I was at Cato earlier today to talk health care. Some folks might be interested in the notes from the chat. People with too much time on their hands can watch the video: Why did I think I'd be here to point out the system's flaws while a conservative defended its outcomes? What sense does that make? David Frum's Comeback quote: "Who agreed that conservatives should defend the dysfunctional American health care system from all criticism? 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. We want outcomes, but we don't want things like car accidents are hangliding catastrophes. Thus, amenable mortality data: "We compared trends in deaths considered amenable to health care before age seventy-five between 1997–98 and 2002–03 in the United States and in eighteen other industrialized countries. Such deaths account, on average, for 23 percent of total mortality under age seventy-five among males and 32 percent among females. The decline in amenable mortality in all countries averaged 16 percent over this period. The United States was an outlier, with a decline of only 4 percent. If the United States could reduce amenable mortality to the average rate achieved in the three top-per forming countries, there would have been 101,000 fewer deaths per year by the end of the study period." But then some say, okay, our health care may not be good, but at least it's quite pleasant. Waiting times: Here's how the dodge works: If you look at waiting times, you'll see that relatively few Americans wait more than four months for surgery, which helps folks claim that America doesn't ration care, and makes our system look pretty good on the waiting times metric. Here's what they don't tell you: When you look at who foregoes care, the international comparisons reverse themselves. About 23% of Americans report that they didn't receive care, or get a test due to cost. In Canada, that number is 5.5%. Worse, the American number is understated, as in order to know you need a surgery or further care, you need to go for an initial appointment, and as it happens, many Americans -- including 36 percent below average income -- aren't even seeking that. And it's this group -- which is largely low-income, and I'd guess, largely urban -- who would, in another country, be experiencing terrific wait times. Here, they never get care at all. We call that "no wait" rather than infinite wait. The studies misleadingly write them out of the waiting statistics, making it look like America has low wait times when the relevant population is simply never getting care at all. But would you rather be the urban poor in London, who wait a year for a hip replacement, or the urban poor in America, who never get one? So it's not good and it's not pleasant. Maybe it's cheap? Canada: $3678 France: $3449 Germany: $3371 UK: $2760 USA: $6714 The difference between UK and America could buy every America 5.3 ounces of pure gold per year. Value: Who has better outcomes is like Camry vs. Accord. Some things are better on one car, some things are worse. But if you paid 15,000 for your Camry, and I paid $22,000 for my Accord, then in fact the Camry is MUCH better. So it's not cheap, and it's not pleasant, and it's not good. We may not agree on what reform looks like, but we should be able to agree that this is not acceptable. There is no defense for a system delivering such poor value. Sidenote: The evidence seems to be that systems that spend $2,500 and systems that spend $7,000 give fairly similar results. More health care dollars does not bring you more health care results, and this is true across nations, but also across states (Minnesota v. Florida). Health care does not seem like a good place to overspend. We should probably err on the side of spending less, not more. Instead, we err on the side of spending much more.
