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.

U.S. Health Spending Not An Economic Burden

Health spending consumes a higher share of output in the United States than in other countries. In 2013, it accounted for 17 percent of Gross Domestic Product. The next highest country was France, where health spending accounted for 12 percent of GDP. Critics of U.S. health care claim this shows the system is too expensive and a burden on our economy, demanding even more government intervention. This conclusion is misleading and leads to poor policy recommendations.

But compared to larger developed countries, Americans have higher income per capita after subtracting health care spending. For example, in the United Kingdom, GDP per capita after health spending was only $34,863 in 2013. So, even though Americans spent significantly more on health care than the British, the average American enjoyed $9,185 more GDP after health spending than his British peer; and just under $6,000 more than his Canadian neighbor.

Read the entire column at Forbes.

The U.S. is the Third Lowest Health Spender of 13 Developed Countries

Scholars affiliated with the Commonwealth Fund recently published another report in the Fund’s series of international comparisons of U.S. health care. These reports are always well received by the media, which run articles lamenting how expensive U.S. health care is, and how great a burden on the country. Encouraged by the Commonwealth Fund to conclude that the major difference between health care in the U.S. and other developed countries is that they have “universal” health systems, many reasonable people understandably conclude that such a reform could reduce the cost of U.S. health care.

These results certainly invite us to question whether we are getting our money’s worth. However, it is not clear that this spending is a burden on the U.S., given our very high incomes. Table I shows that when we subtract U.S. health spending from our Gross Domestic Product (GDP), we still had $44,049 per capita to spend on everything else we value. Only two countries, Norway and Switzerland, beat the U.S. on this measure. In the United Kingdom for example, GDP per capita after health spending was only $34,863 in 2013. So, even though American health care is significantly more expensive than British health care, the average American enjoyed $9,185 more GDP after health spending than his British peer, and just under $6,000 more than his Canadian neighbor.

Read the entire column at Forbes.com.

How the U.S. Single-Payer System For Seniors' Health Compares Internationally

The Commonwealth Fund has published another survey of health care across countries. The Commonwealth Fund’s widely reported surveys, while thorough, are frustrating because they invoke abstractions (for example “universal health insurance coverage“) to explain why the U.S. health system underperforms.

The latest survey should be able to get around this problem because it surveys only people aged 65 years and older in 11 developed countries. Because almost all American seniors are on Medicare — a single-payer, government-run program that is mostly funded by taxpayers — we might expect the Commonwealth Fund to find that the U.S performs about as well as other countries.

No such luck.

Read the entire column at NCPA's Health Policy Blog.

Australia Will Raise $5 Billion By Privatizing Its Biggest Health Insurer

Australia’s federal government is about to raise almost $5 billion by privatizing its largest health insurer:

Australia has been shrinking the role of government in health care. Although a national single-payer scheme was established in 1975, the federal government re-introduced private choice within a few years. Indeed, Medibank Private is the descendant of the original single-payer plan, Medibank.

Read the entire article at NCPA's Health Policy Blog

Hospital Administrative Costs Higher In U.S. Than Other Countries

The Commonwealth Fund has sponsored yet another study that concludes that the U.S. health system is less efficient than others. This time, the measurement is specifically hospitals’ administrative costs. As always, it recommends single-payer, government monopoly as the solution.

Readers of this blog know that I am not about to defend hospitals’ bloated administrative costs. However, the Commonwealth Fund’s scholars go way off-base when it comes to capital costs.

Read the entire column at NCPA's Health Policy Blog.

U.S. Infant Mortality Still Lags Other Developed Countries

There’s more bad news for the U.S. on the infant mortality front: The U.S. ranks last of 26 countries in infant mortality: 6.1 per 1,000 live births, versus 2.5 in Sweden, according to a new study by the Centers for Disease Control and Prevention (CDC).

Regrettably, other evidence points to large racial disparities in the U.S., with black babies doing especially poorly. Nevertheless, even if we exclude black babies, white, Hispanic, and Asian U.S. babies appear to do worse than in other countries.

Read the entire article at NCPA's Health Policy Blog.

We're Number 44! Bloomberg Ranks Countries on Efficient Health Care

Bloomberg (the media business, not the former mayor of New York, although the latter appears to have regained control of the former), has ranked 51 high- and middle-income countries on healthcare efficiency. The U.S ranks 44th.

44 of 51 is pretty bad. (Indeed, we are bracketed by the Dominican Republican and Bulgaria). However, the Bloomberg rankings suffer from some of the same problems that we see with other rankings.

Read the entire column at NCPA's Health Policy Blog.

Understanding Waiting Times For Health Care

In Sunday’s New York Times, reporter Elizabeth Rosenthal discusses evidence that that waiting times for medical care in the United States do not always compare favorably with those of other developed countries.

I don’t think I've met anyone, pro- or anti-Obamacare, who does not expect waiting times to increase as long as Obamacare exists. So, we better get used to them. How to explain them?

Read the entire article at the national Center for Policy Analysis Health Policy Blog or the Independent Institute's Beacon Blog.

Does the United States Over Diagnose Cancer?

Ezra Klein challenges the notion that patients in the United States get better cancer treatment than patients in other developed countries.

Klein goes on to report that actual death rates (in the U.S. population) have not really changed for many cancers, despite much greater detection. Further, this epidemic of over diagnosis can cause harm, because people will undergo surgery who don’t need it.

Although this argument is not trivial, I find it hard to accept.

Read the entire column at the National Center for Policy Analysis Health Policy Blog or the Independent Institute's Beacon Blog.

Broken Mirror On The Wall: On The Commonwealth Fund's Comparison of National Health Systems

The Commonwealth Fund has released another edition of its Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally. Following tradition, it concludes that the American health “system” is the worst of eleven developed countries.

We sympathize with the Commonwealth Fund’s criticism of U.S. health care as overly bureaucratic and suffering from administrivia. We haven’t met anyone who would disagree with that. Where we differ is on the idea that transferring some of that administrative load towards government efforts to “coordinate” care is going to improve things.

Read the entire column at NCPA's Health Policy Blog or The Independent Institute's Beacon blog.

Changes in Survival: The US in International Comparison

Linda Gorman dissects a study published in Health Affairs, which asserts (among other things), that U.S. health outcomes suffer from a lack of government spending!

I really enjoyed the straw man that Ms. Gorman quoted: “The findings undercut critics who might argue that the US health care system is not in need of major changes.”

Debunking Richard Cohen: How Does the U.S. Health-Care System Stack Up?

Richard Cohen had an extremely ill-informed column in the Washington Post, which Tom Miller of the American Enterprise Institute handily demolishes: Debunking Richard Cohen: How Does the U.S. Health-Care System Stack Up?