Wonkblog's Wonky Claims About American Health Care
Over at the Washington Post's Wonkblog, there are some apparently wonky claims about the American health care system. In a recent article by Ezra Klein and Evan Soltas, these two authors discuss the results from a limited survey of international health care systems by the Commonwealth Fund.
Klein and Soltas state that this survey "compares the U.S. to Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, and the United Kingdom on a host of health-system measures, both objective (like diabetes amputations) and subjective (like satisfaction). The results are a reminder of why reform is so badly needed." Unfortunately, the WaPo article about this Commonwealth Fund survey contains some apparent errors and distortions. Also note that the survey includes data for Italy and Denmark.
Klein and Soltas claim the survey shows that "[w]e [Americans] go to the doctor less often than anyone but the Swiss." Referring to the original survey document under its data for "Average Annual Number of Physician Visits per Capita," there is no data for Switzerland (i.e., this nation reports "n/a" for the variable in question). Who else is there no physician visits data for? Italy and New Zealand. How can Klein and Soltas claim the report proves that "[Americans] go to the doctor less often than anyone but the Swiss," when the report itself apparently has no physician visit data from Switzerland, as well as Italy and New Zealand?
WaPo goes on to claim that "[w]e don't have more hospital beds than other developed countries, and when we do go to the hospital, we don't stay longer." The survey reports "Number of Acute Care Hospital Beds per 1,000 Population." What do we find? The USA is at 2.56, higher than Canada (1.73), Sweden (2.01), Norway (2.40), and the United Kingdom (2.41), and just barely behind New Zealand (2.61) and Italy (2.75). Actually, the USA does have more hospital beds than a number of "other developed countries," and 48% more hospital beds per capita than its northern neighbor (Canada) with its notoriously socialistic health care system.
Similarly, the survey reports "Average Length of Stay for Acute Care (days)." Referring to the actual report, we see that the USA is at 5.4, higher than Norway (4.5), Australia (5.0), France (5.1), and Sweden (5.1), and essentially equivalent to New Zealand (5.6) and even the Netherlands (5.8). But since when is length of hospital stay any real indicator of health care system quality/value on its own? Ignoring basic demographic and lifestyle choice differences among nations, a longer stay in a hospital may indicate better quality of care, or worse. The devil is in the details, even assuming we can unpack them out of the demographic and lifestyle choice noise between countries.
If the health care system can fix the problem more quickly, this is advantageous from the patient's perspective -- even if more money is expended in the process. Many, if not most, people would be willing to pay a bit more for a shorter stay in the hospital, provided the health issue was remedied to a similar standard. Thus, this indicator cannot be used to show "why reform is so badly needed" in the American health care system. It is largely a useless data point that integrates many conflicting underlying variables.
Klein and Soltas then claim that "America is second only to Canada in the number of adults reporting difficulty getting a next-day appointment when they're sick." Huh? Referring again to the actual survey results for "Able to Get Same/Next Day Appointment When Sick," the USA is at 57%, equivalent to Sweden (57%), and much higher than not only Canada (45%), but also Norway (45%). No data for Switzerland was reported.
According to WaPo, "Americans also find it unusually difficult to get after-hours care." Under the survey data for "Very/Somewhat Difficult Getting Care After-Hours," the USA is at 63%, equivalent to France (63%), and lower than Canada (65%) and Sweden (68%). How is this "unusually difficult" for Americans? It is not, unless we agree that the socialized systems of Canada and Sweden are even more "unusually difficult."
The United States does spend a great deal of money on health care, but WaPo has yet to provide a strong case that ObamaCare will either provide higher quality care or cost containment/reduction. When the American system is compared to socialized systems, in many cases the USA's approach outperforms most other nations for quality and R&D indicators, and even the Commonwealth Fund report notes that average annual per capita real health care expenditures in the USA between 2000 and 2011 (3.0%) grew less than in Sweden (3.1%), New Zealand (3.8%), the UK (4.0%), and the Netherlands (4.7%), and equal to the cost growth seen in Canada and Japan (3.0%). Of course, Wonkblog has had some prior issues in discussing cost trends for the American health care system, as I've previously noted on American Thinker here and here.
Perhaps the answer to any current inefficiencies and inadequacies in the American system is less public sector involvement, not more?