Here we go again, another report on how bad the US health system is. This one is the latest in a series from the Commonwealth Fund. (Commonwealth Report) The authors look at cost, access and quality issues and compare our performance to supposed national and international standards and benchmarks. On the positive side, the report notes that performance on many quality measures has improved, although so have the international benchmarks. But even here the authors miss a fundamental issue; it is likely that the US was always performing better than reported on these measures, it was just that until providers were incented to report, the data was likely incomplete or inaccurate. Completeness and accuracy of data, across all national systems, is a very significant problem for any of these comparative analysis.
The analysis properly notes the difficulty that many people have in obtaining health insurance in our country, and the effects lack of insurance, and high out-of-pocket costs, likely have on access to care. But it is a stretch to say, as the authors do, that this results in high rates of avoidable deaths. It is much more likely that poor health behaviors in the segments of the US population with the least access to insurance are responsible for higher rates of morbidity and mortality. It is those poor health behaviors that drive much of the need for care in the first place. On a possible score of 100, the system rates an overall 64, with 75 on quality, to 53 on efficiency. Obviously there is room for improvement, particularly in areas of reducing inappropriate care. But the fundamental issue of cost is almost impossible to address unless we are willing to substantially reduce the compensation of physicians and other providers.
The US health system has many problems, most of which stem from not recognizing basic economic and behavioral laws that should be taken into account in any human endeavor. But these comparisons are very flawed, largely because they do not recognize the very significant differences in the makeup of the US population and culture compared to other countries, the lack of personal responsibility for health that many US citizens have and the inadequacy of data collection in our and many other countries. Many citizens in other countries to which we are compared are increasingly unhappy with their own systems and flaws in those systems have become more apparent. We should do everything we reasonably can to improve our health system, but we should also disregard these essentially useless comparisons to other countries.