Today’s Straight, No Chaser is another in which we comparatively analyze the performance of the U.S. healthcare system. It’s important that this be done. It’s not enough to assert we have “the best healthcare in the world” without using objective data to substantiate these claims. Unfortunately, by any objective measure of the totality of our system, we pretty clearly don’t have the “best” system in the world. What we have is the most expensive healthcare in the world, and for those at the very top levels (of wealth) in society, we have access to options that aren’t found many other places in the world, and it can be argued that these individuals have access to the best medical services in the world. But what about the rest of us, especially the 30 million Americans projected to be without healthcare, even after full implementation of the Affordable Care Act? What about the actual system?

For the fifth time in a row, including studies in 2014, 2010, 2007, 2006, and 2004, the United States has been ranked last in a review of eleven rich, industrialized nations’ health care systems by the Commonwealth Fund, a prominent healthcare think tank. The eleven countries compared include Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the US. The report clearly demonstrate that the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of health care access, efficiency, and equity.
It should come as no surprise that our failure to perform is squarely tied to the lack of access that results from not having universal healthcare. The US is the only country in the survey not having universal healthcare. Consider these resultant illustration:

• 37% of Americans said they didn’t fill a prescription, visit a physician or seek recommended care because of the additional out-of-pocket cost considerations inherent in our system. Now compare this to 4% of citizens of the UK saying the same, and it becomes easy to understand how access to care produces better health care outcomes between countries., not technological advantages we may have. That 37% number was the largest among countries in the survey.

In case you’re interested in the study’s methodology, the report incorporates the following considerations:

• Patients’ and physicians’ survey results on care experiences and ratings on various dimensions of care
• Information from the most recent three Commonwealth Fund international surveys of patients and primary care physicians about medical practices and views of their countries’ health systems (2011–2013).
• Information on health care outcomes featured in The Commonwealth Fund’s most recent (2011) national health system scorecard,
• Information from the World Health Organization (WHO)
• Information from the Organization for Economic Cooperation and Development (OECD)

I guess the obvious thought in your minds might be about the effects of Obamacare (the Affordable Care Act, ACA).

• The data that contributes to Commonwealth Fund’s survey was collected before Obamacare took effect. The authors point out that the “historic legislation” represents an “important first step” to fixing some of the US’ persistent issues with high costs and lack of access to insurance. The health reform law hopes to expand insurance coverage to millions of Americans who have been locked out of the health care system, and that could finally improve the U.S.’s rankings in areas like access and equity.
• But there are still some gaps, due to resistance to Obamacare’s optional Medicaid expansion, which would extend public insurance to additional struggling Americans, about six million of the country’s poorest residents are still left with no access to affordable health care whatsoever.

More from the report: “The claim that the United States has ‘the best health care system in the world’ is clearly not true…To reduce cost and improve outcomes, the U.S. must adopt and adapt lessons from effective health care systems both at home and around the world.”

The lesson I would have you learn is to remember, the U.S. healthcare system is a capitalistic enterprise that delivers $2 trillion a year to various corporate interests. That is a statement of fact, not politics. The delivery of healthcare within this system is expected to be a byproduct of capitalism’s competitively-induced incentives to those in the business, with the expectation that the system will become the best it possibly can be as a result of pursuing that $2T. This is a completely different paradigm than building an outcomes-based system based on putting in place initiatives to accomplish the desired end results and competitively bidding down the costs to the system. We in the U.S. do not have that framework as our underlying focus. The presumption that “the market will fix” the ills of our system leaves us where we are relative to other industrialized countries. Even the ACA only seeks to build on and improve upon the existing system, not replace it with a system resembling those producing better outcomes at lower cost around the world.

Until and unless the conversation and legislative efforts migrate toward universal health care (which is still possible incorporating a “distinctly American solution/system” – despite talking points to the contrary, providing universal health is not necessarily the same as “socialized medicine”), there is no realistic reason to assume these surveys will reveal anything much different that the current results. The confusion that exists in your mind is a belief that better healthcare outcomes are actually the focus of the system. It’s not. As is the case with many other things in our country, the answer is to be found by following the money.
To access the full report, go to http://www.commonwealthfund.org.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what 844-SMA-TALK and http://www.SterlingMedicalAdvice.com(SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.