people hear about, GP's can't hold them back, so demand soars. Or in rural or remote areas, where it's hard for any town to hold doctors. Yes, there's line-ups and waits sometimes, but if it's urgent, you get shoved up.
The rich still do their thing, and insist on being treated immediately, by the "best." So they go to Mayo or wherever. Great. You guys got some great people there. And a lot of our best researchers and docs go work there too. People here tend not to care if some of the rich want to go pay for extra stuff. They pay their share for all, if they want extra, fine.
As for the comment above about "foreigners" coming to the States, well, lemme say this. There are hundreds of thousands of Canadians who live, pretty much year round, in the US. Mostly Florida (the "Sunbirds"), but California, Texas, etc. Where do they get their health care? Ha. The bastards all FLY HOME. So it's paid for here. So the US gets all their consumer spending, billions of it... with no significant health care"burden." In short, 7,000 at Mayo matters not a whit compared to that other flow.
Bottomline? Canada spends 10% on health care, and gets better outcomes than the US --- which spends 15%-17%. And health outcomes? Canada does better. Now, 5%-7% of GDP is $650-$900 billion a YEAR. People stressing about the Bail Out? Well, there's a Bail Out a year, and for what....?
Nope, no system is perfect. Canadians will whine all day about it. Right wing think tanks will tell you the horror stories of waiting lists and delays etc. But I'm not sure that matches either my own experience, or the $650-$900 million a year extra to achieve poorer outcomes. (And yes, Canada has a larger immigrant population, and lots of poor areas, and a big Native population, so it's not thaaaaaaaaat different than the US.)
Anyhoo. I'm hoping everyone can give the US a great big mighty heave starting ohhhh, Wednesday morning at 9:00, and get this thing done. My sibs in Boston and Arkansas just wanted me to throw that in.... ;-)
So go Demo-beasts go! GOTV... and then party like crazy! But the Wed. 9:00 health care for all meeting is STILL on!
November 2, 2008 2:06 AM | Reply | Permalink
Amen Quinn, I'm with you brother. I wish all the ideologues would shut up about all kinds of things. Heck, I wish everyone would shut up right about now, including the two-year old who I love dearly but who just denied me that much coveted one-day benefit of daylight savings time.
We do know how to screw up the healthcare debate, even us Democrats. Heck, remember why everyone got all pissed off when HRC said "shame on you Barack"? That was because BHO was circulating a flier to the good people of Ohio in which he charged that HRC's forward-looking universal healthcare plan was going to result in the garnishment of their wages. Then what happens, BHO adopts the same darn healthcare plan when he vanquishes the evil Hillary, and ole' McCain starts accusing Obama of proposing a healthcare plan that's gonna garnish working people's wages! I think McCain used Obama's surplus fliers and just crossed out Hillary's name and replaced it with Barack's. That's not a knock on Barack Obama per se (heck HRC and Elizabeth Edwards and Paul Krugman were banging Barack over the head for not proposing universal healthcare at the time), but it is an example of how even we Democrats know how to screw up an important issue like healthcare. We wrote the book and we keep writing the updates on how to screw up the prospects for real and lasting healthcare reform.
In the meantime, we watch unionized workers struggle to preserve access to basic health protection, and you can imagine what is happening in the much larger non-unionized sector. [Don't forget to tell our "progressive" buddies around here to keep this basic reality in mind as some of them begin to feel that post-partisan gooey inclination to turn their backs on the Employee Free Choice Act, the bill that organized labor has been promised and expects to be passed next spring; mark my words, I sense in my bones that it's not going to happen.]
Hey, quinn, I'm a pragmatist at my essence and I'm all for adopting a foreign model if it works. And I've seen that Canadian system of yours work up close and personal. Back in '84 I was up in Ottawa where my brother-in-law was plagued with the cancer that would wrest his young life away. I watched those dedicated professionals come to his home every day, every damned day, so that he could die in comfort and with dignity in his own home with his loved ones around him. Yea, I know it can be done.
That said, the first guy in DC who begins the debate by saying, hey look how the French do it, or lookie up there at what that crotchety quinn's got, gets sent to the back of the cloakroom. That's just the way it is around here. Yea, it sucks, but anyone who wants to make real change around here better keep in mind that Americans, for lots of genuine and disingenuos reasons, are a very proud people, and they really in the aggregate detest being told that people over there are better than them--whether it's cooking, making cars, playing "football", or providing healthcare. Rightly or wrongly, and I ain't saying it's right by any stretch of the imagination, that's the environment in which the healthcare debate is going to be waged in this country.
November 2, 2008 8:07 AM | Reply | Permalink