Every year we get one or two reports from some non-profit think tank about how bad US health care is–too expensive and worse outcomes. What these organizations never tell you is that they are run and funded by people who want a government-run single payer health system–they want a few bureaucrates to determine the health and health care of everyone. Might want to ask the UK how well that is working out for them right now. The Commonwealth Fund is one of the worst of these garbage organizations and they put out one of their regular pieces comparing the US health system to those in other developed countries. (Commonwealth Report)
So let me do my usual debunking in regard to this entire body of research. Yes the US system is more expensive. But it is more expensive not because we have excessive care but because our unit costs for care are very high. We pay our doctors and other clinicians way more than anyone else. Do you want your doctors paid less? Do you think that will get you better physicians or better care? We pay our hospitals way more than any other country does? This is a result of allowing massive consolidation of hospitals and other provider types–immense horizontal and vertical market power, which allows unconstrained pricing. For commercial business this is combined with a very consolidated health plan market. So the health plans and the hospital-run large health systems conspire, at least implicitly, to just charge more to employers and individuals. Our drugs are high because we allow abusive patenting practices.
This time the report makes some simply ludicrous statements regarding how we have fewer physicians and hospital beds per capita. Last time I checked this is a good thing. We want lower costs and a more efficient system, then being more productive with your resources is what you need. The US does the best job in the world in keeping people out of expensive hospital settings and delivering same day surgeries and treating people at home or in other outpatient settings, with no change in outcomes, in fact often the outcomes are better. So in this regard, the US is far ahead of other countries.
And in terms of health metrics, like life expectancy, obesity rates, etc. we are bad. Really bad. Because we have lousy policies, not a bad health system. We won’t allow people to be penalized by paying more for insurance or health care if they insist on bad health habits, like not exercising, eating poorly, smoking, using alcohol and drugs to excess. God forbid people should be required to show some responsibility. Now we are glamourizing being fat. There is nothing glamorous about the diseases which accompany obesity. And if you adjust for the minority status of our population and other relevant factors, our performance actually doesn’t look too bad.
So we have problems with our health system, but those problems result from our policy choices. Our system is actually very efficient in use of resources and produces very good outcomes. But we allow a lot of very bad individual behavior with no consequences and we have ignored the concentration of health resource that allows excessive unit pricing.
And if you want to see a really bad health system, just go to the UK, where both the payment and the provider side are government controlled. Whackos like those who run the Commonwealth Fund never seem to report on that, however.