03 August 2009

Scott Atlas on American Health Care

Mr. Atlas from the conservative Hoover Foundation offers some positive observations about American health care. The most solid include:

1. Americans have better survival rates than Europeans for common cancers. Breast cancer mortality is 52 percent higher in Germany than in the United States and 88 percent higher in the United Kingdom. Prostate cancer mortality is 604 percent higher in the United Kingdom and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher.

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

3. Americans have better access to treatment for chronic diseases than patients in other developed countries. Some 56 percent of Americans who could benefit from statin drugs, which reduce cholesterol and protect against heart disease, are taking them. 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.

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, prostate, and colon cancer:

Nine out of ten middle-aged American women (89 percent) have had a mammogram, compared to fewer than three-fourths of Canadians (72 percent).

Nearly all American women (96 percent) have had a Pap smear, compared to fewer than 90 percent of Canadians.

More than half of American men (54 percent) have had a prostatespecific antigen (PSA) test, compared to fewer than one in six Canadians (16 percent).

Nearly one-third of Americans (30 percent) have had a colonoscopy, compared with fewer than one in twenty Canadians (5 percent). . . .

6. Americans spend less time waiting for care than patients in Canada and the United Kingdom. Canadian and British patients wait about twice as long—sometimes more than a year—to see a specialist, have elective surgery such as hip replacements, or get radiation treatment for cancer. All told, 827,429 people are waiting for some type of procedure in Canada. In Britain, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.

My observations:

First, these conditions disproportionately involve Americans who are covered by Medicare, a government single payer system, and among non-Medicare populations disportionately involve groups of people with higher rates of private health insurance. The kinds of conditions that disproportionately impact the uninsured and children are not included.

Second, the mortality rates given are derived from five year survival rates. But, one only enters into five year survival rate statistics if one has sufficient health care to be diagnosed in the first place. In other words, U.S. survival rate statistics implicitly exclude many people who die of "natural causes" outside the insured health care system without ever being diagnosed. Thus, some of the U.S. advantage is merely a statistical artifact that makes the measure used inappropriate for the kind of comparison being made by Mr. Atlas.

Life expectency numbers don't support the hypothesis that overall mortality reducing medical care is better in the U.S. that the statistics cited by Mr. Atlas seem to imply.

Put another way, I don't disagree that American health care can be very good for those who have access to the best that it has to offer. But, the system remain the most expensive in the world, and at a public health level, it does a poor job because too many people don't get the care that they need.

1 comment:

Anonymous said...

I think you should look at the references for the 10 points.

Personally, I found something seemed a bit amiss in the list. The writer never compared the US to any international average, but alwaus to a shifting single country, Canada, Germany, UK...
And lots of the points were about cancer, as if the writer could not find 10 different points but had to reuse the same one over and over.

Any system can look good if you get to pick ten single points and compare each to one to a country of your choice. That doesn't mean its good, it just means you can find ten points where its not dead last.

So I looked up the references. Surprise.

Most are not actual research, but papers produced by rightwing think tanks. The one that I looked up that is actual research -concluded exactly the opposite of what Mr. Atlas author claimed!