Widespread Government Failure in Health Care

The Commonwealth Fund has published yet another survey comparing health care in the United States to health care in other countries. The title emphasizes US Adults Still Struggle With Access To And Affordability Of Health Care.

Really? As I’ve previously written, I agree fully with the Commonwealth Fund scholars that health care in the U.S. is inefficiently delivered and over bureaucratized. 

Nevertheless, suggesting U.S. health care is the worst overall is not consistent with the data. The latest survey compares 11 developed democracies. The relationship between government control of health care and various measures of health status is not at all clear, despite other countries having so-called “universal” health systems.

When it comes to actual access to care, 35 percent of low-income Americans (with household incomes below one half the median income) had to wait six or more days to see a primary-care doctor or nurse the last time they needed care. However, so did 38 percent of low-income Germans and 32 percent of low-income Swedes.

Fifty percent of low-income Americans used the emergency department in the last two years, but so did 46 percent of low-income French and 44 percent of low-income Canadians.

One argument made against the fragmented U.S. health system is that it leads to un-coordinated care. Thirty-six percent of low-income Americans reported “any coordination problem in the past two years,’ but so did 48 percent of French and 37 percent of British.

When considering residents of all income levels, 35 percent of Americans used the emergency department in the last two years, versus 41 percent of Canadians. Six percent of Americans waited two months or longer for an appointment with a specialist, versus 13 percent of Canadians.

The idea behind Obamacare and the 2015 Medicare payment reform was that top-down government control will improve continuity and coordination of care. However, the country that performed the worst on two important measures – specialists having access to their patients’ medical histories or regular doctors not being informed about specialist care, and gaps in hospital discharge planning – was Norway, a relatively ethnically homogeneous country of five million people!

If the Norwegian government cannot effectively centralize care coordination and continuity, it is the height of vanity to believe the United States government can.