Noah Pollack starts this post by saying “I am far from knowledgeable about health care,” and then gets right down to the busy of proving it, using the oft-discredited prostate cancer stats to argue that “survival rates for many diseases are higher in America than in western countries with socialized health care systems.”
We’ve been down this road before, of course. It’s very hard to compare cancer mortality because you must somehow hold constant “cancer stage” and “risk of death at time of diagnosis.” America is much more aggressive at testing for cancer and so we’re much more effective at catching cancer — including lots of non-lethal cancer. But it’s not at all clear that we’re better at treating cancer. That’s why the linked data is so important. We have much higher “incidence,” which is to say we diagnose much more of our population with prostate cancer. But as many doctors now agree, lots of prostate cancer shouldn’t be treated, and early treatment can actually be harmful. Meanwhile, we have almost the exact same death rate as the UK. So if you’re going to use the incidence data rather than the death rate data, you’d better have a good argument for why. I rather doubt Pollack has such a reason. Meanwhile, the same study that provides the cancer statistics also has an aggregate statistic tracking years of life lost due to all causes that health interventions could prevent. So rather than cherrypicking cancer, we can examine the average:
So in the aggregate, Americans lose more years of life due to bad medical care than residents of any other advanced country. It’s not a shocking conclusion: 15 percent of our population has no regular access to the health system, and another 15% to 20% has insufficient insurance coverage. But don’t take it from me. I’m some sort of liberal. Later today, I’ll be at Cato, responding to a paper from Glen Whitman that examines cross-country health outcomes data. I’m there as the liberal opposition. Glen is there because Cato’s director of health policy studies, Michael Cannon, likes his work. Glen concludes:
Given the general consistency over several studies, and the large number of patients involved, the higher survival rates in the US in comparison to Europe, Canada, and in some cases Australia and Japan, are likely reliable, and worthy of consideration. But they are not necessarily indicative of higher quality medical care, because these studies do not adjust for cancer stage and risk of death at the time of diagnosis. A particular concern is survivor time bias: those patients with cancers detected earlier are likely to have higher survival rates even if they receive the same quality of health care. Thus, these statistics may indicate that cancer care is better in the U.S., or simply that cancers tend to be diagnosed earlier in the U.S. In fact, there is significant evidence that Americans are more likely to undergo regular screening tests for cancer than are citizens of other countries.
Other health policy experts, such as Robert Ohsfeldt and John Schneider , and David Gratzer, have argued that survivor time bias is not a problem because earlier diagnosis offers more chance of cure anyway. It is true that many cancers have better outcomes if found at an earlier stage, but that only opens up another question. Are those Americans who are diagnosed earlier than their European and Canadian counterparts getting better treatment as a result? More data is necessary to answer that question. For now, the most reasonable conclusion is that it is unlikely for the U.S. to have any worse outcomes than any other country, but that the better survival in the U.S. may be due primarily to earlier diagnosis.
And in order to receive that ringing endorsement, Americans only pay $4,000 more per person, per year, than the British. Suck on that, England! Meanwhile, Whitman’s paper concludes that Canada is probably better than America at treating heart disease, and chronic diseases like diabetes or kidney failure are dealt with better in Canada and Europe. Indeed, he says, there’s “no clear evidence that US is number 1” in care outcomes, “but also no evidence that US is poor, certainly not 37th.”
So despite paying twice as much per person as any other country on earth, it’s not clear that we get the best care (and there’s no evidence, anywhere, on any measure, that our care is twice as good). Canada seems better at treating heart attacks, and most universal systems are better at treating chronic diseases like diabetes and kidney failure. On the bright side, we’re probably not 37th. And this is coming from a scholar being published by Cato.
Whenever I read posts like Pollack’s, I’m reminded of something David Frum wrote in his book Comeback. “Who agreed that conservatives should defend the dysfunctional American health care system from all criticism?” He asked. “Who volunteered to take the bullet for every crummy HMO and overpriced surgeon in the country? Who decided that it was okay with us for tens of millions of Americans to lack health care coverage?” It’s a good question. Noah Pollack should ask it of himself more often.
