A new report claims that America’s healthcare system ranks last out of 11 wealthy nations, all of which have more government control than the U.S. model. But is this true? Here are the facts.
What does the media say?
The Washington Post’s coverage proved typical: “U.S. health-care system ranks last among 11 high-income countries, researchers say.”
- Numerous other news outlets — including The Hill, U.S. News & World Report, and Yahoo! Finance — carried similar headlines. The report’s dour talking points were reported by websites spanned the gamut from the left-wing UK Guardian to the conservative outlet The Daily Caller.
- Their stories are based on the latest Commonwealth Fund report, which measures healthcare in 11 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States.
- Some U.S. news outlets explicitly claimed the U.S. would do better to adopt a national healthcare system, like the UK or Canada. “Unlike other countries surveyed, the United States does not have universal health coverage,” The Washington Post pointed out. “The high performers stand apart from the United States in providing universal coverage and removing cost barriers … and investing in social services.”
What does the report say, and is it reliable?
The Commonwealth Fund report — “Mirror, Mirror 2021: Reflecting Poorly: Health Care in the U.S. Compared to Other High-Income Countries” — did, indeed, rank the U.S. last. But its rating rests on a number of questionable factors:
- Part of the issue is the built-in bias of the Commonwealth Fund report. “The survey is designed so that single-payer systems are strongly favoured,” explained Philip Booth, a professor of finance in the UK and a senior fellow at the free-market Institute of Economic Affairs. “One question asks whether patients have ever had disputes with their insurers. If the system is nationalised with no insurers, this simply will not happen.” Booth said that previous reports have asked whether patients make co-payments at the point of service; but in national healthcare systems, patients pay via taxation before (or, too often, instead of) receiving medical treatment.
- This year’s report measures “equity,” which “focuses on income-related disparities” and “divergent” outcomes. “The U.S. consistently demonstrated the largest disparities between income groups,” the report states. But “divergent” outcomes do not necessarily imply bad outcomes.
- Part of the problem comes from comparing apples to oranges. For instance, the U.S. ranks poorly on infant mortality — but that’s because other nations lower their numbers by not counting some children as having being born. “Is a baby born weighing less than a pound and after only 21 weeks’ gestation actually ‘born?’ In some countries, the answer is no, and those births would be counted as stillbirths” instead of infant mortalities, according to Texas A&M University. “These premature births are the biggest factor in explaining the United States’ high infant mortality rate.”
- Part of the problem is the high U.S. rate of violent crime and automobile accidents (which is linked to high U.S. car ownership and low use of public transportation). “As Scott Atlas noted in 2011, the U.S. ranked 19th globally in life expectancy, but #1 when all variables except fatal injuries are adjusted for. Even adjusting only for differences in car fatalities and homicide, the U.S. ranked #1 in life expectancy,” wrote Matt Palumbo.
How does U.S. healthcare compare to other nations?
While the U.S. healthcare system faces real challenges, it has demonstrably better outcomes than some of the nations rated higher by the report.
- U.S. patients spend less time waiting to see a specialist, giving their underlying conditions less time to metastasize. In 2016, 27% of Americans had to wait a month or more to see a specialist; it was 39% in Australia, 52% in Sweden, and 61% in Canada and Norway.
- The U.S. system has better outcomes on cancer than the British system. “In the UK there may be up to 15,000 avoidable deaths from cancer every year in people over the age of 75 years,” reported The Lancet in July 2019. “[B]etween 2003 and 2005, cancer mortality rates in the UK were … 31% higher than in the USA among people over the age of 85 years.”
- In 2017, the British Red Cross said the UK’s National Health Service had created a “humanitarian crisis” thanks to long waits, overcrowded facilities, and understaffed offices.
- Americans spend much less time waiting in the emergency room than other nations.
- In the pre-pandemic U.S., 74% of patients spent less than an hour waiting in the emergency room for treatment, and 44% of Americans waited less than 15 minutes, according to the CDC. At the same time, Canadians waited 3.2 hours, and the UK has not met its goal of having 95% of patients admitted within four hours in years. More than 5,000 British patients had to wait more than an hour inside the ambulance before being taken inside the emergency room.
- “In all 5,449 people have lost their lives since 2016 as a direct result of waiting anywhere between six hours and 11 hours” in UK accident and emergency (A&E) departments, reported the Guardian.
- The average wait for a knee replacement is twice as long in Canada as in the U.S.
What about healthcare rationing?
Critics of the U.S. healthcare system often accuse it of “rationing,” as insurance companies decline to pay for certain treatments. For instance, the Commonwealth Fund report scored the U.S. worst for the number of people who said that their “[i]nsurance denied payment for medical care or did not pay as much as expected.”
While high deductibles (which have more than doubled since the passage of the Affordable Care Act) and reduced benefits cause headaches of their own, they do not compare to genuine rationing. National healthcare systems can deny treatment outright:
- The NHS denied care to infants Charlie Gard and Alfie Evans, and it fought a legal battle to prevent their parents from taking them to other healthcare providers who offered their services free of charge.
- The NHS denied treatment to cancer victims like Alexander Vinson, age 2, and Charlie Ilsey, age 12, who sought treatment elsewhere.
- If the government does not forbid them, families with the means may travel abroad for treatment (often to the U.S.), while poor families wait at home to die. (Talk about “disparities” and “inequities.”)
- An investigation by London’s Sunday Times found that the NHS kept COVID-19 hospital admissions artificially low by withholding treatment from the elderly based on an “age-based frailty score.” The NHS contests this allegation.
This denial of treatment inherent in any socialized medicine system may explain why the U.S. rated highest in the report for the number of chronically ill patients who “discussed with [a] health professional their main goals and priorities in caring for their condition,” as well as their “treatment options,” over the past year.
What’s the verdict?
The U.S. does not have the worst healthcare system of the developed world. The Commonwealth Fund report “lacks context” by skewing its results toward nations that embrace national healthcare systems.
Of course, this is not to say that America’s increasingly government-dominated healthcare sector is without its share of challenges. The U.S. has a very real problem with obesity, addiction, and suicide. But America can best focus on its real healthcare challenges without biased media coverage urging us to adopt socialized healthcare schemes that will only worsen Americans’ health.
The views expressed in this piece are the author’s own and do not necessarily represent those of The Daily Wire.
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