Many people—okay, mostly conservative politicos—like to say that the U.S. has the best health care system in the world. Time and again, those of us in the reality-based community offer a legion of evidence as to why this isn’t true; the ethno-centrists wag their fingers and repeat their refrain; and so the cycle continues.
But recent numbers from the Commonwealth Fund should put a stop to this cycle: the U.S. health care system places last in the world when it comes to stopping preventable deaths. In other words, we spend more but accomplish less—does that sound like success to you?
The new study, funded by Commonwealth and appearing in the Jan/Feb ’08 issue of Health Affairs, looks at “deaths from certain causes before age 75 that are potentially preventable with timely and effective health care.” Relevant causes of death include diabetes mellitus, intestinal infectious diseases, whooping cough, childhood respiratory diseases, leukemia and others.
The authors, both from the London School of Hygiene and Tropical Medicine, found that America’s success in staving off these health problems has decreased over time. Between 1997/1998 and 2002/2003, preventable deaths fell by an average of 16 percent in all 19 industrialized countries considered; but the decline in the U.S. was only 4 percent. In 97/98, “the U.S. ranked 15th out of the 19 countries on this measure—ahead of only Finland, Portugal, the United Kingdom, and Ireland—with a rate of 114.7 deaths per 100,000 people.
“By 2002–03, the U.S. fell to last place, with 109.7 per 100,000. In the leading countries, mortality rates per 100,000 people [for 2002-2003] were 64.8 in France, 71.2 in Japan, and 71.3 in Australia.” [see graph below, courtesy of Commonwealth]
These are compelling statistics because they look specifically at the point of health care intervention: how well do we save lives that are in fact savable? The answer is, not very well at all—and we’re not making much progress. In fact, when compared to other countries we’re falling further behind.
But hey, no worries—at least we spend more than any other country in the world on health care. That’s got to count for something, right?
You’ll have to excuse my sarcasm, but many opinion-shapers refuse to acknowledge the incredibly simple equation: when a health care system spends more than any other in the world and is still unable to stop preventable deaths, something’s seriously wrong. We’re first in spending and last in effectiveness.
And, surprising no one, the spending situation is getting increasingly dire. The newest U.S. health spending numbers are out, and they’re not pretty. Let’s go to the Wall Street Journal, which gives us the best snapshot of what’s going on:
• Health spending totaled $2.1 trillion in 2006 — or 16% of gross domestic product. That was up 6.7% from 2005, which experienced a growth rate of 6.5%.
• Total spending amounted to $7,026 a person, up from $6,649 in 2005, according to the study by the Centers for Medicare and Medicaid Services.
• In all, Medicare spending increased at the fastest pace since 1981 — nearly 19%, to $401.3 billion in 2006 from $338 billion in 2005. Meanwhile, spending for Medicaid, the federal-state insurance program for the poor, slipped 0.9%, to $310.6 billion in 2006.
• A major factor in the faster pace of growth in retail drug spending in 2006 — 8.5%, compared with 5.8% in 2005 — was greater use of prescription drugs. That accounted for roughly half of the growth in drug spending in 2006, up from 20% in 2005. This was in part due to the new prescription D program. Seniors are taking more drugs. But are they taking more effective drugs? No one knows.
Put these two reports together and they are compelling. The WSJ-reported numbers provide a very clear snapshot of our sky-rocketing health care spending, and while the Commonwealth study offers a hard look at preventable deaths—one of the most simple and direct gauges of health care effectiveness you can imagine. I hope this turns heads and changes minds—not so much among voters, who more or less understand that here’s a crisis, but among leaders who constantly regurgitate comforting falsehoods about our health care success.
I wouldn’t count on it though. Like so many other issues that should be decided on evidence, more often than not health care debates turn on ideology—and it’s notoriously hard to reason with dogma.
I want to know why the French still allow 65 people of every 100,000 to die an unneeded death.
Maybe their red wine makes their medications more effective, but not the perfect death preventer.
At the effectiveness of the French, which according to this graph are hands down, the most effective, at only 65 deaths per 100K population, that would still leave 195K unneaded deaths in the US, instead of 330K.
As I remember a few years ago, the head line shocking 100K deaths a year due to medical errors.
Even at the rate of the best of the best (the French) 195K deaths looks like a disaster still.
The success or failure is all in how you look at the numbers.
When I look at these numbers, it says to me that quality, according to the French standard, and applied to the US population would, at best allow 200K a year to die an unneeded death that was preventable. That’s the best standard out there right now.
The quality initiatives that place zero forgiveness or room for error based on the patient specific qualities, their social situation, their compliance, their motiviation, their general heatlh status. I find that the French standard of quality is not zero deaths, but still a very large portion of preventable deaths.
Thats realistic quality. It is not an all or none phenomenon.
Niko, Do you really think it is ideology that is the problem? I think it is money, who stands to lose out if we stream line the health care system; Health Insurance companies, pharmacuetical companies, Liability insurance companies, for profit hospitals, and for profit medical device manufacturers. Who stands to gain, people with little or no resources, businesses who pay for health insurance. HMMMM, who contributes to campaigns? who can afford to market thier agenda on most all major media? hmmm?
I would like to see the same chart however divided by “people with resources i.e. good insurance vs everybody else”
COMMONWEALTH FUND + W.H.O. DATA = BS
Well, the usual suspects are gleefully touting the latest Commonwealth Fund study as if it settles the health care debate in their favor. Heres the chart that has set their hearts atwitter:
Looks bad. But, as is usually the case with the Commo…
GOT A CALCULATOR?
The great thing about “academic studies” are, when groups want to prove their point, they can skews the data to make their talking points.
If U.S. health care is so terrible, viz. Mr. Michael Moore and the C. Fund — how many of countries have cases like, oh, Hazelle Roa?
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/07/13/BAGTDQVMMG1.DTL
My best-guess:
Zero. Nada. None. Zip. Hazelle would be dead.
U.S. health care has some the best medicine in the world. In the U.S. medical-malpractice lawyers (the Democrat’s friend), specialty MDs, and health care executives are the highest-paid in the world. The U.S. lives better, eats more, smokes as much, and drinks as much, as any other country.
If CF and Mr. Moore can fix any of the above excesses — over-eating, smoking, alcohol-consuming — the world would love to see their authentic results. But it won’t be holding its breath.
Russ,
Our health care system is only as good as what we do at our worst. It is nice to point at a single example of something good, in fact great, and say, “this is our health care system” but it is shallow and weak. Take a look at how many people in this country who live close to this “great care” but can’t get it because of $ and subsequently die. Your example (being a one off case) is far weaker than the stats you so easily criticize.
Happy Hospitalist–you’re right, we have to be realistic. But I think you’ll agree that the problem here is relative–the problem isn’t so much that the US isn’t saving absolutely everyone, but that we’re doing worse than other nations while spending more. That relationship, to me, is the big problem.
drmatt, you make a good point–special interests are a problem. But I suppose I don’t expect any new data to every sway them, however, as their priorities are not systemic effectiveness but their own narrow pursuits. Those who in fact believe that our system is better on principle are the ones I’m hoping to take notice.
I think Russ’s comment proves my point better than I ever could–many people who, to my knowledge, aren’t in the pocket of particular lobbies insist that U.S. health care is the best in the world, on what seems like a matter of principle.
A lot of folks think that because it’s the AMERICAN system, it must be the best. It’s an ideological commitment to American exceptionalism more than anything else. That impulse is what the interests you speak of mobilize to get some grass-roots support–and it’s counter-productive.
Russ, I’m not out to get America–quite the opposite, we all want it to actually BE the best. And there are of course examples of actual successes. But as drmatt says, the picture is much bigger than that. And while you’re right, every study has its weak spots, after a while enough research starts to shape a bigger picture of large trends. In US health care that trend is spend more, succeed less. Not good.
Studies like these need to be taken with many grains of salt – there isn’t all that much really accurate data on cause of death and trying to estimate how much of it is really preventable is speculative almost to the point of ridiculousness.
A better measurement is improvements in life expectancy, which also bear little relation to health care expenditure.
Our health care system is only as good as what we do at our worst.
—
Per Slick Willie: define worse.
Define measurement v’bles. Define average (mean? median? mode?). Cross-check against mortality rates and quality measures. Adjust for illegal drug usage.
Any data-smoothing needed? Any really nasty reality-checks, like millions of illegals flooding into the U.S. and chewing up 25% of Calif. Medicaid budget?
Selected v’bles cover the millions of possible v’bles? Like France and the U.S. being totally different environments? Causation? Or mere correlation (red wine v. beer)?
More government spending, more government employees, and more government bureaucracy are not the solution.
http://www.nytimes.com/2008/01/08/us/08grady.html?_r=1&ref=health&oref=slogin
Gummit is the problem. Do not add more fuel to a broken vehicle.
Fix the vehicle first. Plan ahead. Save. Measure results. Restrain the John Edwards med-mal crowd. Accept that in the end, there are limits.
The majority of the public is deeply skeptical of claims that more government bureaucracy will help.
http://www.newsweek.com/id/88764/output/print
Additional data-smoothing by C.F. and its Democrat friends will not convince the public. Only authentic results will.
Trust is earned, not passed as detail-free earmarks in the middle of the night.
Prove your claims in the real world by actions, not mere words. It will be hard, but try anyway. It will not hurt — much.
I’d like to see more about the methodology of this study. Is this like some of the infant mortality rates, in which many countries use an entirely different definition of ‘live birth,’ putting the US behind right from the beginning.
This sounds an awful lot like a study that was rigged from the start to show that state-sponsored health care is vastly superior to our semi-private system.
Your anti-enthocentrist comment at the beginning belies your bias and willingness to be deceived by numbers that appear to support your ideology.
Again, where are the internals? What is the methodology? How did each country define preventable death?
The Commonwealth Fund, the sponsor of this study, has a political agenda, so I would feel a lot better if you’d link us to something other than vague generalities about how they arrived at these ‘results.’ Otherwise, this sounds like scaremongering for a state-sponsored, single payer health care system.
I’m not sure how the failure of Grady points to how more government spending is BAD. To do that, you’d have to prove that the only reason Grady failed was due to waste because of government involvement.
The Roa case, while compelling, doesn’t tell us anything whatsoever about the state of health care in this country. For every Hazelle, I wonder how many there are who either didn’t seek care because it wasn’t covered or were deported before the could or didn’t receive the cheapest alternative–pre-natal care.
In the big picture, people can snipe at details all they want. The fact remains that we are the only developed nation without universal health care. The reason people don’t trust the idea of universal health care is because the decision has been propagandized. Will it work better to have a national system?
How could it work any worse? Worse than the Trauma Center in Las Vegas closing because of malpractice? Worse than 30-40 million with no coverage? Worse than those WITH full coverage being the highest proportion of new ED visits, per the IOM, because their clinics can’t see them? Worse than a president who believes that Emergency Rooms are our universal health care? Because EMTALA is so well funded.
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When I look at these numbers, it says to me that quality, according to the French standard, and applied to the US population woul
The quality initiatives that place zero forgiveness or room for error based on the patient specific qualities, their social situation, their compliance, their motiviation, their general heatlh status. I find that the French standard of quality is not zero deaths, but still a very large portion of preventable deaths.
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Do you really think it is ideology that is the problem? I think it is money, who stands to lose out if we stream line the health care system; Health Insurance companies, pharmacuetical companies, Liability insurance companies, for profit hospitals, and for profit medical device manufacturers. Who stands to gain, people with little or no resources, businesses who pay for health insurance. HMMMM, who contributes to campaigns? who can afford to market thier agenda on most all major media? hmmm?