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American health care is far from the best
Michael Hiltzik: U.S. health care system the worst in the developed world

Date published: 7/3/2014

LOS ANGELES

--The U.S. health care system notched another dubious honor in a new comparison of its quality to the systems of 10 other developed countries: Its rank was dead last.

The new study by the Commonwealth Fund ranks the United States against seven wealthy European countries and Canada, Australia and New Zealand. It's a follow-up of previous surveys published in 2010, 2007, 2006 and 2004, in all of which the U.S. also ranked last.

Although the United States ranked in the middle of the pack on measures of effectiveness, safety and coordination of care, it ranked dead last on access and cost, by a sufficient margin to rank dead last overall.

Conservative pundits hastened to explain away these results after the report was published.

In the conservative Washington Examiner, for instance, Philip Klein complains that the study is "rigged to produce a result that favors socialized health care systems." He observes, accurately, that the low ranking for the United States results heavily from its lack of universal health care and thus scores low on "equity." He doesn't seem to think that's a bad thing. "It's an ideological decision to view equity as one of the most important factors in judging a health care system," he writes.

So, there you have it: The principle that health care should be available to all is just "ideology." It doesn't matter if a huge percentage of your citizens can't get health care, as long as the people with access do all right.

Klein also objects that Britain ranks first, despite its falling behind the United States in several medical outcomes measures. This is a point made frequently by apologists for the American system, but it's highly misleading. Typically, they rely on survival rates--the time after diagnosis that the patient remains alive.

Knowledgeable experts view survival rates as a poor substitute for the really important metric, mortality rates. That's because survival rates are very sensitive to the lead time of a diagnosis--the earlier it's made in the progress of a disease, the better the survival rate. But that often has no effect on mortality.

The phenomenon can be viewed through statistics on breast cancer. American women have a 97 percent chance of surviving five years after a breast cancer diagnosis is made; British women only 85 percent.


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