American Health Care: Last Place?

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Monday, the Commonwealth Fund released a report claiming the U.S. has the worst health-care system in the developed world, and Great Britain has the best. But a closer look reveals serious problems with the report’s methodology: The criteria seem deliberately designed to elevate socialized health care while ignoring the strengths of the U.S. system — in particular its high survival rates. For example, a woman diagnosed with breast cancer in the U.S. has an 89 percent chance of surviving it, higher than anywhere in Europe.

The Commonwealth Fund’s dubious conclusion ordinarily wouldn’t deserve comment. But Commonwealth’s work is partly to blame for our current predicament, struggling with Obamacare. Earlier versions of the report issued in 2004, 2006, and 2007 bamboozled some members of Congress into believing that health care is better in countries where government calls the shots. For example, in October of 2009, Senator Kent Conrad (D., N.D.) pointed to a large blue chart during a Finance Committee meeting showing the United States in last place in health performance. “All of these countries have much lower costs than we do,” Conrad said, “and they have higher-quality outcomes than ours.”

Commonwealth gives heavy weight to “equity,” meaning equal access to care, so on this measure countries with government-run systems by definition come out on top. Another criterion gives countries points when doctors say “it’s easy to print out lists of patients by diagnosis.” And countries are rewarded when patients are “routinely sent computerized reminder notices for preventive or follow-up care”; the U.S. lost points because it is more common here to telephone patients than e-mail them. Never mind that American women have a better chance of getting regular mammograms than do women in most other countries, a reason for America’s top breast-cancer survival rate.

The report’s biggest trick is penalizing the U.S. for having the highest number of deaths due to preventable diseases, meaning diseases that are curable if treated soon enough. This measure conflates the incidence of disease with the treatment of disease. The U.S. has a high incidence of cardiovascular disease, considered preventable, because for 50 years Americans were the heaviest smokers and now are among the most obese. Bad behavior, not bad medicine, is to blame. As a National Research Council (NRC) panel cautioned in 2010, “It seems inaccurate to attribute … high death rates from these causes to a poorly performing medical system.”

In fact, when it comes to treating disease — the primary purpose of the health-care system — the U.S. performs extremely well, and not just when it comes to breast cancer. The U.S. is also, for instance, stunningly effective in treating prostate cancer: An American diagnosed with it has a 99.3 percent chance of survival. In Great Britain only 70 percent survive, in Germany only 82 percent, and in Denmark a shockingly low 48 percent.

The Commonwealth report also penalizes the U.S. for having an overall lower life expectancy. But don’t be fooled. The causes of reduced U.S. life expectancy are our higher rates of auto fatalities and violent crime, plus half a century of excessive smoking — again, not bad medicine. As the NRC panel concluded, “the low longevity ranking of the United States is not likely to be the result of medical failures.”

Biased rankings influenced at least a few lawmakers to vote for Obamacare. Proponents of government-run health care never say die: They bend the facts to make it look successful, even as headlines from supposedly top-ranked Britain scream of unacceptable cancer death rates.


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