From the academic side, here's the most common diagnosis for the high price of U.S. health care: a highly complex and fragmented payment system that weakens the demand for health care and has high administrative costs that don't improve anyone's health. No. 37 is where the United States' health status was ranked by the World Health Organization. Here's how U.S. health care stacks up in other ways (in most recent statistics available): - No. 1 in total health costs as a percentage of gross domestic product.
- $878 per person spent on pharmaceuticals -- the most among the world's 30 largest economies.
- 2.4 practicing physicians per 1,000 people in the United States. Countries with fewer physicians per 1,000 are Canada, Japan, Mexico, New Zealand, Poland, South Korea and Turkey.
- 3.1 hospital beds per 1,000 people -- the fewest beds per 1,000 among the world's 30 largest economies, except for Mexico, where there are 1.7 beds per 1,000.
- 34.3 percent of Americans are obese (with a body mass index of 30 or higher), the most of any developed country.
- 25.9 magnetic resonance imaging units per million people makes the United States No. 1 among the world's largest economies. The United Kingdom, in contrast, has about one third the number of the U.S.
- 84.5 coronary bypasses per 100,000 people makes the U.S. the second most bypassed among developed nations, topped by Germany which has 131.8 bypasses for every 100,000 people.
- 15.4 percent of the U.S. population are daily smokers -- the second smallest percentage among the world's 30 largest economies (only the Swedes smoke less).
Read it all ~~ OECD Health Data 2009
The American health care system puts patients at greater risk of harm from medical or surgical errors than patients elsewhere and ranks behind the top countries in extending the lives of the elderly. It has a mixed record on preventive care — above average in vaccinating seniors against the flu, below average in vaccinating children — and a mixed record of caring for chronic and acute conditions.
Contrary to what one hears in political discourse, the bulk of the research comparing the United States and Canada found a higher quality of care in our northern neighbor. Canadians, for example, have longer survival times while undergoing renal dialysis and after a kidney transplant. Of 10 studies comparing the care given to a broad range of patients suffering from a diverse group of ailments, five favored Canada, three yielded mixed results, and only two favored the United States. Read it all at NYTimes.com
From Umair Haque at HarvardBusiness.org
Be sure to click link above to read it all and check out the charts.
Where does the United States stand compared to other countries? It loses the most potential years of life amongst developed countries. In the United States, 6397 years of life are lost per 100,000 males — compared to just 4574 in the United Kingdom, or 4018 in Italy. The United States (the bright red line) has seen the smallest reductions in PYLL, by a wide margin. In fact, Korea — the bright blue line — now loses fewer potential years of life than the United States, and has done so since approximately 1999. The United States gets the smallest bang for the buck in terms of life itself amongst developed countries: it realizes the lowest level of "life returns." The U.S. healthcare system returns the fewest life years for each dollar spent. The United States, for example, has invested an additional 8.3% of GDP in health since 1971. That investment yielded a PYLL reduction of 5157 years. America realized a return of 621 potential years of life gained for each additional percentage point of GDP invested in health.
The United Kingdom invested an additional 3.3% of GDP in health since 1971. That investment yielded gains of 4421 fewer potential years of life lost. The United Kingdom realized a return of 1340 potential years of life gained for each additional percentage point of GDP invested in health. The United Kingdom healthcare system delivers life returns more than twice those of the American healthcare system.
Canada, in contrast, has invested a marginal 2.6% of GDP in health since 1971. That investment yielded a PYLL reduction of 5393 years. Canada realized a return of 2074 years for each additional percentage point of GDP invested in health. The Canadian healthcare system delivers life returns more than three times greater than those of the American healthcare system.
Now, please take all this with a grain of salt. PYLL is an imperfect measure, and it doesn't capture all the richness of healthcare inequities and imperfections. Equating life years lost to life years gained might have methodological issues. Comparing PYLL over time might need statistical adjustment. This is a blog post, not a journal article, and I crunched these numbers on a Sunday afternoon over a quick coffee.
The point isn't that this is the best, only, or final measure of healthcare effectiveness. The point is this:
A more productive debate begins with assessments of effectiveness, so costs can be compared to benefits. Debate is the lifeblood of a democracy — but the current debate lacks those. And that, perhaps, is why it's so frustrating for both sides. I hope this post offers a measure of effectiveness that everyone can use to have a more productive debate.
by Chuck Idelson | Guaranteed Healthcare
In Canada, it took the dogged determination of one province, Saskatchewan, and a visionary leader Tommy Douglas, to pave the path to a national health care system, which they call Medicare.
For all the detractors of the Canadian system in the studios of Fox News and the board rooms of rightwing think tanks, consider this one note: In 2004, the Canadian Broadcasting Corporation conducted a national poll to select the greatest Canadian of all time. The winner in a landslide -- Tommy Douglas.
While the federal window remains open for reform, with two national single payer bills, John Conyers' HR 676 in the House and now Bernie Sanders' S 703 in the Senate, many nurses, doctors, and health activists are turning to the states to lead as well. More than a half dozen U.S. states now are considering legislation to establish single payer systems, essentially an expanded and updated form of the U.S. Medicare system to cover everyone in their states. Here's a roundup of some of the state bills:
California
The latest bill SB 810 passed its first legislative test Wednesday in the Senate Health Committee on a party line 7-4 vote before a room packed with nurses, doctors, medical students, California School Employees Association members, and healthcare activists.
In her lead testimony, Malinda Markowitz, RN, co-president of the California Nurses Association/National Nurses Organizing Committee noted that "nurses know insurance companies don't provide any value whatsoever in the delivery of medicine. Under SB 810, we would be free of their interference, their denial of care, their massive bureaucracy, and their waste of healthcare dollars."
UC Irvine medical student Parker Duncan said that he did not want to “be in a world not doing what I was trained to do,” referring to the paperwork that is one of the expensive burdens that undermine the ability of the current system to deliver health care.
Twice this decade California's legislature passed earlier versions of SB 810 (SB 840 carried by now retired Sen. Sheila Kuehl), but the bills were vetoed by Gov. Arnold Schwarzenegger. State activists say they will continue to push single payer in California, even if they need to wait until the next governor, who won't be Schwarzenegger, is elected in 2010.
Colorado
House Bill 1273 by Fort Collins Democrat John Kefalas, passed its first vote in the state House April 6. The bill sets up a 23-member commission to design a universal health-insurance system.
"Our current health-care system is not well," Kefalas said. "Our current health-care system is unsustainable, with the cost of health care and the numbers of the uninsured rising dramatically."
Press reports note a state Blue Ribbon Commission on Health Care Reform two years ago studied single payer and found it was the only approach that saved money compared to what Coloradans now spent on healthcare.
Illinois
HB 311, the Healthcare for All Illinois Act, sponsored by Rep. Mary Flowers, had its first hearing in March. Though no votes have been taken yet, the new Gov. Pat Quinn is a long time supporter of single payer reform.
At an introductory press conference, Brenda Langford, Cook County RN, said that “Illinois can once again be a symbol of hope and progress for our nation. Nurses are tired of watching our patients suffer from denial of care and lack of access to coverage. We see far too much of this at Cook County hospitals—and that’s why we support guaranteed healthcare through a single-payer system.”
Maine
LD 1365, sponsored by Brunswick Rep. Charles Priest, and co-sponsored from legislators from all over the state, had its first hearing April 13.
The hearing came just days after both houses of the Maine legislature passed resolutions calling on President Obama and Congress to enact federal single payer legislation. A poll this winter showed 52 percent of Maine physicians also favor single payer.
As Cathy Herlihy of the Maine State Nurses Association put it in a state forum featuring U.S. Senator Olympia Snowe, a single-payer system is the “the only solution,” she said. “We do not have time to wait. Our health should not be sacrificed for limited reforms.”.
Pennsylvania
Two single payer bills are alive in the state, House Bill 1660, the “Family and Business Healthcare Security Act of 2009,” and Senate Bill 300.
Gov. Ed Rendell has said that if a single payer bill were to make it to his desk, he will sign it, reports Chuck Pennachio of Health Care for All Pennsylvania.
The state Democratic House Caucus is holding a public forum on the bill Friday, April 17 at 10 a.m. at the University of Pennsylvania campus in Philadelphia, featuring speakers from Physicians for a National Health Program, the Pennsylvania Association of Staff Nurses and Allied Professionals, and other single payer supporters..
The hearing comes on the heels of a resolution passed by the Philadelphia City Council calling for both state and federal lawmakers to establish a single-payer health system.
Other states
Single payer bills are also on the docket in Minnesota, Missouri, and Washington.
The report from the Business Roundtable, which represents CEOs of major companies, says America's health care system has become a liability in a global economy. Americans spend $2.4 trillion a year on health care. The Business Roundtable report says Americans in 2006 spent $1,928 per capita on health care, at least two-and-a-half times more per person than any other advanced country.
The United States is 23 points behind five leading economic competitors: Canada, Japan, Germany, the United Kingdom and France. The five nations cover all their citizens, and though their systems differ, in each country the government plays a much larger role than in the U.S.
The cost-benefit disparity is even wider _ 46 points _ when the U.S. is compared with emerging competitors: China, Brazil and India.
Other countries spend less on health care and their workers are relatively healthier, the report said. So you have to ask how they logically reach this conclusion: The CEOs of the Business Roundtable believe health care for U.S. workers and their families should stay in private hands, with a government-funded safety net for low-income people. Oh yeah, they are asking people like the CEO of the insurance company Cigna what he thinks. Protect profit at all costs is how. Fools.
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