The Atlantic Magazine sponsored a forum on health care on Monday in Washington DC, at which Henry Waxman gave the keynote address. According to the write-up of the moderator, Atlantic editor Joshua Green, the public option remains the go-to strategy if the current plan of establishing insurance exchanges does not create the sorts of health-care coverage and competition demanded. Mr. Green also pointed out that such monumental legislation takes on its own life, which means it needs constant monitoring and reconsideration as the US healthcare environment changes. To assist in that monitoring, Gerard F. Anderson and Patricia Markovich of Johns Hopkins University (with support from The Commonwealth Fund) have recently posted a statistical report entitled “Multinational Comparisons of Health Systems Data, 2008.” Though statistical, the report presents a series of easy-to-grasp comparative charts that compare spending and outcomes of a number of advanced western economies/countries.
Health Care Spending Per Capita (2008)
The first and well-known quality is that the US far in excess of any other country on health care. We spend 2 1/2 times the median $2880, and well over $2000 more per capita than our nearest ‘competitor,’ Switzerland. In itself, the number could be meaningless – nay, a sign of the great economic power of the US: we are also the wealthiest country in the world, and if folks want to spend some, most, or all of their income on their health, then what should stop them? Even if one considers the opportunity costs of such investment (i.e., what we might have bought or invested in had we not spent some $6700 on our health-care bills), the money pumped into the health industry employs a great many people, R&D drives universities and federal grants, and who does not want to be healthy? Indeed, even with a $6700 bill, many (although, of course, not enough) Americans still have pretty high standards of living.
But Americans are also known to seek out bargains, to be consumer savvy, to be loyal to the bottom line. Thus we surely get a good thing for our $6700 (Drum roll, please!)
Life Expectancy ofSome Industrialized Western Nations
As many of our readers probably know, we do not. Our life expectancy (as of 2006, when we thought the economy would grow, like, forever) was 80.4 years for the ladies and 72.2 for the gentlemen. True, we were only a bit over a year shorter than our UK cousins across The Pond, but we were paying $4000 (Yes, Four Thousand Dollars!) MORE for the privilege of living a year less. Not a good investment.
The Devil’s Advocate argues: life expectancy is, in many ways, outside the purview of what health-care investment could provide. We have more cars, for example, and drunk drivers lower the average across the nation. Or the extensive coal mining that still drives much of our energy economy is a dangerous occupation. And the British do not have the same numbers in the industry – or the same wealth derived from it.
Deaths From Medical Error (per 100,000 people)
But what about statistics and costs embedded within the health-care industry? Nothing is more a (tragic) part of health care than the errors or mishaps that bring death to the patient. We are humans, and humans make mistakes – to argue that we ought to remove such human foibles from the equation would be rather like arguing we should take gravity out of the discussion of how to make planes safer. What was to us the most shocking of the statistics was the fact that for every 100,000 Americans, .06 of them die per year due to what the report defines as ‘Surgical or Medical Mishaps.’ Less than one person per thousand? A wonderfully low number (and may it go lower still before I next need surgery)! We are tied with France and Germany, both of whom have extensive national health-care services (or what some call “Communism”), which suggests we need not redo our system if we are so favorably comparable to these systems.
But go back to the first chart, and remind yourself that we are spending twice as much as they, and they both have life expectancies longer than the average American by just over two years. The investment we are making – twice or thrice what our economic peers invest – is clearly not going to a rise in our health care per se. If I had been writing about the cost of automobiles or computers, we would all be outraged and demand a new kind of market or provider. We should be doing the same for health care.
The debate is not over, and, as Congressman Waxman stated, the passage of health-care reform is the beginning of the process, not the end. The wonderful quality of the Commonwealth Fund report by Professors Anderson and Markovich is that the charts and figures lay bare what supporters of reform know. The accessibility of percentages and the easy-to-grasp charts make it a fine tool for sharpening our arguments – and our convictions.
