A New Tracker for the US Health System

We have noted before that many people like to belittle the American health system, particularly in regard to the wonderful systems found in other developed countries.  (This is sarcasm, in case it wasn’t clear.  Most Americans, including the ideologues who do most of the belittling,  wouldn’t think of trading their health care for that they would have to settle for in most other countries.)  The Kaiser Family Foundation and The Peterson Center on Healthcare are joining forces to create a new periodic tracker of the performance of our health system.   (KFF Tracker)   The initial release describing the tracker has the usual observations about the percent of our GDP that goes to health spending and our outcomes, in terms of mortality and health status.  The intent is to take a macro-view, with a primary comparison to other large developed nations, although the trends within our country will also be examined.  The group hopes to develop useful analyses of the cost and utilization components of spending and health outcomes that are most meaningful to patients.  In nominal dollars our health spending has increased 3600% since 1970.  On a per-person, inflation-adjusted basis, the change is from $1693 in 1970 to $8745 in 2012, or about a five-fold increase.  This is currently 42% higher than per-capita spending in Norway, the next highest spender.  And there is a good example of what is wrong with these comparisons.  In what significant way is Norway anything like the US, demographically, culturally, economically?  It is not.  In fact, there is no other country in the world which is close to our size that has our demographic diversity.  About 17% of our GDP goes to health care, compared to an average of 11% in the comparator countries.  But all the other countries have an almost exclusively public health insurance and/or medical services system, which may lower costs, but comes with other costs, such as waiting times and limited access to technology.  This initial brief also states that while health outcomes have improved in the US over time, the rate of improvement has been slower than in other countries.  As usual, a focus is on life-expectancy, but the brief does note the socio-demographic reasons why the US may have a lower average life expectancy.  If you took a demographic cross-section of Americans similar to Norwegians, I think you would not see a gap.  And when you look at leading causes of death, it is notable that for cancer, the US actually has a lower death rate, which reflects better access to new drugs and other technology.  I expect more from a group like this, but they can’t resist citing the Oregon Health Insurance Experiment, which randomly assigned low-income people to Medicaid, for helping to avoid health-care related financial stress, but don’t note that this program did absolutely nothing to improve meaningful health outcomes.

We don’t have a perfect, or even a good, health system.  But when fairly compared on an equivalent basis to the ones in other countries, it is no worse and better in some respects.