Tuesday, August 14, 2012

The Relative Strength of US Health Care

When it comes to US health care, I have to admit that my knowledge of policies and data is rather limited. I’ve been fortunate to avoid needing much medical care during my life, to this point, but have certainly experienced my share of long wait times and other frustrations. Given those experiences and countless stories from others, I was generally willing to accept the reports and claims about how poor the US health care/insurance system is when compared globally. A few recent items, however, have altered my impression and made me skeptical about the actual inferiority of the US health care system.

Two weeks ago, Russ Roberts hosted a podcast with Scott Atlas, Senior Fellow at Stanford University's Hoover Institution and author of In Excellent Health. Atlas discusses the methodological and data inconsistencies contained in several widely heralded reports, then dismantles the impression that health care and services are more widely and readily available in other countries. He also touches upon a surprising difference in level of care for patients with and without health insurance:

Guest: there are studies in the literature--in fact numerous studies, study after study--that show in a variety of settings, whether it's heart disease, cancer, transplants, all kinds of things: people have better outcomes, better medical care, if you just take the people who are just as sick from each of those populations--private insurance, Medicaid, and no insurance whatsoever. Private insurance has far better outcomes than Medicaid. Even the same sickness of person. It has nothing to do with how sick somebody was when they started. And then, the even more alarming thing is it is very common in these studies--these are peer reviewed studies in the medical literature--that the people with Medicaid do worse than the patient with no insurance whatsoever.
Later in the podcast, Atlas draws into question the true number of uninsured individuals within the US:
Guest: I do a lot of international traveling, I read the newspapers and speak to people outside the United States, and it is portrayed as scandalous that we have 50 million or so Americans with no health insurance. Which I mentioned is equated with no health care. As if they're synonymous. Russ: As if they are out on the streets if something happens. Guest: But I think here, this is a measure that really has to be scrutinized. And I did in my book. This so-called 50 million uninsured--because when you look who is this population, the raw data, the documents, the U.S. Census Bureau documents, and others, you find out that it's not really 50 million people. After you say: Well, okay, about 10-15 million people are not U.S. citizens in that group--and I'm not saying they shouldn't get health care, but I'm not sure you are going to reform the U.S. health system to get non-citizens insured. Russ: Correct. That's going to be a challenge. Although not that group, but there are others who are illegal who do get health insurance. Guest: Who do have health insurance. Right. And then you take a look at who answered the U.S. Census Bureau survey and said they didn't have health insurance, and it turns out--let's just say, I don't remember the exact number, but about another 10 million or so that said they didn't have insurance that actually were using insurance. And we know that because the Census Bureau people went and looked, looked up and found medical records; these people had insurance that they were using, and mainly Medicaid. Russ:They didn't consider that insurance. Guest: They probably when they answered the question, they thought the question meant: Do you have private insurance? But, be that as it may, this is in one of the Appendices of the U.S. Census Bureau documents, Appendix C-- Russ: Good to know--Guest: Is that they actually were aware--the U.S. Census Bureau were aware. But they didn't change the response to the question. And then there's another 13 million adults and children--of these 50 million people, 13 million who actually are already eligible for public insurance--Medicaid, a tiny bit Medicare, and the Children's Health Insurance Program (SCHIP or CHIP)--that simply did not sign the paperwork because they haven't accessed the system. So, they haven't used it. Common sense says you wouldn't want to redesign another system to make them eligible for that when they are already eligible for the current public health insurance system. So, you are left with a population of less than 5% of people in the United States who don't have insurance or who are not already eligible for current government insurance programs. I would not call that a crisis in the uninsured.
Separate from this conversation, John C. Goodman at The Beacon recently wrote about Private-Sector Socialism: What the Right and Left Don’t Understand about Healthcare in Other Countries. In this post, one of several regarding the broad topic of health care, Goodman comments on the immense similarities between US and global health care systems:
The pluralism of US healthcare is important to keep in mind in thinking about health reform. Suppose you are dissatisfied with the way the healthcare system is working in your city or your locality, and you are curious about whether somewhere in the world people have found a better way of doing things. Odds are that you are going to find better answers somewhere within the United States than outside of it.
People on the left and right who are prone to stress the differences between US healthcare and the healthcare of other countries invariably ignore the 80 percent commonality and focus on the remaining 20 percent. On the left, the focus is usually on the ways we appear to be worse; on the right, the focus is usually on the ways we appear to be better. But even here the differences are narrowing, and I expect that trend will continue.
There may be equally good reasons to be skeptical of the perspectives provided by Atlas and Goodman, but my intention is simply to offer a counter argument to the frequent claims that America’s health care system is a disgrace among advanced economies. In my opinion, the thoughts provided by Atlas and Goodman, at the very least, suggest taking a more critical look at the supposed successes and failures of health care systems worldwide. Failure to do so may encourage policy decisions that push current levels of care in the wrong direction. The current US health care system is certainly not great, but relatively it may be far better than many realize.


  1. It's certainly interesting to hear these views but they do sound like they're reaching somewhat.

    The US spends nearly twice the next country in % GDP on healthcare so to have so many uncovered I find astonishing.

    From the UK perspective I can think of plenty of things wrong with the NHS but one of the main benefits is good preventative healthcare. I don't have to think about cost or whether I've had a previous condition or if I have a job - I just go and get help.

    My understanding of the situation in the US is that if you don't have cover you only get treated for serious conditions, i.e. at the hospital - is this correct? If so it's a costly system if lots of people are waiting to get really sick before seeking help.

    I recall seeing a documentary a couple of years ago where some doctors/dentist had set up mobile clinics where the queues were in the hundreds (I think it was in California) and they interviewed a doctor who basically said we normally do this in Africa.

    1. Dave,

      Thanks for the comment and perspective. As I mentioned, I'm no expert in this field, but one difference I keep hearing is that Americans on the whole display poorer health, irrespective of genetics, than other developed countries. Whether this is lifestyle, lack of preventive care, or other causes I'm not sure.

      Regarding preventative care, I would actually be in favor of costs shifting in that direction. Unfortunately, to the best of my knowledge, the new health care laws are still centered around making treatments more available and subsidized.

  2. Hey Woj! Not that I want to play the guilt by association game but I can't help but notice the first study you looked at is from Hoover-a pretty notrious Right wing think tank.

    This is not to say this decides the matter in itself but it would make me cautious.

    The idea that Medicaid is worse than no insruance at all sounds like something that conservativew want to hear-'aha government can't do anything right!'

    1. Mike,

      You make a fair point. As an independent, I'm generally cautious of views from both sides and wouldn't expect anything less from readers. An important caveat to the comment about "no insurance" is that it doesn't apply to all cases or even all of any certain type of illness. I think its important to recognize that Medicaid/Medicare, similar to any type of insurance, has to provide some limits on the procedures it's willing to cover. We should not be surprised that some doctors may be willing to go beyond those limits when there are no clear limits set.

      There are ways I could imagine the current system improving with increases in govt and with far less govt. My simple hope is that before we start trying to mimic Canadian or European systems, the struggles within those systems will be discussed and compared more openly.

  3. WOJ please check out my latest piece about Medicare and Romney's claim about Obama's "cuts" I know you aren't so much into partisan politics but this goes to the heart of this discussion

    Romney's specious attack on Obama's "cuts" http://diaryofarepublicanhater.blogspot.com/2012/08/romneys-foolish-attack-on-obamas.html

    When you talk about partisan by the way, it's unavoidable to point out that Medicare-and Medicaid-is a Democratic programt that Republicans have been tyring to destroy for 40 years.

    I do agree with you that some who criticize the American system most sharply-Michael Moorre more than any one person comes to mind-do tend to assume that these systems are more or less flawless.

    I'd be happy to hear some of the real drawbacks that exist in the "European" model as it were.

    Do you know much about what they are? I'd like to hear about them and no dbout you have point. In fact Obamacare is clearly an American solution as it doesn't simply elmiinate private insurers and give us single payer and idea I don't support though I would have preferred a public option at least.