December 13, 2010

The Ignored Facts of American Healthcare

Highly publicized rankings deride the American health care system. But the facts tell another story.

This article is the first in a two part series exploring the ignored facts and disregarded options in health care reform. The essay below examines the ignored facts of American health care.

Medical Care in the United States has been loudly derided as inferior in comparison to health care systems in the rest of the developed world in highly publicized rankings, most notably the World Health Organization’s World Health Report comparing health care in almost two hundred nations. These rankings have gained tremendous traction, despite being exposed in leading academic journals for gross distortions from severe methodological flaws, including huge measurement errors that produce results with no statistical significance, data missing from dozens of countries, biased assumptions, and extreme subjectivity.

Health Care
Illustration by Barbara Kelley

Government officials, policymakers, insurers and even many academics used this pseudo-data to justify their personal agenda centralizing power over health care to government by imposing the radical changes to America’s health care contained in the Patient Protection and Affordable Care Act (also known as "ObamaCare") on a largely unwilling public.

Why has the public remained steadfast in its opposition to the reforms imposed by Congress and President Obama? On one hand, much of the American public still assumes the criticisms of our system are sound, because the calls for change have been so ubiquitous and the topic so complex. Indeed, a large majority of Americans have repeatedly concurred that their health care system needs "fundamental change" or "complete rebuilding."

Yet despite that general opinion, in multiple studies, over 80 percent of Americans are satisfied with the quality of their own health care, a number rising steadily over the past several years. (This striking contradiction in public opinion, while ignored by policymakers calling for radical changes in the debate over the state of America’s health care, reveals the fundamental truth: Americans understand, from personal experience, that American medical care is the best in the world. Americans understand what they could lose in a government-centralized health system in which government is empowered to exercise unprecedented control over the most personal decisions in the lives of individuals.

The reality, from analysis of facts, is that American health care is superior. This inescapable conclusion derives from actual data, not opinion. The world’s leading journals are filled with studies demonstrating the superiority of American medical care to care found in other countries with systems more heavily controlled by government bodies.

These studies verify better survival from serious diseases like cancer, better access to treatment for the most prevalent chronic diseases, wider access to preventive care and cancer screening, broader availability of the newest life-changing medical technology, wider access to the most accurate diagnostic technology, quicker access to innovative, life-saving cures and safer, less invasive treatments, more rapid access to highly trained specialists, and ultimately far better access to the world’s leading doctors and medical scientists who themselves are the source of the world’s leading innovations by any metric examined.

Fact and data prove that American health care is superior, despite the pseudo-data that claims otherwise.

Before accepting a radical overhaul of the world’s leading medical care system, and instead of turning to government as the solution to the widely recognized problems of health care, these important unheralded facts about America’s health care system should be carefully considered.

Fact No. 1:

Americans have better survival rates than Europeans for most common as well as rare cancers. Among more common cancers, the breast cancer mortality rate is 52 percent higher in Germany than in the United States, and 88 percent higher in the United Kingdom. Prostate cancer mortality is strikingly higher in the UK and in Norway. Age-standardized death rates from prostate cancer from 1980 –2005 have been reduced far faster in the United States than in the fifteen other developed nations studied, attesting to superior outcomes in what is the most common cancer among men.

The mortality rate for colorectal cancer among British men and women is about 40 percent higher. Americans, whether men or women, enjoy superior overall survival from cancer than western Europeans.

Fact No. 2:

Americans have lower cancer mortality rates than Canadians. Breast cancer mortality is 9 percent higher, for example; prostate cancer is 184 percent higher; and colon cancer mortality among men is about 10 percent higher than in the United States.

Fact No. 3:

Americans have better access to treatment for chronic diseases than patients in other developed countries. Some 56 percent of Americans who could benefit are taking statins, which reduce cholesterol and protect against heart disease. By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons, and 17 percent of Italians receive them.

Fact No. 4:

Americans have better access to preventive cancer screening than Canadians. Take the proportion of the appropriate age population groups who have received recommended tests for breast, cervical, prostrate and colon cancer:

  • Nine out of ten middle-aged American women (89 percent) have had a mammogram, compared to less than three-fourths of Canadians (72 percent).
  • Nearly all American women (96 percent) have had a pap smear, compared to less than 90 percent of Canadians.
  • More than half of U.S. men (54 percent) have had a PSA test, compared to less than 1 in 6 Canadians (16 percent).
  • Nearly one-third of Americans (30 percent) have had a colonoscopy, compared with less than 1 in 20 Canadians (5 percent).

Fact No. 5:

Lower-income Americans are in better health than comparable Canadians. It is often claimed that government-financed health care systems, such as Canada’s, eliminate income-related barriers to health. The ‘‘health- income gradient’’ (i.e. the concept that higher income achieves better health, and lower income means worse health) for adults 16 to 64 years old reveals a more severe disparity in Canada than in the United States.

Specifically, twice as many American seniors with below-median incomes self-report "excellent" health compared to Canadian seniors (11.7 percent versus 5.8 percent). Conversely, white Canadian young adults with below-median incomes are 20 percent more likely than lower-income Americans to describe their health as "fair or poor."

Fact No. 6:

Americans spend much less time waiting than patients in Canada and the UK—to see a specialist, to have life-changing elective surgery like hip replacements or cataract removal, or to get radiation treatment for cancer. All told, 827,429 people are waiting for some type of procedure in Canada. In England, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.

Fact No. 7:

Americans are not alone, among residents of developed countries, in believing their health systems need major reforms. The unspoken truth is that those with more government control of their health systems, the very countries purported to serve as the models for a reformed American system, are similarly highly dissatisfied and believe their own health systems need fundamental change or complete rebuilding.

More than 70 percent of German, Canadian, Australian, New Zealand and British adults, say their health systems need either "fundamental change" or "complete rebuilding," and 60 percent of western Europeans say their systems need "urgent" reform.

The same health systems held up as models by those interested in overhauling America’s are held in very poor regard by the very people who live under them.

Fact No. 8:

Americans are more satisfied with the care they receive than Canadians, a highly government-controlled health system often portrayed by the media as a system to emulate. When asked directly about their own health care instead of the "health care system," more than half of Americans (51.3 percent) are very satisfied with their health care services, compared to only 41.5 percent of Canadians; fewer Americans are dissatisfied (6.8 percent) than Canadians (8.5 percent).

Fact No. 9:

Americans have much better access to important new technologies like medical imaging than patients in Canada or the UK. An overwhelming majority of leading American physicians say computerized tomography (CT) and magnetic resonance imaging (MRI), which have been maligned as a waste by economists and targeted by the Congress and many policymakers naïve to actual medical practice, were the most important medical innovations for improving patient care during the previous decade.

The United States has thirty-four CT scanners per million population, compared to twelve in Canada and eight in Britain. The United States has nearly twenty-seven MRI machines per million compared to about six per million in Canada and Britain.

Fact No. 10:

By any variety of measures, Americans are responsible for the vast majority of all health care innovations, innovations from which the entire world benefits. The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other single developed country.

Since the mid-1970s, the Nobel Prize in medicine or physiology has gone to American residents more often than recipients from all other countries combined. From 1969 to 2008, Americans (2009 population, 307 million) won or shared the Nobel Prize in Medicine and Physiology fifty-seven times compared with forty times by medical scientists from the European Union, Switzerland, Japan, Canada, and Australia combined (2009 combined population, 681 million).

Indeed, of the past thirty-four years, there were only five years in which a scientist living in America didn’t either win or share in the prize.

***

Cloaked with the straw man argument that "doing nothing is simply unacceptable," the Democratic Congress of 2010 voted for a 2,500-page bill that pushes a radical overhaul of the world’s most advanced health care, a bill opposed by the majority of American voters, and paid at a cost of a trillion dollars by massive taxes, penalties, and cuts in coverage. That legislation is based on government mandates and penalties on individuals and businesses, a dramatic expansion of already unsustainable government insurance programs, and new government authority to regulate access to medical care, physician-patient decision-making autonomy, and insurance benefits.

It may shock many Americans that the same health systems held up as models by those interested in overhauling America’s are held in very poor regard by the very people who live under them.

Much of the urgency for reform was pressed on the American people by distorting the problems with the system and blatantly ignoring the facts that point to the excellence, and indeed the superiority, of American medical care. Americans enjoy unrivalled access to the most advanced medical care in the world, and important facts—data published in leading peer-reviewed journals—point to the superiority of America’s health care.


Scott W. Atlas is the David and Joan Traitel Senior Fellow at the Hoover Institution and senior fellow by courtesy at the Freeman Spogli Institute for International Studies at Stanford.

Atlas's research interests are domestic and global health care policy, particularly the role of government in pricing, quality, access, and innovation. He lectures throughout the world on MRI advances and key economic issues related to technology innovation. Atlas has been interviewed on television, radio, and other news media, including BBC Radio and the Lehrer News Hour, and in newspapers such as England’s Financial Times, Brazil’s Correio Braziliense, Italy’s Corriere della Sera, and Argentina’s Diario La Nacion. His most recent book, In Excellent Health: Setting the Record Straight on America’s Health Care (Hoover Institution Press, 2011), gives evidence of the high quality and access found in the US health care system relative to those of other countries and suggests free-market reforms to reduce costs and maintain quality and consumer choice. Atlas, who has received numerous awards and honors, has been a member of the Nominating Committee for the Nobel Prize in Medicine and Physiology for several years.

Atlas received his BS from the University of Illinois Urbana-Champaign and his MD from the University of Chicago.


This article is excerpted from the Hoover book "Reforming America’s Health Care System."

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