The US Health System Stinks…Or Does It?

It is an embarrassment how badly the US health system performs compared to its counterparts in other developed nations.  Report after report demonstrates this.  The Commonwealth Fund has released the most recent one.   (Commonwealth Fund Report) And there is absolutely no reason to question the motivations or bias of the authors of these reports, right?  Or the inadequacy of the methods that they use to reach their conclusions?  Or their definition of the appropriate characteristics and objectives of a health system?  Naw.

The report compares the US, Canada, Germany, the Netherlands, Australia, New Zealand and the United Kingdom.  No explanation of why only these countries were chosen and not some other larger ones such as Japan, France, Italy, Spain.  It looks at several dimensions supposedly designed to identify quality, access and cost.  Much of the underlying “data”, however, is just relatively limited surveys of patients and physicians for their “views” of their country’s health system.   The questions used for the various dimensions don’t directly relate to outcomes.   No attempt is made to adjust for the health behaviors of the citizens of the countries, behaviors which the countries have little ability to change.  To the extent that the United States has worse health outcomes on measures such as life expectancy, it is due to our unhealthy behaviors; behaviors which are ultimately an individual’s responsibility.  Similarly, the report takes the view that lack of insurance means lack of health care and poorer health.  That logic has been questioned by other research which indicates that lack of insurance is not linearly linked to receipt of needed health care or health outcomes.  And millions of low-income Americans who are eligible for Medicaid don’t even bother to enroll.  These are likely the same people who have high levels of poor health behaviors.

The Commonwealth Fund tends to have a particular political bias, which is reflected in this report and other work it publishes.   That is also reflected in its support of and praise for the reform bill, which it says will improve disease management, care coordination and lead to better outcomes, which will improve our system’s ranking.  We’re curious exactly which parts of the bill it thinks will create those better outcomes.  We have a lot of problems in our health system, but so do many other countries.   None of the countries to which this report attempts to compare the US have the same set of cultural and individual behavioral issues and if they did, their health systems would look a lot worse on the Commonwealth rankings.  Reports like this one are designed to drive a very specific legislative and regulatory agenda and should be ignored.