PBS/NYT Hit Jobs on the American Health Care System
Within the comments on my AT article about how "America's Healthcare System is not Cruel," two interesting stories from the mainstream media came to light that warrant some additional discussion in hopes of straightening out the warped health care debate.
The first is a PBS Newshour article by Jason Kane on "Health Costs: How the U.S. Compares With Other Countries." Kane starts off his article with the following statements:
But let's consider what 17 cents of every U.S. dollar is purchasing. According to the most recent report from the Organization for Economic Co-operation and Development (OECD) -- an international economic group comprised of 34 member nations -- it's not as much as many Americans expect.
In the United States:
- There are fewer physicians per person than in most other OECD countries. In 2010, for instance, the U.S. had 2.4 practicing physicians per 1,000 people -- well below the OECD average of 3.1.
- The number of hospital beds in the U.S. was 2.6 per 1,000 population in 2009, lower than the OECD average of 3.4 beds.
- Life expectancy at birth increased by almost nine years between 1960 and 2010, but that's less than the increase of over 15 years in Japan and over 11 years on average in OECD countries. The average American now lives 78.7 years in 2010, more than one year below the average of 79.8 years."
The nonsensical use of life expectancy as a core health care system quality indicator has been addressed by a number of commentators. It is pure junk science. As I noted in my original piece, "lifespan statistics are effectively useless for comparing the capabilities of health-care systems. Life expectancy data integrates many lifestyle and socioeconomic factors beyond the health-care system, such as rates of murder, suicide, obesity, and other dietary choices, smoking, alcohol and drug consumption, traffic accidents, geographic factors, and on the list goes." When we account for some of these other factors -- as Scott Atlas did -- we find that the USA actually has the highest life expectancy. Had Kane been practicing rigorous journalism at PBS, he would have noted these issues at first mention of the life expectancy data in his article.
Moving on to the physician and hospital bed density data that Kane quotes without context. The USA has 2.4 practising doctors per 1,000 population. The OECD average is 3.1. So, yes, the USA has fewer than the OECD average. But who else has fewer physicians per unit population than the OECD average? Twenty-two nations that include Australia, Belgium, the Netherlands, Finland, Luxembourg, the United Kingdom, New Zealand, Canada, Japan, and South Korea, among others. Canada -- the socialized medicine paradise for many ObamaCare supporters -- has the same number of practising doctors per 1,000 population (2.4) as the USA. Note all the nations with universal health care that have as few, or fewer, doctors per person than the USA. Greece has the highest number of doctors per capita; Russia is ranked third. Neither is a bastion of great health care.
Canada (217 per 100,000 pop.) and the USA (210 per 100,000 pop.) have equivalent physician densities in urban areas, but the USA (113 per 100,000 pop.) has a 35% higher physician density in rural/remote areas than Canada (only 84 per 100,000 pop.). Isn't Canada's socialized medical system supposed to reduce this type of health care system access inequality? If so, it isn't working well.
The USA has 3.1 hospital beds per 1,000 population. The OECD average? 4.9. Other nations below the OECD average include Ireland, Greece, the Netherlands, Australia, Italy, Denmark, Israel, Canada, Norway, the United Kingdom, Sweden, and a number of others. Sweden -- a supposed socialist paradise with a classic single-payer system -- has 10% fewer hospital beds normalized to its population than the USA. Who has the second-most hospital beds per 1,000 population? Russia. Hardly a health care system model. Never confuse quantity with quality.
This PBS story goes on to note that the USA spends far more than other nations on health care, both per capita and as a function of the economy's size. True, but nobody seems to probing deeper as to why this is the case (beyond the easy targets such as waste, price-gouging, etc.). The USA is undoubtedly the global leader in health care research and development for everything from preventative medicine to surgeries through to pharmaceuticals, and by a large margin. This costs big dollars, and these high first-stage costs are often passed on to American health care consumers as early adopters prior to mass dissemination on a global basis.
Meanwhile, many other nations (if not nearly all) engage in economic parasitism off the American system. In other words, because the USA's approach is to lead in health care innovation and quality, and then share the knowledge and technology with the rest of the world, what we find the rest of the world generally doing is sitting back, letting the USA do most of the heavy financial and intellectual work, and then reaping the benefits with minimal costs. The approach is analogous to what we see in the defense arena. The USA pays most of the costs of keeping the free world free (and policing the rest of the global flotsam), while other free nations put their feet up, minimize their defense spending, and allocate the available resources to other -- far less worthy -- government programs.
Consequently, if other nations were required to internalize the positive health care externalities emanating from the USA, what we would probably find is that the health care spending gap between America and these other countries would be significantly reduced, and perhaps even eliminated. On the other hand, if the USA moves to a socialized system like ObamaCare, innovation will likely diminish, leading not only to a reduction in the quality not only of American health care, but of that of the rest of the world as well. Americans shouldn't be subsidizing the health care systems of other nations, but they are (much as the USA subsidizes the national defense budgets of many other countries), and these other players should recognize the gifts and be more grateful (better yet -- they should step up to the plate and start contributing rather than just receiving). The take-home lesson is that, as with many other health care statistics, we need to find ways of further normalizing health care spending in order to make accurate comparisons between various jurisdictions and remove all externalities.
Kane's PBS story attempts to look into why the costs for purportedly equivalent medical procedures and hospital stays are generally higher in the USA than in other nations. First off, we need to state the obvious: not all procedures and stays are created equal. There are certainly wide differences in quality between the same procedure performed in one nation versus another (and within nations, too). We know this from our experiences buying various consumer goods and services. Are all televisions created equal? Are all plumbers and electricians producing equal-quality work? Of course not. You often get what you pay for. So in order to compare costs for health care systems, we first need to normalize for quality differences to ensure we're not comparing apples and oranges.
PBS notes that the cost of staying in an American hospital is higher than that in Canada, and costs for specific procedures (e.g., appendectomy, coronary angioplasty, etc.) are higher in the USA than, say, Australia and Canada. Fair enough. But we also then need to consider that the OECD is reporting that rates of a "foreign body left in during procedure" and an "accidental puncture or laceration" are much higher (i.e., between two- and threefold higher) in Australia and Canada than in the USA. Information like this suggests that costs are being lowered in Australia and Canada at the expense of quality. That doesn't seem like a preferential model.
This leads us to the second story of interest, entitled "In Need of a New Hip, but Priced Out of the U.S." from the New York Times. The article involves the anecdotal report of an American who found a cheap new hip installation in Belgium, at a price well below what it would have cost him in the USA.
Single-person storylines (i.e., isolated case studies) provide entertainment value, but they get us no closer to being able to make generalizations between national health care options and any resulting rational policy choices. What the NYT article failed to consider was the potential reason why some procedures are so cheap in Belgium. Perhaps they are compromising quality in order to cut costs? OECD data suggests they may be. Belgium has rates of a "foreign body left in during procedure" that are 60% higher than the USA, trailing only Switzerland (in first place for this level of dysfunction), Australia, Canada, and New Zealand. Belgium ranks second in rates for an "accidental puncture or laceration," at levels 160% higher than in America, and behind only Canada for causing unnecessary injury and distress to the patient.
There is always the balance between cost and quality, and health care is no exception. A "foreign body left in during procedure" or an "accidental puncture or laceration" may not show up in bulk statistics such as life expectancy, or even more health care-focused indicator datasets, but the physical and mental trauma resulting from such mistakes are very real -- and have economic costs that ObamaCare proponents fail to consider.