Waiting times: Here's how the dodge works: If you look at waiting times, you'll see that relatively few Americans wait more than four months for surgery, which helps folks claim that America doesn't ration care, and makes our system look pretty good on the waiting times metric. Here's what they don't tell you: When you look at who foregoes care, the international comparisons reverse themselves. About 23% of Americans report that they didn't receive care, or get a test due to cost. In Canada, that number is 5.5%.

Worse, the American number is understated, as in order to know you need a surgery or further care, you need to go for an initial appointment, and as it happens, many Americans -- including 36 percent below average income -- aren't even seeking that. And it's this group -- which is largely low-income, and I'd guess, largely urban -- who would, in another country, be experiencing terrific wait times. Here, they never get care at all. We call that "no wait" rather than infinite wait. The studies misleadingly write them out of the waiting statistics, making it look like America has low wait times when the relevant population is simply never getting care at all. But would you rather be the urban poor in London, who wait a year for a hip replacement, or the urban poor in America, who never get one?

So it's not good and it's not pleasant. Maybe it's cheap?

Canada: $3678
France: $3449
Germany: $3371
UK: $2760
USA: $6714

The difference between UK and America could buy every America 5.3 ounces of pure gold per year.

Value: Who has better outcomes is like Camry vs. Accord. Some things are better on one car, some things are worse. But if you paid 15,000 for your Camry, and I paid $22,000 for my Accord, then in fact the Camry is MUCH better.

So it's not cheap, and it's not pleasant, and it's not good. We may not agree on what reform looks like, but we should be able to agree that this is not acceptable. There is no defense for a system delivering such poor value.

Therefore, the reason wait times seem shorter in the United States is that many people can't afford the service in the first place and thus forego the procedure entirely.  This is a perfect example of what statisticians would call a selection bias.  This particular selection bias occurs when you are actually selecting on the dependent variable.  That is to say that the sample (those in line for a health service) is not complete by the very nature of what your trying to measure (the number of people waiting for service).  The number of people in line for health services and the amount of time on waiting lists would drastically increase if everyone were able to afford the procedure.  Because costs keep people off the waiting lists, measuring waiting times as indicator of a good health system will make the system look more efficient than it actually is.

This is consistent with my previous post because it illustrates how a public system in which everyone could participate would represent an aggregate improvement in health.