With thanks to Dr. Brian Jarman for sending this along, here is the latest Commonwealth Fund report comparing health care in several countries. The main conclusion:
Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries.
Here is the chartpack with all the slides summarizing the data.
No doubt many will argue that this is proof of the need for a national health plan like those found in the comparison countries -- Australia, Canada, New Zealand, the UK, German, France, the Netherlands, or Japan.
Personally, I think it argues for broader insurance coverage in the US, perhaps along the lines recently enacted in Massachusetts. Plus, it argues for better reimbursement in the US for primary care physicians. Plus, it clearly argues for greater emphasis by US hospitals and physicians for more systematic implementation of quality control, perhaps with more than gentle nudging by government and private payers. (See chart #50 for the percentage of primary care doctors who report any financial incentive for quality improvement: The US is lowest at 30%).
But I recognize that many disagree, and my point here is not to get into that debate. (I have done that elsewhere.) Instead, I want to raise the question of whether there is broad political support in the US for a major change. Notwithstanding similar data for years and lots of speeches on the subject, there has not been movement along these lines. Why have there not been votes for passage?
Hidden away in these charts might be indications of why the national health plan idea has been politically unpopular in the United States. Chart #60 shows the percentage of "sicker adults" who had to wait more than four weeks to see a specialist: Germany 22; US 23; NZ 40; Australia 46; Canada 57; UK 60. Chart #61 shows the percent of physicians who feel that their patients often have long waits for diagnostic tests: Australia 6; Germany 8; US 9; Netherlands 26; NZ 28; Canada 51; UK 57. And chart #62 shows the percentage of people who waited four weeks or more for needed non-emergency or elective surgery: Germany 6; US 8; Australia 19; NZ 20; Canada 33; UK 41.
So, if you think about things in purely political terms, because of proximity and/or language, the US public is most likely to hear about the experience of Canadian and British citizens with regard to these aspects of care. "Everyone" has a story about a friend of a friend from Canada who choose to fly to the US for elective surgery because he or she would have had to wait months for that treatment in Toronto. In the US, there is an expectation that when you need or want treatment, you get it quickly.
In addition, chart #97 presents a fascinating story, the percentage of people above average income in the Australia, Canada, NZ, and the UK who have chosen to buy private insurance to gain access to care not provided by their national health plan -- 63, 81, 57, and 35 percent, respectively. This factor gives yet another indication that the rationing of care provided under the national plans is not viewed positively by those of better economic means.
Finally, charts #126 and #127 give an indication of physician dissatisfaction with their country's health system and their own practices. The numbers are all over the place, with no clear mandate for change in the US among physicians -- or at least no clear distinction on this point with those in other countries.
For years, the Democrats have pushed the health care agenda, citing the equity and access reasons inherent in this report. For years, the Republicans have not, citing the issues of personal choice and government rationing. While many polls have showed public interest in major change, those same polls have often showed that there is less interest among people who vote. Have the Republicans been politically astute by not pushing this agenda, or have the Democrats locked onto an issue that will finally have traction?
