Is U.S. healthcare terrible?

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Is the U.S. health care system terrible compared to the rest of the world? That???s the claim of a new study from the Commonwealth Fund, but it???s a flawed examination:

A new report from liberal think tank the Commonwealth Fund released on Monday ranks the United States health care system as the worst among 11 developed countries, but the report is deeply flawed.

The first giveaway that something is amiss should be the fact that the United Kingdom ranks as the top health care system of those studied. As I reported in a feature last fall, the U.K.???s National Health Service is facing severe problems and has been plagued in recent years by cascading scandals involving horrific neglect of patients. In U.S. policy debates, liberal supporters of single-payer health care have even backed away from touting the NHS as a model to strive toward in recent years, instead pointing to systems such as France, which offers relatively more choice.

The problem with the Commonwealth Fund study is that it???s rigged to produce a result that favors socialized health care systems. The study determines that the U.S. system is worse because it lacks universal health insurance coverage and the report emphasizes ???equity??? as one of the key factors in evaluating a health care system. But it???s an ideological decision to view equity as one of the most important factors in judging a health care system, just as it is for the study to leave out a factor such medical innovation, which would work to the advantage of the U.S., or choice, which would work against the centralized NHS.

The study also doesn???t mention cancer outcomes. As it turns out, the U.S. ranks well ahead of the U.K. in five-year survival rates for 22 out of 23 types of cancers, according to data from the American Cancer Society. The study also relies on surveys of patient satisfaction, which are subjective, because they vary based on people???s expectations. If people have low expectations, then a system with objectively bad health outcomes could still be viewed as satisfactory.

Avik Roy has more:

One of the disappointing things about healthcare policy research is that its volume is inversely proportional to its quality. Each year, sheaves of research papers are produced by academics and think-tankers, thick with tables and charts, purporting to argue that 62% of all bankruptcies are due to medical expenses, or that 45,000 people a year die because they don???t have health insurance. These studies are then broadcast uncritically by the press, and repeated as gospel by soundbite-seeking politicians. Unfortunately, the methodologies used in such research are often poor, and in the two examples above, intentionally misleading. (Megan McArdle is one of the few writers who has tackled this subject well.)

Such is the case with a new study published last week by the Commonwealth Fund that argues that, compared to six other developed countries, ???the U.S. health care system ranks last or next-to-last??? on measurements of its quality, access, efficiency, equity, and ???healthy lives.??? Overall, the study ranked the Netherlands first, followed by the United Kingdom, Australia, Germany, New Zealand, and Canada, with the U.S. ranking dead last.

The study is typical of the genre: drawing conclusions that are not warranted by the data; failing to account for alternative (and more plausible) explanations; and using flawed methodologies. The point of view of the authors is clear: in the first paragraph of the report, they write that ???newly enacted health reform legislation in the U.S. will start to address these problems by extending coverage.??? But they do their cause no favors with such a tendentious report.

I have been mocked in the past for my defenses of the American health care system as essentially impossible to compare to the health care systems of Europe given the dramatic cultural differences ??? namely, the prevalence of guns and cars here in the United States as compared to Europe. While this is a broad generalization, when looking at how America???s system performs in treating and curing disease for the aged and for those with serious diagnoses, the outlook is very good ??? in some instances, the best.More on this topic here:

If you really want to measure health outcomes, the best way to do it is at the point of medical intervention. If you have a heart attack, how long do you live in the U.S. vs. another country? If you???re diagnosed with breast cancer? In 2008, a group of investigators conducted a worldwide study of cancer survival rates, called CONCORD. They looked at 5-year survival rates for breast cancer, colon and rectal cancer, and prostate cancer. I compiled their data for the U.S., Canada, Australia, Japan, and western Europe. Guess who came out number one?

Another point worth making is that people die for other reasons than health. For example, people die because of car accidents and violent crime. A few years back, Robert Ohsfeldt of Texas A&M and John Schneider of the University of Iowa asked the obvious question: what happens if you remove deaths from fatal injuries from the life expectancy tables? Among the 29 members of the OECD, the U.S. vaults from 19th place to ??? you guessed it ??? first. Japan, on the same adjustment, drops from first to ninth.

It???s fine that organizations like Commonwealth are more interested in producing fake studies to create biased visions of the American health care system. We just should see them for what they are: political talking points, not fair analyses of the good and bad of the systems in question.