Health Care Sucks in the USA

[steven nenzel]

Or, is it the best in the world.... this flies in the face of WHO. I knew from personal experience that the health care provided here was better than what I received in Canada. Now we have evidence. Of course this does not fit the agenda of the media so you will never here a word about it.

Scott W. Atlas, MD is the David and Joan Traitel Senior Fellow at the Hoover Institution, Stanford University, and author of the recently published book In Excellent Health: Setting the Record Straight on America’s Health Care

To justify more government control of America’s health care, ObamaCare supporters frequently assert that access to and quality of health care in the United States are poor. However, the facts from source documents and medical journals show that Americans enjoy superior access to care compared to nationalized systems, the very systems put forth as models for ObamaCare — whether defined by wait-times for diagnosis, treatment, or specialists; timeliness of surgery; access to screening; or availability of medical technology and drugs. The separate issue of quality of care also demands analysis of objective data – and that means data from peer-reviewed medical journals, rather than subjective “rankings” and surveys by advocacy groups.

Even before medical care quality is compared, one should understand that a population’s lifestyle, behavior, and heterogeneity impact health outcomes and life expectancies, even when medical treatment is sound.

For instance, cigarette smoking and obesity are proven to increase risk for serious diseases, worsen outcomes from those diseases, and decrease life expectancy—even with excellent medical care. And their impact is huge.

Cigarette smoking alone accounts for about 443,000 deaths, or nearly one of every five, each year in the US, and is independently responsible for about 35 percent of all heart attacks, particularly fatal ones, and about 20 percent of strokes.

The rationale for President Obama’s radical transformation of the US health care system was incorrect. Combined with the fact that the law does not reduce health care expenditures, it represents one of the most tragic errors of misguided government in modern history.

Because smoking harms nearly every organ of the body, it causes or exacerbates many additional diseases, and it worsens outcomes from surgery and innumerable other treatments.

Obesity is now linked to greater risk of death from heart disease, stroke, diabetes, high blood pressure, all of the most prevalent cancers, and worse treatment outcomes after heart surgery, trauma and burn surgery, and transplants. It is not simply that rates of diseases are higher; the treatment outcomes are significantly worse for cigarette smokers and obese patients.

Why would these behaviors have particular impact on US health care rankings?

First, the prevalence of obesity is far higher in the United States than in all other OECD nations. More than one-third of Americans are obese, compared to 15.4 percent in Canada, 10.2 percent in Sweden, and 9.0 percent in Norway. Thorpe separately compared the US to ten Western European nations (Austria, Denmark, France, Germany, Greece, Italy, Netherlands, Spain, Sweden, and Switzerland) and found that Americans were nearly twice as likely as Western Europeans to be obese (33.1 percent versus 17.1 percent). It’s not a fluke that Japan, where only 3.4 percent of people are obese, has the greatest longevity.

Second, the United States harbors a far higher burden of cigarette smoking than other nations. Almost 70 percent of U.S. men born between 1910 and 1930 were regular smokers by age thirty-five. The US had the highest level of cigarette consumption per capita compared to all other developed nations over a five decade period ending in the mid-1980s. Americans are still significantly more likely than Western Europeans to be current or former smokers (53 versus 43 percent). Although some emphasize that smoking cessation rates are higher in the US than in Europe, the WHO was correct when it stated that “current prevalence of tobacco smoking is an inadequate predictor of the accumulated risk from smoking” because “the diseases caused by smoking, particularly cancers including lung cancer, occur after long delays...with an average time lag of twenty- five to thirty years.” Clearly, the high historical burden of cigarette consumption in the US continues to have impact.

Let’s compare data for cancer, heart disease, and stroke, the most common sources of sickness and death in the US and Europe, and the diseases that generate the highest medical expenditures.

American cancer patients, both men and women, have superior survival rates for all major cancers. For some specifics, per Verdecchia, the breast cancer mortality rate is 52 percent higher in Germany than in the US, and 88 percent higher in the United Kingdom; prostate cancer mortality rates are strikingly worse in the UK, Norway, and elsewhere than in the US; mortality rate for colorectal cancer among British men and women is about 40 percent higher than in the US. Removing “lead-time bias,” where simply detecting cancer earlier might falsely demonstrate longer survival, death rates from prostate and breast cancer from the early 1980’s to 2005 declined much faster in the US than in the 15 other OECD nations studied (Australia, Austria, Canada, Finland, France, Germany, Greece, Italy, Japan, the Netherlands, Norway, Spain, Sweden, Switzerland, and UK). The inescapable conclusion from objective data is that US patients have superior outcomes from nearly all cancers.

Treatment for heart disease is also superior in the United States.

First, a comparison of the US to ten Western European nations (Austria, Denmark, France, Germany, Greece, Italy, Netherlands, Spain, Sweden, and Switzerland) showed that 60.7 percent of Americans diagnosed with heart disease were actually receiving medication for it, while only 54.5 percent of Western Europeans were treated (a statistically significant difference).

Likewise, US patients needing surgery for heart disease receive it more frequently than heart patients in countries with nationalized insurance. For example, twice as many bypass procedures and four times as many angioplasties are performed per capita in the US as in the UK. A separate comparison between Canadian and American patients showed the same pattern: of patients diagnosed with coronary heart disease, a higher percentage of US patients actually received treatment.

But is there evidence that Americans with heart disease actually benefit from receiving treatment more frequently compared to patients elsewhere? The answer is yes. Specifically, the US shows a significantly greater reduction in death rates from heart disease than Western European nations, the European Union as a whole, and Japan.

A separate study showed that Americans had a significantly longer five-year survival after acute heart attack than Canadians. The authors concluded that “our findings are strongly suggestive of a survival advantage for the US cohort based on more aggressive revascularization.”

Another comparison study showed that fewer Americans than UK residents die (per capita) from heart attack despite the far higher burden of risk factors in Americans for these fatal events. In fact, the heart disease mortality rate in England was 36 percent higher than that in the US. These superior outcomes from US medical care are particularly impressive, considering that American patients have far more risk factors (diabetes, obesity, chronic kidney disease) that worsen outcomes and death rates after heart attack and after heart surgery.

The US shows a far greater reduction in death rates from stroke, the third leading cause of death and the leading cause of disability in adults in the US and most Western European nations, than almost all Western European nations and the European Union overall.

One reason for better results of stroke care is that modern therapy has been more widely available and was available years earlier in the US than in countries with nationalized insurance. Even given the disadvantages inherent to American patients (physically inactive, obese, and with high blood pressure – all significantly higher than comparison countries), studies still prove better medical care for stroke in the US.

What about treatment for chronic diseases like hypertension and diabetes?

To assess the quality of care for high blood pressure, or hypertension, we must look at two sets of data. First, once hypertension is diagnosed, is it treated or does it go untreated? About two-thirds to three-fourths of patients with high blood pressure in Canada and Europe were left untreated, compared to less than half in the US, with England having the lowest level of treatment, followed by Sweden and Germany, Spain, Italy and Canada, all far behind the US in a comparison study. In a different study, 88.3 percent of patients aged 18 to 64 in the US diagnosed as hypertensive received treatment, compared to 84.1 percent of the Canadians with hypertension, a pattern also seen in older patients.

Second, hypertension treatment in the US has been more successful in controlling blood pressure than elsewhere. One comparison showed that control in treated patients at 140/90 blood pressure, as well as at a higher standard of 160/95, was highest in the US, outperforming Canada, England, Germany, Italy, Sweden, and Spain.

In a separate analysis of over 21,000 patients already visiting doctors for hypertension in five Western European nations (France, Germany, Italy, Spain, and the UK) and the US, the best rate of success was in the US (63 percent), compared with 31 percent to 46 percent of patients in the European countries. The facts show that more successful blood pressure control was seen in the US for both women and men under treatment, differences that are statistically significant. As for why, the conclusion by the authors is not surprising: “lower treatment thresholds and more intensive treatment contribute to better hypertension control in the United States” …that is, because of the delivery of better medical care in America.

No disease has more far-reaching and more serious consequences than diabetes, a disease near the top of the list of the world’s most important health challenges, fueled by a relentless rise in obesity. The risk for death in diabetics is about twice that without diabetes, and disease outcomes are also significantly worse. While “type 2” diabetes (90 to 95 percent of diabetes) is preventable by an individual’s own choices (weight loss and increased exercise), medical care focuses on control of blood glucose to limit organ damage and complications.

Receiving diabetes care is the first concern, and then attaining control is the second. In 2011, the WHO determined that of seven countries, the US had the highest proportion of adult diabetics who were actually receiving treatment for their known diabetes, as well as for their hypertension and for their high cholesterol.

A 2007 comparison of Canadians and Americans showed the same -- a higher percentage of American diabetics than Canadian diabetics actually receive treatment. In the same WHO analysis, the US also performed best by several different quality measures, including blood glucose control, as well as effective management for all three key factors in diabetics (blood glucose, blood pressure, and blood cholesterol), approximately twice the success of England and Scotland. Here’s the bottom line: if you had diabetes, you were more likely to receive treatment and be treated successfully for the disease and the important risk factors for its serious sequelae in the US than in any other country studied.

Objectively, the world’s leading medical journals are filled with studies demonstrating the excellence of American medical care in comparison to other systems more heavily controlled by government bodies, the very systems held as models by those asserting the need for radical change to US health care.

These studies verify better survival from serious diseases like cancer, better access to treatment for the most important chronic diseases, and superior control of diseases that cause disability and death and are themselves significant risk factors for other deadly diseases … all this even though US life expectancy and disease outcomes are worsened because Americans harbor more risk factors than all other countries.

Yet another inescapable conclusion is evident – the rationale for President Obama’s radical transformation of the US health care system was incorrect. Combined with the fact that the law does not reduce health care expenditures, it represents one of the most tragic errors of misguided government in modern history. All Americans, as well as children and adults throughout the world who benefit from US health care innovation, will be far worse off for it.

[Dan R.]

A lot of reading, but a great read.
It told me what I thought I knew from seeing the world's wealthy traveling to the USA for medical treatment. Follow the money, it will always show the way.

[szw21]

I think "Cost of Healthcare Sucks in the USA" may be a more appropriate point/title.

Having good healthcare is great but how does that help the large numbers who cannot afford healthcare and and do not have insurance due to not being able to afford it or being denied coverage?

[Burkie]

The cost of healthcare has spawned an entire industry of Medical Tourism. Costa Rica has a few and we are building a big hospital down here for same.

My step brother lives in Melbourne Fl which is medical country every type of Doctor is everywhere. They have a good health plan but goes to the Dentist down here when they travel back. Much cheaper.

If there is something major the people who can afford it fly to Melbourne mostly or Miami and Toronto. We have good doctors down here but the after care facilities are not the greatest to say the least.

Regards

[Dan R.]

The biggest drier of health costs seems to be liability. Lawyers are stressing healthcare here in the USA, with lawsuits.

[steven nenzel]

Now your first statement is spot on... the cost of health care in the US SUCKS!!! Now explain to me how Obama care is going to bring the cost down? In fact it is causing it to go up. Nothing in Obama care was directed towards bringing health care costs down... nothing! This bill will go down as the worst piece of legislation in US history.

[Burkie]

Correct Dan. Quite a few of these medical facilities are staffed with US Doctors on "working Holidays". They may work for less but may actually work for more when you work out the legal liability insurance saving.

Regards

[Miles]

Health care, like sales, is a completely results based business. In either field, effort means nothing if it doesn't produce the desired results. In the US, we spend a lot of effort (money) and we don't get the desired results (health and longevity). What I read in this article is that the US system offers more treatments for more ailments and symptoms. We have unique circumstances because our population is more unhealthy, thus we can't expect any better results. Yet the results are what they are and the costs are still the highest in the world. This article seems to argue that the Obama plan is terrible, yet offers no alternative. On the contrary, it argues that what we're doing is great and we should continue what we're doing.

But the results say otherwise. I hear similar arguments from sales people who aren't selling.

[steven nenzel]

Because they offer no alternative this makes the Obama plan good? What is the point of offering another plan....there is no stopping this fckd up legislation.

Miles, your defense of the policies of this administration is so contrary to how you run your business and how you live your life. How you rationalize the irrational amazes me. You know dam well free enterprise is responsible for for the the quality of goods and services we receive in the private sector and you cannot refute that it has made this world a better place to live in. Business not gov't brought the cost of a laptop down to $600.

So tell me why health care costs so much if free enterprise can bring the price of a lap top down to $600 dollars? Please explain to me why you think health care is so expensive.

[Miles]

Health Care is different than any other product produced by free enterprise. First of all, we don't guarantee somebody that if they show up at Best Buy without a laptop, we'll give them one. But in the US, if you show up at the emergency room you're getting covered with or without insurance. That's not free enterprise. I'd be more in favor of a system that didn't cover those without insurance than to say the system we have works fine.

Decades of free enterprise healthcare has not produced the equivalent of a 600 dollar laptop. It's produced the equivalent of a 10,000 laptop. You can get by without the 10k laptop, but we all need healthcare at some point or another.

I'm not defending Obamacare. I'm defending govt. run healthcare, like is done almost everywhere else in the world. it wasn't Obama that came up with this. It has been proposed by every Democratic President for 100 years. And apparently, it was also the idea of this years Republican presidential candidate as well.

[Stonecuttter]

I'm not defending Obamacare.

[steven nenzel]

Again Miles, please tell me why health care costs so much. Since you believe free enterprise does not work to bring health care costs down I'm wondering why it does not work. It seems to work in all other industries where gov't is not involved. So, in your opinion what specifically causes health care to be more expensive in the US?

Just because something is proposed or done by a republican does not mean I agree with it. There are lots of things bush did that I do not agree with. I'm an independent thinker. I have no emotional attachment to the parties.

The facts presented to you show that we get better treatment here than in Canada so gov't run health care produces worse results.

[Miles]

Canadians live longer. That's results.

The reason that health care is not like other free market products is our guarantee of coverage even if you can't pay. So those with insurance pay for those without. That's one reason.

The other is that it is not normal supply and demand. A doctor tells you you need something and your insurance covers it, you're going to get it. So there is an inflated demand in our system.

Insurance itself distorts the free market.

[Curtis R. Marburger]

Would have to change the Hippocratic oath for doctors.
So they can refuse help to those who dont have money

[steven nenzel]

Canadians may live longer but is it because of their health care system or life style? The study tells us that health care received here is better and from my experience I agree.

Miles, is it insurance or gov't that distorts the market? I can't buy the kind of insurance I want because the gov't says so. The rules gov't has in place is what is distorting the market. You seem to believe, beyond all fact, that we have unfettered capitalism operating in the health care system. We have a collusion of big business and gov't.

[steven nenzel]

Miles, I have to say, you really have to go to great lengths to rationalize support for Obama. A business owner who supports a president and party that has not produced a budget in 4 years and may not for another 4 years, supports a president who is running up a debts unlike any other in history and will continue to do so for another 4 years, a president who passed a 2,700 page health care law that does not bring down health care cost, etc. must live in a world of reality and fantasy at the same time; a pretend world where debts and deficits do not matter and the real world where business operates by containing costs and providing goods and services at a profit. Some how you keep these two worlds apart as the principles of one do not apply to the other.

It is truly bizarre.

At what point do the facts begin to filter past your emotional attachment to being a democrat? Are you still encouraged that Obama will tackle the big issues of debt, deficit, entitlement reform, etc. You got your tax increase so now what can divert your attention away from what is actually going to solve our problems? Maybe immigration will solve all the problems or perhaps gay marriage or income equality.

[Dan R.]

Heard a ad today why it s important to file your income taxes: A married couple with 2 kids will get subsidized help paying deductibles if their combined income is 4 x the poverty level or under, which equates to $90,000 annually. It seems like an odd stat to me, but that is what they said. So now we are going to subsidize every family under $90,000? Where does this end well?

The commercial also stated that it will be cheaper to buy insurance through the program than to pay the fines. Greta news for freedom of choice!

[szw21]

Maybe I missed it but I cannot see where Miles was defending Obamacare. I personally do not like Obamacare and I can see how premiums have gone up for many people including myself. However, the simple fact is that the cost structure of the medical system has been broken for a long time before Obamacare. I too believe that affordable heathcare should be considered a basic necessity and a system should be in place to at least provide everyone such a system and if necessary govt mandated healthcare as is available in many countries.

On top of that there can be private healthcare for those who can afford it and want the best care. There is no reason why the two cannot coexist like for example in the UK.

[Tank]

First, healthcare in this country does NOT suck !! As Dan has pointed out, when people from countries with socialized medicine need major surgery, they come HERE, there's a damn good reason for that.

Second - I find it hard to believe that the very people who keep complaining about the cost of healthcare are the very same people who voted to re-elect Obama. Is it so difficult for you guys to understand that it's the GOVERNMENT who has created all the red tape and regulations that are directly responsible for the cost of your healthcare? It's really not that difficult to understand.

I will use the car insurance analogy...again, the reason car insurance is relatively inexpensive is because there are tons of providers who are not restricted as to where they can and can't sell their product, this creates competition for business, competition for customers drives prices down, it's a proven economic fact...competition forces providers to provide more services for their customers and potential customers at a lower cost, thus the consumer receives more for their money - it's basic economics 101.

On the other hand, the Federal Government restricts healthcare providers as to where they can and cannot sell their product, which in turn limits the options available to consumers, this does not benefit the consumer and makes the healthcare provider the "only game in town" so they can charge pretty much what they want for their service or product because there is little to now competition for that business - again, basic economics 101.

Don't believe me? do a little research and see what the average family pays for healthcare insurance in New Jersey, then see what the exact same coverage costs you in Pennsylvania.

It absolutely IS normal supply and demand, when I need to go to the doctor, I go, when I need food, I go to the store, when I need gasoline, I go to a gas station, no one is forcing people to go to the doctor...yet.

The other part of the increased cost is doctors, specifically doctors who accept medicare or Medicaid patients, they are required to provide the same level of care to everyone, yet the Federal Gov't only reimburses them a fraction of the cost to provide that care to medicare or Medicaid patients - how long could any of you stay in business if you had to do business that way?

[H. Adkins]

Insurance itself distorts the free market.