United States and Medical Care: We’re #1


Of course we are.  No one really REALLY thinks that we’re not.

Some people, like those crazy guys that just moved in down the block, they DO think other parts of the world rank better.

Well, given the peculiarity of the health care market, and the fact that all other industrialized countries have a much less expensive, much more effective, it seems that too much government involvement is not the problem with our current health care system.

The problem is, of course, that it’s just not true.

Now, to be sure, there ARE studies that show the United States coming in some other place than first, but I don’t think the measurement system is really one that can be trusted to measure medical care delivery.  Afterall, they’re measuring things not really associated with medical care:

Mean Minimum Maximum
Health 25 20 40
Health Inequalities 30 20 30
Responsiveness Level 12.5 5 15
Responsiveness Distribution 12.5 5
Fair Financing 25 15 35

To be sure, some of these are fair measurements.  Others, however, not so much.  For example, Fair Financing.  This metric doesn’t speak to the quality of care, simply the amount of income to purchase it.  Others again, fail to measure the qualify of care given.  They simply measure distribution of said care.  Without a doubt the inclusion of such characteristics may be acceptable from your POLITICAL position, but it in no way measures the quality of care being delivered.

But really, the point I wanna make is this.  The world comes here for care.  We don’t go there.

In the past five years, would-be parents from as far as Istanbul and Uruguay have turned to healthy, young American mothers to serve as surrogates, according to the Detroit Free Press.

The babies are born U.S. citizens, but surrogacy agency officials say that’s not a primary motivation for the parents, who typically come from European and Latin American countries where surrogacy is illegal or socially unacceptable. The parents have exhausted other options and are willing to pay about $50,000 to $100,000 — part of which goes to the surrogate — to have biological children.

The world, having exhausted all other options, are willing t pay money to come to America to take advantage of our medical delivery services.

So, is the fact that people are willing, and ABLE mind you, to pay $50-$100k for a procedure, impacting the amount of money spent in American health care costs by the way, a good thing or a dirty rotten example of how America just sucks at all things medical care related?

Yeah.  That’s what I thought too.

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19 comments
  1. nickgb said:

    You’re not picking the fight with me, so I’ll just take two low hanging fruit:
    For example, Fair Financing. This metric doesn’t speak to the quality of care, simply the amount of income to purchase it.
    You can’t remove affordability from health care. If you have a million dollars, you will be able to get fantastic health care in any country. Health care, on a country by country basis, must include some metric as to whether the level of care is accessible to the people supposedly using it.

    The world, having exhausted all other options, are willing t pay money to come to America to take advantage of our medical delivery services.
    I’m not going to say this is right or wrong, necessarily, because this isn’t really my bag and it’s too early to go research just for a rebuttal, but the quote you’re using to back it up has nothing to do with what you’re saying. That quote basically says that we allow surrogacy, both socially and legally, and therefore parents (usually same-sex parents) come here to have a surrogate parent give them a child. There’s two big points here: (1) The surrogacy has NOTHING to do with quality of care, but rather social and legal rules; (2) The person getting the health care in this scenario is AMERICAN, not foreign.

    Oh, and doing a single google search turns up this report by Deloitte that makes it clear that many more Americans go abroad for health care than tourists come here for the same.

    • pino said:

      Health care, on a country by country basis, must include some metric as to whether the level of care is accessible to the people supposedly using it.

      Which car is better? A Cadillac or the Chevy Volt? Ouch, bad example, the Volt isn’t cheap either.

      Okay, okay okay……

      Which car is better, a Cadillac or a Ford Focus?

      The fact remains that organizations like WHO have determined already what the characteristics of “Good Care” must mean. And when our care doesn’t meet their expectations, they ding us. To borrow a concept from Ephemeral, “It’s fine to make the case that you prefer medicine to be more socialized, but that’s a political preference”.

      The surrogacy has NOTHING to do with quality of care, but rather social and legal rules

      In some cases this is true. In others, it’s because the world doesn’t know how to manufacture babies. However, part of my point is that the reason we spend more on medical care is that we have the ability to do that. Further, it’s SO great here that people come here in ORDER to spend more money.

      Can you imagine if someone said the US was a horrible place to live based on the fact that we are able to spend so much money on food that we enjoy?

      many more Americans go abroad for health care than tourists come here for the same.

      Yes. Commoditized care is being done over seas. For the same reason IT support is being done over seas.

      • nickgb said:

        It is useless to have a great health care provider that no one can afford. You have to take into account availability, which includes cost, if you want to look at a country’s health care.

        I don’t get your criticism of WHO. Of course they have already determined the characteristics of good care, that’s their job. And of course they ding us if we don’t meet the criteria, that’s the point of having criteria. If your criticism boils down to “the WHO hates America”, I would need to see some evidence.

        As for the surrogacy, I was just quoting the reasons that were given in the article you cited as support. Do you have any evidence that people come here for surrogacy because no one else knows how to “manufacture babies”?

        Finally, you’re sticking to your argument that US care must be really good because people come here to use it, while simply acknowledging the fact that Americans go elsewhere far more than people come here. That’s a serious contradiction you need to address. Especially since it pretty much disproves your statement that “The world comes here for care. We don’t go there.”

      • pino said:

        It is useless to have a great health care provider that no one can afford.

        Hi Nick,

        If it were the case that rich people were the only ones benefiting from care while the poor were dying in the streets, I might be more inclined to advocate your position. However, I don’t think that’s the case. Rather, I think that what we have is phenomenal care all along the wealth spectrum AND the fact that we have cutting edge high end innovations being rolled out. THOSE may be very expensive and available only to those with large amounts of wealth.

        I don’t get your criticism of WHO. Of course they have already determined the characteristics of good care, that’s their job. And of course they ding us if we don’t meet the criteria, that’s the point of having criteria.

        Clearly. However, I suspect you would object to any form of judging of a nation’s well being if I included 25% of the ranking being Capitalist or not. Capitalism may be a very good way of managing an economy. Or it may not. What SHOULD matter is how well that system works. So, if I do or don’t socialize care, it shouldn’t matter. What SHOULD matter is how well folks are being served a priori of the management formation and distribution of that care.

        Finally, you’re sticking to your argument that US care must be really good because people come here to use it, while simply acknowledging the fact that Americans go elsewhere far more than people come here. That’s a serious contradiction you need to address. Especially since it pretty much disproves your statement that “The world comes here for care. We don’t go there.”

        It’s the same argument that I would use to explain technology.

        The world’s greatest innovation occurs here in America. Once we understand that technology and how to implement and support it, we send it overseas. This is true of building computers to iPhones to technical support.

        Why that should be any different in medicine isn’t clear to me.

        For example, we are going to India for standard procedures. We are NOT going to India for the newest cutting edge innovation. Certainly you have to understand the difference?

  2. dedc79 said:

    Medical tourism is probably not the metric you want to be arguing. People travel from all over central america and south america to get medical procedures done in Cuba. People cross the border into Canada to get medicine…

    • pino said:

      People cross the border into Canada to get medicine…

      Because the Canadian government has mandated that prices be below fair market value; not because they have better medicine.

      • dedc79 said:

        I don’t see your point. Are you saying that the canadian medicine is inferior? If it’s the same and cheaper how does that support your argument?

      • I’m interested in what the chart includes in “out of pocket” expenses. I think it’s changed since I’ve been there, but Alberta had a family rate of about $95 per month for health care. Prescriptions and other things were supplemental through private plans which would raise that cost.

        As for the US system being #1, however, I’m also unclear. I remain steadfast that the Canadian system, apples-to-apples, is better overall when it comes to preventative care and financial impact on citizens. Quality of care in Canada is “good” at worst (one tick shy of “Great!”), whereas in the U.S. quality of care at its worst is literally non-existent. I just spent two years helping care for a very sick relative in Nevada without insurance, and that’s even under the “Nevada plan”. The “they can never be refused care” line is b.s. – there’s much more to the situation than the rhetoric from both sides reveals.

        If you have insurance in the U.S., healthcare is fantastic. Fast, professional, comfortable, affordable, and top-rate. If you don’t have insurance through loss of job or whatever, all those attributes go away. So ultimately I might agree that when you can get U.S. health care, it’s #1. That assumes, however, that everyone gets it. If you don’t have insurance, care is far from #1.

      • Up there I wasn’t allowed to pay for better care. That’s what frustrated me the most. If I could afford a private hospital, I should be able to pay for one and not have to take beds away from those less able. The Canadian system is “afraid” of becoming like the U.S. system and vice-versa, so any move in the opposite direction is met by fear. The true solution, I believe, is in a sensible combination of both systems. Get almost everyone paying in like they do in Canada, but give those who can afford more the ability to pay to get more. Those who can afford $50k to get surgery sooner shouldn’t have to leave their home country to do it.

      • pino said:

        Are you saying that the canadian medicine is inferior? If it’s the same and cheaper how does that support your argument?

        Insofar as people are jumpin’ the border to get cheap Canadian medicine, it’s the same, sure. However, if the United States were to mandate that drug companies must sell their drugs for a loss, do you suspect we’d see more or less drug innovation?

  3. dedc79 said:

    I think Vern’s point is a good one, and is a common “republican” mistake. Nobody disputes that the american medical system is great if money isn’t an option. It can be disastrous when money is an option and that’s where the US slips below many other countries.

    • dedc79 said:

      i completely bolloxed that up. Mean “great if money is no object….disastrous when money is tight”

  4. I have never seen a comparative analysis put the US anywhere close to the top. To say we are number one is simply wrong. In some high tech very rare cases people come here, but that’s such a small proportion of the health care system that it doesn’t trump all else. Most countries spend 8.9% (OECD average) on health care, have health statistics usually better than ours, and cover everyone. We are the only country with health care cost related bankruptcies — and that accounts for nearly 60% of our bankruptcies. We don’t cover tens of millions, we charge more for those without insurance than with, and push people to ER for primary care because otherwise they won’t get admitted. And all that costs us nearly 17% of our GDP! My wife is a CPA who works in a hospital. She’ll rant about how f***d up the system is. If you are wealthy, chances are you’ll get the best care here. But insurance companies try always to find ways to deny coverage, and require high turn over (meaning physicians don’t spend time really getting to know a patient’s problems). Moreover we over prescribe expensive medications, and a huge chunk of our costs are very high end of life costs. Most people will have their highest hospital bills right before they die. We pay massive amounts in medicare for those who are about to die, while not covering people who have a life ahead.

    Europeans, including doctors and conservatives, constantly ask me why the US has such an expensive, unfair and dysfunctional system. Anyone analyzing health care would laugh out out at the absurd claim that we’re number one. We’re number one in how much we spend, but again, except for some really high tech very rare procedures, overall our system is a mess.

    • pino said:

      I have never seen a comparative analysis put the US anywhere close to the top.

      **GASP** Tar Heel Red doesn’t count? 😉

      To say we are number one is simply wrong.

      Actually, it isn’t.

      Most countries spend 8.9% (OECD average) on health care

      I suspect you are making the point that we spend much more on our health care. To which I answer that we spend much more on EVERYTHING! We are a rich nation with a “stupid low” cost of things like food and clothing. Serious. Of all the things you would want to spend money on, wouldn’t being healthy be at the top?

      For example, we include in our cost of health care things like:

      1. Braces
      2. Glasses
      3. Plastic surgery
      4. Lasic
      5. Hair implants
      6. Breast implants
      7. Liposuction
      8. Sexual medications
      9. Sleep apnea surgeries
      10. Athletic reconstruction
      11. Child manufacturing

      Of all the nations in all of the world spanning all of time, do you find the fact that the United States spends more on such things a “good” or a “bad” indicator of our society?

      Imagine if I tried to make the case that the United States spent more on books than other nations, could you call that a bad thing?

      have health statistics usually better than ours

      I don’t find the studies as indicating those nations have better “health statistics” than we do. After digging into the subject a little deeper you find that normalizing for violent and other non-health-care related deaths, the United States ranks #1 in the world for lifespan. Further, when low birth weight distribution factors are considered, the United States ranks with Norway, which is leading the world. If you would continue to factor in other social considerations combined with inconsistent record keeping [many nations, for example, have experienced the disappearance of a generation of women through gendercide] we would again rank #1.

      and cover everyone.

      You’re falling for reflectionephemeral’s trap. While it is perfectly reasonable to argue that a health care system should be socialized, you cannot make the fact that it is or isn’t a deciding factor in the quality of that system. Fact is, America’s doctors and hospitals are the best in the world.

      Most people will have their highest hospital bills right before they die.

      I assure you that if I have a gabillion dollars in my dying days, I’ll gladly spend all of it to live a few more. A feature. Not a bug.

      Europeans, including doctors and conservatives, constantly ask me why the US has such an expensive, unfair and dysfunctional system.

      I hardly find Europeans to be the arbiter of things fiscal.

      The point is this. The world is more socialist than we are. The world would like to see us more like the. Their ability to create measurement systems that, as a means of measurement, contain the degree to which they would like us to be like them, is flawed.

      • No, you can’t just remove violence and suddenly things equal out. Statistical games are invalid on a variety of fronts. The fact is we simply do not provide better health care than other industrialized countries. The high cost is killing our economy, is the main drain on Medicare, it sucks money from paychecks as benefit costs go up, and is a cause of budgetary woes at the state and federal level. This is a serious problem. Given that many European economies are starting to out perform ours, it’s not like we can afford to pay more than they can.

        The health care cost comparison is legit. The Europeans are rich and count the same things in their health care costs. I also don’t think you can ignore all those medical bankruptcies, uncovered patients who often choose not to get care in fear of bankruptcy. and other factors. That’s part of quality — making sure that people have access to health care and aren’t afraid to get care.

        However, our system is also not free market. Much of the crappiness comes from government programs, regulations and involvement. I’ll blame government as much as insurance companies. I’m not sure how you can defend it, except out of wishful thinking — wanting to believe that “socialized” medicine is bad because you don’t like anything socialized. Take ideology out of it. Look at the evidence without regard for ideology, recognizing that sometimes something ‘socialized’ might work better, sometimes it won’t. I think it’s really hard not to see why the Europeans are generally happy with their health care systems while most see the US system in crisis due to its cost. Just as some people on the left have too much faith in government, some on the right have too much faith in markets. Maybe the European way isn’t for us, but what we’re doing isn’t working. (Again, part of my vehemence on this issue is from what I hear from my wife who works pretty high up in the finance department of the local hospital — she’s a CPA and thinks in terms of common sense and not ideology or politics.)

      • pino said:

        No, you can’t just remove violence and suddenly things equal out.

        It appears that you can:

        Then they adjusted life-expectancy stats to get a rough handle on what life expectancy would have been like had the rates of these deaths been the same in all 29 countries. Their result: The U.S. would have ranked first, at 76.9 years of life expectancy — an increase of 1.6 years. Meanwhile, Japan fell from 78.7 years to 76 years, indicating it had been benefiting inordinately from low rates of accidental deaths and homicides.

        The fact is we simply do not provide better health care than other industrialized countries.

        That is simply not true. We do provide better health care than other industrialized countries. In fact, we provide the BEST care.

        I’m not sure how you can defend it, except out of wishful thinking — wanting to believe that “socialized” medicine is bad because you don’t like anything socialized.

        I’m not saying that socialized medicine is bad. I’m simply objecting to the WHO claiming it’s GOOD! There is no doubt that a BMW M5 is a better car than the Ford Focus. Just because most people can’t afford an M5 doesn’t change that fact.

        Period. The M5 is better. End of story.

        Try this. Provide me data that demonstrates the number of people in America NOT getting the care they need for want of money.

  5. Oh, and I agree that you should be able to pay for special treatment. In most European countries you can — the wealthy can get better care, but there is a baseline for everyone. Also, I think the British system is probably the worst in Europe (which is why it’s always the one trotted out when people want to scare Americans), and single payer systems usually have real problems. In the US a single payer system on the national level would be a disaster, I think. I prefer reform that focuses on states having the lead (and the resources). My wife (the hospital CPA) supported the Obama reforms because of a lot of necessary changes they had, especially regarding insurance companies. But I think her take is that the system is so dysfunctional that only a more radical reform can fix it. Ultimately the system we’ve had is unsustainable — too expensive and inefficient.

  6. I believe the British system suffers the same problem as the Canadian system – those with more aren’t allowed to pay more and they cannot go completely private or self-insured with their care. Is that true for Britain?

    • Britain did make some changes, so it’s not as inflexible as before, but I’m not sure exactly what the rules are now. Britain’s system started out driven more by ideology — the Labour Party’s socialism of the early post-war era — and not pragmatics. The other European countries were more pragmatic and thus have more flexible systems. France and Italy have been ranked at the top, though cost problems have hit them. Each do allow flexibility. Demographics will be tough for the Europeans, since so much of the cost is now directly before death. I can’t imagine why someone would want massive technological support to just add a few months, but that’s become the norm in the industrialized world. To question it sounds like one’s invoking ‘death panels,’ but the growth in technology has created real dilemmas. It would be nice to have a real conversation about that.

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