Weakness in the healthcare system – sister cities
The Olympics are over, but the memories and photos of the athletes doing their best to take credit for their homeland remain. We’ve seen competitors bring in different styles of pole vaulting, discus or out of the pack at distances and BMX racing.
However, we’ve never seen an athlete prepare to carry a backpack full of rocks before announcing the call for “history” – which the United States has done from the start as a global economic competitor by sticking to a healthcare system as ineffective because it is unfair. In general, this means wastefulness and injustice.
Poet Robert Burns argued that “seeing ourselves as others see us” is a gift. It is difficult to do as an individual and perhaps impossible for the 331 million people as a whole. However, the first step, which is simply comparing ourselves to others, is a great first step.
For decades, colleges have taught courses in “Comparative Economic Systems”. But then the communist regimes collapsed and many economists agreed that these cycles were a waste of time because the American approach was now dominant.
Fortunately, some institutions still have useful system-by-system comparative studies for sectors such as healthcare. The Commonwealth Trust, a New York-based charity, is one such organization and was recently launched. “Mirror, Mirror 2021 – reflects poorly: US healthcare compared to other high-income countries.”
The report compares health system performance in five categories in 11 different high-income industrialized countries and compares them to expenditures. These comparisons are not new and the conclusion that we lost control in terms of high cost and low performance would not surprise anyone familiar with the problem.
Skeptics, who compare everything being done elsewhere in the United States, will argue that measures of performance in some sectors, such as health care, are inherently self-involved in selecting, measuring, and weighing indicators. This is correct. So the easiest thing to do is to read the 41-page report yourself. You can download the PDF file from the link above.
The countries compared in the study include the United States, Canada, Australia and New Zealand, as well as France, Germany, Sweden, the Netherlands, the United Kingdom, Switzerland and Norway. European countries, with the exception of the last three, are members of the European Union. Note that neither Japan nor southern EU countries such as Italy, Spain or Portugal or any of the newly communist EU members such as Poland or Hungary are included. The research therefore comes from countries with political cultures in Northwest Europe.
Much of the discussion in our nation over the past two decades has focused on addressing grievances in access to care. President Barack Obama’s Affordable Care Act focused on these issues by introducing insurance swaps, premium subsidies for low-income people, and expanding Medicaid. For many, it has improved, but the problems remain. We still underperform in comparative income countries.
Then there are the costs. Our healthcare expenditures are approximately 17% of the value of the total output of goods and services, or GDP. The comparative average for the other 10 countries in this survey is just under 11 percent. Because GDP per capita is generally higher than the others, the variance in the absolute monetary value of health spending is greater here than in parts of GDP. But here comes the question of what exchange rates to use in such comparisons between the dollar and the euro or the franc, so leave it to the basic fact that we spend more in terms of money and a greater share of production.
However, it is useful to look at what the difference in GDP of 6 percentage points means for our country. This year’s output is about $20.9 trillion. Six percent of that is $1.25 trillion. This brings us back to the analogy of an Olympian choosing to load rocks before an event: Even if we didn’t improve our health system’s performance at all, if we could bring costs down to the average of the other countries studied, we’d try to do so. $1.25 trillion could be used for other needs. That’s more than we spend on Social Security. Almost double what is spent on the Ministry of Defense.
With the 2020 Census figures of 331 million Americans, the 6-point difference approaches $3,800 per capita in our country. Bullwinkle Moose called this “antihistamine money, it’s not something to sneeze at.” It has the effect of a tax levied on every family, it is not due in any other similar family.
It also helps that Canadians, our neighbors to the north who have a similar economy and political culture, score slightly better than us on measures of study performance, tenth overall and tenth on two of the scale’s five subcategories. But they do so at 6 percent less than GDP.
When one raises issues like these, one will undoubtedly hear that our country has more pioneering technologies and procedures. Then there is the issue of comparative waiting times for surgeries in Canada and the UK, which is partly reflected in the ‘process of care’ section of the study, where we come in second, followed by France, Germany and Sweden.
Yes, we have very advanced medicine, but our advantage is not as great as we think. Yes, other countries have serious problems. But many of our opinions about health care in other countries are based on myths and fiction rather than reality.
The complex issue, even if we accept that our country is not doing well, is how to change it. The label “single payer” (in other words, the government pays) because some kind of medicine is useless if we already have expensive individuals and institutions and have a lot to lose from the change already made; This is like calling for “arms control” when there are 400 million guns in the possession of individuals. You cannot undo the predicament we have been pushing ourselves into for decades.
However, it is a necessary first step to see ourselves in a comparative context. Studying the Commonwealth may not be flawless, but it is an excellent starting point for interested citizens.
St Paul economist and writer Edward Lauterman can be reached at [email protected]
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