Misconceptions
Writing for the Commonwealth Fund, Karen Davis sounds familiar themes from a previous tome in “Mirrror, Mirror . . . “, emphasizing international comparisons. This popularizes misconceptions about what is and is not “healthcare.” For example, infant mortality is mostly related to the absence of prenatal care, so a comparison across groups that actually did receive prenatal care would provide a fair comparison of the quality of that care. Similarly, life expectancy has only recently been even remotely related to healthcare. Genetic and environmental factors are still far more important in longevity.
Our system has never been geared for preventive care, but we do rather well, according to Dr. Davis’ comparisons:
PAP test - first
Mammograms - first
Flu shot over age 65 - third
BP and cholesterol check for hypertensives - tied for second
Wait time for elective surgery - We’re the best.
Statistics from other sources also show good performance in cancer survival and various cardiac conditions.
Davis faults the US for not using non-physicians to manage chronic disease patients. This is a fault? Show me that cheaper providers do a better job.
We lag in penetration of IT, but countries (like the UK) that have state sponsored healthcare can institute electronic records by fiat, without regard to the cost. Physicians in the US want to see the advantage before investing. This is an argument for another day, but it’s not clear that there is a convincing economic case for electronic record systems. And the privacy sacrifices with current government proposals are enormous. If you thought listening to your phone records was bad, stay tuned.
Any comparison of “safety” begs for clarification of reporting differences. A study of errors in Canadian hospitals found virtually identical numbers to those in US hospitals. Medical errors are a common problem and the US is doing better at improving than anyone else.
The report contains a paragraph on “Efficiency” but it begins by defining efficiency to exclude any measure of efficiency. For example, they talk about percent of GDP spent on healthcare without measuring what that buys. Administrative costs would be a viable subject if we had credible measures to compare. Anyone who thinks a government can manage a health insurance plan at lower cost than an investor owned company raise your hand.
I have worked in an overseas healthcare system and deal now with US citizens who live overseas and use local healthcare. I believe we do it better than anyone. Not that we’re perfect--or even good at some things. And not to deny we could learn from others. But no one who has been both places would choose to get their healthcare in the UK or Germany or Canada or . . . . Now, our politicians might wish we had a less expensive healthcare system so they had more money for another war, but from a patient’s perspective, I’d rather be right here.
Our system has never been geared for preventive care, but we do rather well, according to Dr. Davis’ comparisons:
PAP test - first
Mammograms - first
Flu shot over age 65 - third
BP and cholesterol check for hypertensives - tied for second
Wait time for elective surgery - We’re the best.
Statistics from other sources also show good performance in cancer survival and various cardiac conditions.
Davis faults the US for not using non-physicians to manage chronic disease patients. This is a fault? Show me that cheaper providers do a better job.
We lag in penetration of IT, but countries (like the UK) that have state sponsored healthcare can institute electronic records by fiat, without regard to the cost. Physicians in the US want to see the advantage before investing. This is an argument for another day, but it’s not clear that there is a convincing economic case for electronic record systems. And the privacy sacrifices with current government proposals are enormous. If you thought listening to your phone records was bad, stay tuned.
Any comparison of “safety” begs for clarification of reporting differences. A study of errors in Canadian hospitals found virtually identical numbers to those in US hospitals. Medical errors are a common problem and the US is doing better at improving than anyone else.
The report contains a paragraph on “Efficiency” but it begins by defining efficiency to exclude any measure of efficiency. For example, they talk about percent of GDP spent on healthcare without measuring what that buys. Administrative costs would be a viable subject if we had credible measures to compare. Anyone who thinks a government can manage a health insurance plan at lower cost than an investor owned company raise your hand.
I have worked in an overseas healthcare system and deal now with US citizens who live overseas and use local healthcare. I believe we do it better than anyone. Not that we’re perfect--or even good at some things. And not to deny we could learn from others. But no one who has been both places would choose to get their healthcare in the UK or Germany or Canada or . . . . Now, our politicians might wish we had a less expensive healthcare system so they had more money for another war, but from a patient’s perspective, I’d rather be right here.
