What evidence exists for the statement that the US provides the best health care?

Great Debates
41

If any evidence exists, I’ve never seen it. I see the contrary, in fact. I don’t doubt that some American, somewhere, is getting the best healthcare in the world, but we shouldn’t even assume that people with good insurance getting care from top hospitals are actually getting the best care. There’s still a largish gap between known best practices and what American hospitals actually do. Look at handwashing rates, for example.

And if the question is how to measure quality, that’s not a bad place to start – with best practices. Take a set of protocols for the treatment or management of some typical medical conditions, and see how a given hospital does, or how we fare nationally. It’s frightening how much variation there is, and how often hospitals depart from best practices, even on comparatively easy stuff. Check out the site of the Leapfrog Group for an illustration.

42

This PDF file is an excerpt from the “OECD Factbook 2007”. The second page of the PDF contains a table called “Total and public expenditure on health”, the third numerical column of which show public (i.e. taxpayer-funded) spending by country for 2004, in US dollars corrected for PPP (purchasing power parity). [2004 is the most recent year for which I could find freely-available tabulated OECD figures.]

The figure quoted for the US, $2727 public dollars expended per capita on health, was exceeded only by Luxembourg ($4603), Norway ($3311) and Iceland ($2777); in contrast, other figures included France ($2475), Sweden ($2399), Switzerland ($2382), Germany ($2341), Canada ($2210), and the UK ($2184).

The first graph on this PDF link shows a bar chart of “Health expenditure per capita, public and private, 2005”, which shows essentially the same rankings.

So, despite the frequency with which it’s trotted out in the US health care debate, it is emphatically not true that countries with UHC invariably spend more taxpayer money per capita on health care than the US does. If such countries do have higher taxation than the US, it’s for other reasons.

[The US, of course, also spends a much greater amounts of private-sector money than other countries, but that’s a separate issue…]

43

Perhaps pertinent to this: description of a new study on preventable deaths in industrialized countries (the original article is not available for free)

44

I think you mean, “Paid out of general taxation.”

45

One difference is that in the US, medical school is post-graduate, while I believe it’s not so in the UK.

46

People are saying that the U.S. is leading in research. I’ve been trying to track down numbers to no avail, but I’d at least like to add something about where some of the giants in the industry have their corporate headquarters.

AstraZeneca - Sweden
Bayer - Germany
GlaxoSmithKline - UK
Novartis - Switzerland
Roche - Switzerland

47

Corporate headquarters locations don’t mean anything. I know Astrazeneca quite well and they are also headquartered, like many companies, in Delaware with many thousands of employees in the U.S.

Most people don’t call it this but the U.S. has heavily socialized national research policies. Billions of dollars in funds are handed out to both academic and corporate researchers in the form of grants. There are also billions of dollars in private grants as well. Much of the U.S. academic infrastructure depends on these grants and the single biggest criteria for academic success depends on academic researchers to procure them successfully and then publishing their related findings. The push is incredibly strong down to the individual level and the academic population’s livelihoods and careers are on the line to make an quick and effective contribution to research in their area. I used to be one of those and the atmosphere is intense and often oppressive. This entire mindset is why I believe the U.S. excels in research.

48

Here’s a short UPI summary. It indirectly speaks to all the “free” health care people get, such as in prison, or emergency rooms. Usually it’s last-resort type care that would have been avoided if affordable, relatively cheap preventative care were available to more people.

49

It’s interesting how US posters will say that they pay lower taxes than nations with Socialised Medical Systems.

It depends upon what you call tax, because tax isn’t just what is paid to the state, tax is paid by all sorts of folk for all sorts of services, tax is pretty much an involuntary deduction from income.

The US pays extremely handsomely for its healthcare, 15% GDP and yet it does not offer comprehensive cover, absolutely nothing like it, and its something of an indictment, but each system has its faults ours is far from perfect too.

The UK system takes up 6% of GDP and does provide this cover, its something that annoys me, because here in the UK we moan about the cost of the Health system, but we could do so much more if we chose to invest it.

Folk in the UK prefer to have their 3 or 4 foreign holidays per year rather than maintain their health and lives through paying for a better system by taxation, very shortsighted, but when we see services in short supply the same people tut and say ‘isn’t it terrible’ or ‘something must be done’.

Yes, UK taxes are higher, but healthcare is only a part of the reason, so you cannot just compare taxation rates on such a crude basis.

It would be far better to ask what the cost of healthcare is to the citizen, and there isn’t any doubt the US system is very much more expensive.

It would be interesting to find out just how much of each dollar spent actually goes directly into medical services, compared to how much goes on profits to various interested parties such as insurance companies, shareholders and the like.

50

<anecdote> It is true that in the US there are a substantial number of foreign born doctors, around the Bay Area mostly from India and China. I’d guess our medical schools are better on average (though I’m willing to be corrected) and I suspect the expected income from practicing here is higher. In my large group I don’t know of any doctors from EU countries.
</anecdote>

51

Because doctors in the UK (for example) are hardly badly paid themselves, so are less likely to move overseas for work.

52

Of course they do. The U.S. is the biggest market. Mercedes probably has a big headquarter in the U.S. too, as does Toyota. But even if Toyota has plants, research, design teams and proudly boasts “American Made” in commercials, I’d hesitate calling a Camry an American car.
The analogy fits. Corporate structures and culture are heavily dependent on the country of origin. Some large American companies have run into problems establishing themselves over here. The corporate culture doesn’t work very well with how us Euro types do business. McD has integrated their franchises well, whereas Toys’r’Us hasn’t. They have a store for every 500k people in the U.S. (587 in total), whereas my ballpark figure for Europe is 1-1.5M per store.

Back to pharmaceuticals -
I can’t back this up, without massive research, but I’m pretty confident that there’s as much research going on within the EU as within the U.S. Now, the EU population is somewhat larger, whereas the U.S. market has more money. The thing is, saying that *not having UHC * in the U.S. has lead to more and better research doesn’t seem true.
Being Swedish, coming from the epitomy of the welfare state, there’s still cutting edge research going on in pharmaceuticals (and telecom), but I’m not all that satisfied with how our UHC works. All I’m saying that despite the flaws of our UHC, there’s still a lot of research going on and advocates against UHC in the U.S. shouldn’t try to use lack of reasearch as an argument against UHC.

The problem we have with UHC is that people over-consume, since it’s free. Kid has a slight cold - go to the doctor to get a prescription. Hurt your knee playing soccer - go to the doctor to get a prescription. Worrying about that fluid, oozing from your genitals - go to the… Well the last one makes sense, but actually, our NHS spend a lot of time, money and effort, *trying to make people not seek * medical treatment.

Once you pass the gatekeepers, the treatments and facilities are top notch. However, the mom with the one year old baby who has just spent 14 hours waiting in the emergency room, with her baby wailing from having tinitus isn’t very happy that she’s been categorized with the 20 other mothers who where trying to see a doctor only to find out their kids had the common cold.
This mom, in need of a prescription for antibiotics, is the one suffering from our generous UHC.

53

No, see here, for example.

As of 2004, EU productivity in biomedical research was only 74% of the United States. The gap is closing fast, however.

54

Actually, there appears to be some methodological errors in that paper that have been acknowledged by the authors, not least they only record English language papers within the EU, meaning the statistics from Eastern Europe are perhaps unfairly low, where there’s a strong tradition of publication in native languages.

55

This might be of interest. Mortality Amenable to Healthcare statistics.

56

No doubt. I do think, however, that a top doctor or surgeon in the U.S. probably makes more than his or her counterpart in the UK. Although given that the UK has a parallel private system, I could very well be wrong.

At any rate a top doctor certainly makes more money here than in India, which is where it seems a huge amount of our medical talent comes from. (Technically speaking, I think that many of them are children of Indian immigrants.)

57

I had a 6 year medical degree from the age of 18-24, rather than an 8 year medical degree from 18-26, however I learnt exactly the same stuff in those 6 years as a North American medical student would learn in 4 years of medical school, and I didn’t faff about with pre-med. If you want to compare me with American doctors of my own age, hell, I’m 2 years ahead of them!

There were about 15 people in my year at Trinity from Canada and the USA. All bar two of them went back, to the internships or residencies they wanted. All of them passed their USMLEs 1 and 2 without difficulty during their degrees.
One guy got a prestigious anaesthetics posting in Canada (he was one of 75 applicants for 2 jobs and had competition from other Canadians, not just foreign doctors) and he was by no means in the top 5% of my class.

I earn £36,000 a year before tax, two years out of medical school. It’s not crazy Wall Street money, but it’s not horrible for a 25 year old. I work between 48 and 56 hours a week with 27 days of annual leave, 10 days of study leave and several statutory days guaranteed off a year, so I have time to have a life. I, like most British doctors, have student debts of around £20,000, which I pay back at specially low interest rates. My debt payments come directly out of my pay and currently it is about about £100 a month (the more I earn, the more they take, but it’s not a lot). My husband (who works in IT) and I bought a 3-bedroom, 2 bathroom apartment and we have a nice standard of living and enough time off work to enjoy it.

Compare with my North American classmates, who on average had 6 figure debts at horrible interest rates, work 70-80 hour weeks with fewer days off a year, and have difficulty buying their own homes because of their debts.

Currently I’m working as a medical SHO (first year resident) in a small (70 bedded) District General Hospital. At weekends, in the evenings and at night when I am on shift I am the most senior medical staff member on site (with my consultant a phone call away). I have ample patient contact, responsibility and training experience.

I’m still waiting for a cite why an American trained doctor would be better trained than me, just because they were trained in America. I don’t doubt there are better doctors than me in the USA, but I don’t doubt there are worse ones too.

Something more than “we have post-grad degrees” or “we have a lot of Indians” would be nice.

Sorry for the snark.

58

Moved from General Questions to Great Debates.

Gfactor
General Questions Moderator

59

The hospital where I work, when it ain’t on fire, trains an awful lot of foreign doctors, including lots of indians (in the past 4 or 5 years, in my unit alone we’ve had Italian, French, Israeli, Indian and South African docs).

I would also hazard a guess why so many Indians train outisde of india, it’s purely the competition for places in India. The Indian docs we train (in SpR or Clinical Fellow posts), who return to India to practice are very, very skilled. What they lack is the routine access to the high tech stuff (although, there are some very well equipped hospitals in India) like radiotherapy planning computers (developed first in the UK) and linear accelerators capable of delivering fractionated stereotactic conformal radiotherapy or intensity modulated radiotherapy.