"You can state all you want that our health care system is the "best in the world," however every study/survey that compiles a spectrum of measurable outcomes ranks us extremely low, and of course the most expensive"
Ok, I’d like to address this point since you have re-iterated it a few times. What you are referring to is the WHO report, a briefing you can find here
There are numerous problems with this report, but let me first ask you what you think are good things to measure the quality of health care on. Lets say for instance we measured the average life expectancy, would that be a fair assessment? At first thought it might be, but consider for starters that the US has twice the land coverage and about half the population density of most every other developed nation (especially Europe) and because of this, we drive much more than our european counterparts, and we spend a much greater amount of time traveling at higher speeds. Naturally, this causes many more premature deaths, since car accidents are one of the leading causes of early deaths. Since such accidents will cause many more people to die much earlier, the entire statistic of ‘average life expectancy’ is skewed in favor of nations which are smaller, have higher population densities (using more mass transit) etc. Is this then a fair and reasonable way to judge quality of health care? Wouldnt a much more accurate represention be how many people survive car accidents, and how long they survive for? Of course, this isn’t very good either because we drive faster and further, which might also put us further from health services. That means that the best judge of care quality would be to look at specific ailments or injuries and see how many people survive these, and for how long.
With that in mind, let’s take a look at the WHO report, from the link above
"In designing the framework for health system performance, WHO broke new methodological ground, employing a technique not previously used for health systems. WHO’s assessment system was based on five indicators: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system’s financial burden within the population (who pays the costs)."
Without getting into detail, do you think it’s fair to judge the quality of a nations health care on such things as the ‘distribution of financial burden within a population’ and ‘distribution of responsiveness within the population’ Notice that these two factors completely ignore how good ACTUAL care is. If you are a snake oil mystic and prescribe vasoline to cure cancer, yet you make everyone pay for this vasoline equally and make sure rich and poor have equal access to it, you will score higher by this standard. If you use chemo, radiation therapy, and stem cell treatments to cure cancers, but your population bears the cost unequally, you would score LOWER than the snake oil vasoline quack. Again, do you think this is a fair representation of the quality of medical care? **How much different people pay for medical care** is irrelevant! to the quality of health care! You can have terrible health care but make sure everyone gets an equal amount of it and score better than a system which gets the best kind of health care to as many people as possible.
If you were to rank the quality of cars in a nation, would you seriously propose ranking how expensive the most expensive care is compared to the least expensive car? And ranking how many people have cheap cars and how many people have expensive cars? Or would you rank the cars for safety performance, fuel effeciency, average age, etc? If you actually care about measuring the real quality of cars, you would ignore aspects relating to relative inequalities, and would average out all cars and measure them for specific attributes.
Basically there are two opposiing philosophical premisses at work here, one is a system which delivers the best possible cars to as many people as possible, and the other is to make sure everyone has a car, and that every car is equal, no matter how old or crappy the car is. Both of these still though are utilitiarian ethics, that is, they consider only the greatest good for the greatest number, but the universal and time tested criticism of utilitarianism is that it routinely ignores and violates the rights of individuals.
This WHO report is a ranking of how well nations score when compared against some abstract ideal of a perfect socialized medicine system, and in only small parts does it actually rank quality of care. ANd where it does actually measure the quality of care, the US wins hands down. Consider:
- The US is 37th, and CUBA is 39th
Cuba has horrible health care, but everyone get’s an equal share of this horrific health care and it costs everyone the same amount. Not to mention it’s a dictatorial communist nation, and as such, no doubt lies about it’s quality of care.
- Responsiveness: The nations with the most responsive health systems are the (1st) United States, Switzerland, Luxembourg, Denmark, Germany, Japan, Canada, Norway, Netherlands and Sweden. (where is CUBA??)
- Fairness of financial contribution (again, why is this relevant to guaging the QUALITY OF MEDICAL CARE?) When WHO measured the fairness of financial contribution to health systems, countries lined up differently - Colombia was the top-rated country in this category (Colombia? Seriously? If you were poor and got to choose where to live if you got sick, would it be Colombia, or the US?)
- In North America, Canada rates as the country with the fairest mechanism for health system finance – ranked at 17-19, while the United States is at 54-55. Cuba is the highest among Latin American and Caribbean nations at 23-25. (And yet the Provicincial governer left Canada to seek treatment in the US)
"ST. JOHN’S, N.L. - Newfoundland and Labrador Premier Danny Williams had his mitral valve repaired in Florida - a procedure he says was not offered in Canada. However, Dr. Asim Cheema, a cardiologist at St. Michael’s Hospital in Toronto, told QMI Agency that mitral valve repair is routinely performed in Ottawa, Montreal and Toronto."
So even though Canada has the ‘fairest’ health care, a leading politician in Canada leaves Canada to get better care in the US.
Don’t worry, it get’s worse
- To assess overall population health and thus to judge how well the objective of good health is being achieved, WHO has chosen to use the measure of disability - adjusted life expectancy (DALE)
What exactly is Disability adjusted Life Expectancy?
From - http://www.who.int/inf-pr-2000/en/pr2000-life.html -
"For the first time, the WHO has calculated healthy life expectancy for babie..based upon an indicator developed by [who else but…] WHO scientists, Disability Adjusted Life Expectancy (DALE). DALE summarizes the expected number of years to be lived in what might be termed the equivalent of "full health." To calculate DALE, the years of ill-health are weighted according to severity and subtracted from the expected overall life expectancy to give the equivalent years of healthy life."
Ok just to make this clear, DALE basically measures fully functioning ‘healthy’ life spans, not, you know, how long you live after you get sick. So by this measurement, if you are a professional athlete, spend your whole life in great shape, then suddenly drop dead from heart disease, you technically have a higher rated DALE figure than someone who is in regular shape, gets sick a few times, get’s really sick later in life, and gets numerous medical treatments, surviving an extra couple of years. DALE conveniently SUBTRACTS these years from any measurement of the ‘life expectancy’
This is utterly absurd.
Consider then that the countries which will score best are the ones that see people die quickly after getting sick, while the ones that score worst are the ones that keep people alive the longest after they get sick. Compare this measurement with cost spent on care, and then the countries that score best are the ones that spend the least and see patients die quicker after they get sick (as long as they take longer to actually get sick in the first place!) while the ones that score worst spend the most and successfully prolong life after someone gets sick (assuming they take a decent length of time to get sick in the first place)
So basically the DALE was created specifically so the United States, which does in fact keep patients who are sick alive the longest by spending alot of money on it would score low, while nations which do not spend that much and do not keep patients alive very long score higher.
The US Ranks 24 by this standard of ‘adjusted life expectancy’
"The DALE system is simple," says Dr. Lopez. "In the old system, we measured a total life expectancy based on the average numbers of years males and females could expect to live in each country. However, people don’t live all those years in perfect health. At some point in your life, you will have some level of disability. These years with disability are weighted according to their level of severity to estimate the total equivalent lost years of good health. You subtract this from total life expectancy, and what remains is the expected number of years of healthy life."
Now WHY exactly would you consider being disabled and alive to be ‘less alive’ somehow than being entirely enabled and alive? Do you think this is a fair why to measure the quality of health care?
To me, the best measure of quality of health care would be things like how long you live after getting diagnosed and treated with X. What are US Heart Transplant Survival Rates? Cancer Survival Rates? Minimally invasive surgery survival rates? Kidney Transplant Survival Rates? I don’t have the time to google these, but why are these not the measurements the WHO is using to guage health care? The only attempt to measure the ACTUAL quality of care is the DALE system, which is inherently biased against any medicine that prolongs the lives of the sick.
Also, who has developed most of the procedures and equipment that currently make good heatlh care possible in the first place? Who invented the artificial heart, the MRI, the CAT scan and PET Scan? Who discovered and tested most of the worlds life saving drugs? Which country has the best medical schools in the world? Etc etc etc.
**See also - http://granitegrok.com/blog/2010/01/the_real_healthcare_rankings.html