I don’t doubt the implications behind the World Health Organization’s ranking in 2000, which placed the United States 37th in healthcare even though we spend more per capita than any other nation. I just wonder if things are a bit more complicated than the topline suggests. New data from the Organisation for Economic Co-Operation and Development offers some perspective:
The United States and Canada have good cancer care, screening more people than most other countries and saving the lives of a greater number of cancer patients. Japan also has higher survival rates for people with cancer than most countries. The Netherlands, Italy, Switzerland and Germany provide good primary care, reducing costly hospital treatment for chronic conditions such as asthma or diabetes. But no one OECD country provides high quality care in all areas….All OECD countries provide universal or near-universal coverage for a core set of health services, except the United States, Mexico and Turkey.
I remember asking Standard & Poor’s chief economist David Wyss back in 2007 (see video) if the high cost and low ranking of the U.S. system is proof that we need to move to single-payer healthcare. His response: “It’s certainly an argument for changing what we’ve got now. I’m not sure you have to go to a single-payer system. Germany does fine with an insurance system, but it has to be a universal coverage.” The sad truth is that after reform, we’ll be closer to universal coverage, but still not there.
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Single-payer does not fit the American values of choice and competition. The Netherlands, Switzerland, Austria, Belgium and Germany achieve universal coverage using private insurers that are regulated, along with risk-adjusted vouchers or subsidies. Those nations were the inspiration for the Wyden-Bennett Health Reform Plan – but that was considered too radical a change, despite having bipartisan support.
Our greatest need in the US is to help patients learn to manage and improve their health. Part of that is developing healthy habits in children, and part is aiding adults and seniors to manage or avoid chronic disease. Unfortunately, investments in disease management and health education often do not have a rapid pay-back and so may be unattractive to publically-traded firms. There should be new alliances between public health and private insurers to bend the cost curve.