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Republican Minority Leader Mitch McConnell, in a floor speech yesterday, insisted that Americans won't stand for a health care system such as those in Great Britain, Canada, or New Zealand. Since he picked the allegedly terrible health care systems of those three countries as the ground upon which he wants to fight this battle, I think Democrats should join the fight with him on precisely that battleground. And if our Senators can find the courage to do so, we should win. Frankly, it wouldn't matter WHAT three countries he had picked, since in every other developed country in the world, health care spending is lower than it is here, and results (not only per dollar spent, but in absolute terms) are better than they are here. But since he picked the three countries, let's show that we're not afraid to join the fight on the battleground of the Republicans' choosing.

First, let's look at per capita health care spending in those three countries, and in the United States:

United States: $5,274
Canada: $2,931
United Kingdom: $2,160
New Zealand: $1,857

Let's look at the figures from a slightly different standpoint, total health care spending as a percent of GDP:

United States: 15.4%
Canada: 9.8%
New Zealand: 8.4%
United Kingdom: 8.1%

On the theory that you get what you pay for, our health care system certainly SHOULD be the best in the world, as the Republicans keep telling us that it is. So the next question is, what is the objective evidence of the results obtained by the health care systems in those three countries, compared to the United States.

I hope that even Mitch McConnell thinks that babies dying before their first birthday is a bad thing, so surely our massive health care spending gives us a lower infant mortality rate than those countries, right? WRONG. Here are the number of children, per thousand live births, who die in their first year of life in these same four countries:

United States: 6.3
Canada: 5.08
New Zealand: 4.99
United Kingdom: 4.93

Well, maybe you're more likely to stay alive as a baby if you're born in one of these countries with such terrible health systems, but surely we have a longer total life expectancy, right? WRONG! Here are the years of life expectancy at birth for the total population (in all cases, the average woman lives a little longer than this, and the average man a little less than this):

Canada: 80.18 years
New Zealand: 79.62 years
United Kingdom: 78.95 years
United States: 77.71 years

Personally, I care a lot less about how many years I live than how many years I live in reasonably good health. Here are the years of heathy life expectancy in these three countries and the United States:

New Zealand: 70.3 years
Canada: 69.9 years
United Kingdom: 69.6 years
United States: 67.6 years

Here are the figures on the average man's probability of making it to age 65 in those three countries and the United States:

Canada: 82.3%
United Kingdom: 81.5%
New Zealnad: 80.9%
United States: 77.4%

I don't know about anybody else, but as a 60 year old man, those countries' health care systems don't look so terrible to me. As a matter of fact, they look pretty good. I don't really know any New Zealanders, but I've known a number of Brits and Canadians, and I have yet to meet the first one who would trade their health care system for ours.

But Senator McConnell is right on at least one thing. Government health care spending, as a percent of total health care spending, IS higher in those three countries than it is here. Here is the public health care spending as a percent of the total in those three countries and the United States:

United Kingdom: 83.4%
New Zealand: 77.9%
Canada: 69.9%
United States: 44.9%

This suggests to me that perhaps government is more effective at limiting costs and improving results in the health care field than is the vaunted private sector, and that increased government involvement in health care would be a good, rather than a bad, thing.

The Republicans' game is clear. They want to focus on a handful of specific examples of the worst things that happened in these countries' heath care systems, and compare them to the best of our system. We can of course play that game, and compare the horror stories from our system (which are replete) with the best examples from their system, and we should do that. But I think most people intuitively understand that what a high school social studies teacher of mine many years ago described as a "My Aunt Emma" argument really doesn't make much sense as a basis for public policy, since both sides can invariably come up with such examples. What DOES make sense is to compare the overall outcomes of one system with another, and on that basis, it is simply impossible to deny that New Zealand, Canada, and Great Britain have health care systems that deliver better results, at far lower cost, than the system we have here in the United States. There is no reason that Democrats should be afraid to join the battle on the ground that the Republicans have chosen. In fact, we should welcome the opportunity to do so.

When will we see Harry Reid, or some other prominent Democrat, stand up on the floor of the Senate and say, in essence, "OK, Senator McConnell, if you want to make speeches about the health care systems of Canada, New Zealand, and Great Britain, let's talk about what those systems cost, and the results that they deliver."

I don't understand the statistics however, if I get run over then an ambulance will take me to hospital where I will get the best treatment they have there regardless of my income, status or religious beliefs or any other criteria.

I watched a recent Hawaii beach patrol prog in which a woman broke her ankle but as she was not insured could not take the ambulance to hospital but had to get a taxi to save money...inhuman!

Remember, America is the nation founded on genocide.

Inhuman is what we do best......and if you give us a hard time about it......we'll kill you.

That's just the way it is.

Some say that we are learning and growing and change is possible.

How audacious.

Perhaps preposterous.

We shall soon see. This health care issue must come to a head in a few months. I suspect we will discover that Obama's much ballyhooed plan turns out to be a toothless dog.

Pax!

We seem to have billions to ensure we can kill people and destroy city's but our reps in congress and the senate wring their hands and cry poor mouth when It comes to something that will help millions with the cost of health care...they also cry socialism when they themselves have tax paid for health care,money in their pockets and retirement all at the peoples expense...I guess it isn't socialism if it's for them...right?

Exactly.

Proponents of government-run health care like to point out that countries with such a system spend a smaller percentage of their gross domestic product on health care than the United States. What they don't like to mention is how those savings are achieved. For example:

Patients Lose the Right To Decide What Treatment They'll Receive. Instead, patients receive whatever care politicians and bureaucratic number crunchers decide is "cost effective."

Britain's National Institute for Health and Clinical Excellence usually won't approve a medical procedure or medicine unless its cost, divided by the number of quality-adjusted life years that it will give a patient, is no more than what it values a year of life in great health - £30,000 (about $44,820). So if you want a medical procedure that is expected to extend your life by four years but it costs $40,000 and bureaucrats decide that it will improve the quality of your life by 0.2 (death is zero, 1.0 is best possible health, and negative values can be assigned), you're out of luck because $40,000 divided by 0.8 (4 X 0.2) is $50,000.

There Are Long Waits for Care. One way governments reduce health care costs is to require patients to wait for treatment. Patients have to wait to see a general practitioner, then wait to see a specialist, then wait for any diagnostic tests, and then wait for treatment.

The United Kingdom's National Health Service recently congratulated itself for reducing to 18 weeks the average time that a patient has to wait from referral to a specialist to treatment. Last year, Canadians had to wait an average of 17.3 weeks from referral to a specialist to treatment (Fraser Institute's Waiting Your Turn). The median wait was 4.9 weeks for a CT scan, 9.7 weeks for an MRI, and 4.4 weeks for an ultrasound.

Delay in treatment is not merely an inconvenience. Think of the pain and suffering it costs patients. Or lost work time, decreased productivity, and sick pay. Worse, think of the number of deaths caused by delays in treatment.

Patients Are Denied the Latest Medical Technology and Medicines. To save money, countries with government-run health care deny or limit access to new technology and medicines. Those with a rare disease are often out of luck because medicines for their disease usually cost more than their quality-adjusted life years are deemed worth.

In a Commonwealth Fund/Harvard/Harris 2000 survey of physicians in the United States, Canada, New Zealand, Australia, and the United Kingdom, physicians in all countries except the United States reported major shortages of resources important in providing quality care; only U.S. physicians did not see shortages as a significant problem. According to the OECD (Organisation for Economic Co-operation and Development) Health Data (2008), there are 26.5 MRIs and 33.9 CT scanners per million people in the United States compared to 6.2 MRIs and 12 CT scanners in Canada and 5.6 MRIs and 7.6 CT scanners in the United Kingdom.

Breakthroughs in Life-Saving Treatments Are Discouraged. Countries with government-run health care save money by relying on the United States to pay the research and development costs for new medical technology and medications. If we adopt the cost-control policies that have limited innovation in other countries, everyone will suffer.

The Best and Brightest Are Discouraged from Becoming Doctors. Countries with government-run health care save money by paying doctors less. According to a Commonwealth Fund analysis, U.S. doctors earn more than twice as much as doctors in Canada and Germany, more than three times as much as doctors in France, and four times as much as doctors in Finland, Norway, and Sweden. The best and brightest will be encouraged to go into professions where they can earn more money and have more autonomy.

Is Government-Run Health Care Better? Proponents of government-run health care argue that Americans will receive better care despite the foregoing. Their main argument has been that despite paying more for health care the United States trails other countries in infant mortality and average life expectancy.

However, neither is a good measure of the quality of a country's health care system. Each depends more on genetic makeup, personal lifestyle (including diet and physical activity), education, and environment than available health care. For example, in their book The Business of Health, Robert L. Ohsfeldt and John E. Schneider found that if it weren't for our high rate of deaths from homicides and car accidents Americans would have the highest life expectancy.

Infant mortality statistics are difficult to compare because other countries don't count as live births infants below a certain weight or gestational age. June E. O'Neill and Dave M. O'Neill found that Canada's infant mortality would be higher than ours if Canadians had as many low-weight births (the U.S. has almost three times as many teen mothers, who tend to give birth to lower-weight infants).

A better measure of a country's health care is how well it actually treats patients. The CONCORD study published in 2008 found that the five-year survival rate for cancer (adjusted for other causes of death) is much higher in the United States than in Europe (e.g., 91.9% vs. 57.1% for prostate cancer, 83.9% vs. 73% for breast cancer, 60.1% vs. 46.8% for men with colon cancer, and 60.1 vs. 48.4% for women with colon cancer). The United Kingdom, which has had government-run health care since 1948, has survival rates lower than those for Europe as a whole.

Proponents of government-run health care argue that more preventive care will be provided. However, a 2007 Commonwealth Fund report comparing the U.S., Australia, Canada, Germany, New Zealand, and the United Kingdom found that the U.S. was #1 in preventive care. Eighty-five percent of U.S. women age 25-64 reported that they had a Pap test in the past two years (compared to 58% in the United Kingdom); 84% of U.S. women age 50-64 reported that they had a mammogram in the past two years (compared to 63% in the United Kingdom).

The United Kingdom's National Health Service has been around for more than 60 years but still hasn't worked out its kinks. In March, Britain's Healthcare Commission (since renamed the Care Quality Commission) reported that as many as 1,200 patients may have died needlessly at Stafford Hospital and Cannock Chase Hospital over a three-year period. The Commission described filthy conditions, unhygienic practices, doctors and nurses too few in number and poorly trained, nurses not knowing how to use the insufficient number of working cardiac monitors, and patients left without food, drink, or medication for as many as four days.

Does Government-Run Health Care Provide Everyone Access to Equal Care? Proponents tout government-run health care as giving everyone access to the same health care, regardless of race, nationality, or wealth. But that's not true. The British press refers to the National Health Service as a "postcode lotter" because a person's care varies depending on the neighborhood ("postcode") in which he or she lives. EUROCARE-4 found large difference in cancer survival rates between the rich and poor in Europe. The Fraser Institute's Waiting Your Turn concludes that famous and politically connected Canadians are moved to the front of queues, suburban and rural residents have less access to care than their urban counterparts, and lower income Canadians have less access to care than their higher income neighbors.

Ironically, as we're moving toward having our government completely control health care, countries with government-run health care are moving in the opposite direction. Almost every European country has introduced market reforms to reduce health costs and increase the availability and quality of care. The United Kingdom has proposed a pilot program giving patients money to purchase health care. Why is this being done? According to Alan Johnson, Secretary for Health, personal health budgets "will give more power to patients and drive up the quality of care" (The Guardian, 1/17/09). It's a lesson we all should learn before considering how to improve our health care system.

It never hurts to look at both sides of the argument, does it?

clean'

There is no real argument.

Only the Racist Fascist Redneck bastards that want poor kids to die are against fixing the health care mess.

Sadly, I just don't think Obama is going to do enough.

Small change is the most powerful enemy of great change.

Pax!

Early diagnostic tests are not synonomous with 'preventative care'. Rather, "preventative care" represents any and all means to enure that people eat the right foods, get enough rest and exercise, are guarded against pesticides, herbicides, and other toxins, as well as undergoing innoculations against the more virulent forms of disease.

Seems as though this one paragraph may give a clue as to the intent of the whole article, in that it reveals the tendency to distort the facts to fit the agenda.

I'd like to see the waiting periods diminished, though, although some diseases and injuries are self-limiting, in that they may heal up O.K. without care. Still, having to wait several weeks for truly needed care can put a load on things...

But when free care is involved, you'll also get all kinds of folks showing up with stuff that doesn't need any care at all, and this could be one area that contributes to the long waits.

doc

Can't prove it by me, Doc.

My military Tri-Care insurance combined with a health-care fund that I have means my care is basically free.

Yet.......I stay away from doctors unless I absolutely MUST go. It's a hassle. It's inconvenient. I have better things to do.

I think most people are like me.

Yes, there are a few hypochondriacs around, but they are so few as to be statistically insignificant.

Someone said that the majority of health care problems resulted from poor diets. Not insufficent food but eating stuff that is not health productive. The U.S. can boast of the largest number of fat - obese people in the world. Even the so-called disadvantaged on government assistance are pushing heart attacks and strokes due to not eating properly, getting enough exercise and building their mental health, which means, I suppose, they're talking about positive thinking.

I really don't know of anyone being refused medical care but me, and that little system of denial was due to religion. I was actually refused treatment because I would not disclose a particular religion. "We need a religion." Being an atheist wasn't what their system wanted to hear, so I told them to select whatever tickled their fancy. The attending lady said they needed this religious information for their records. I suppose they need it in order to track statistics or otherwise discriminate against people. Like shifting a person off to another facility or lying and saying they don't do those procedures anymore. Whatever.

Of course, if eveyone imbibed Golden Brew (coupled with a deep abiding faith in ****) every morning then their health would be marvellous. But you cannot force them to do the best for themselves.

Logos: "We shall soon see. This health care issue must come to a head in a few months. I suspect we will discover that Obama's much ballyhooed plan turns out to be a toothless dog."

Are you beginning to doubt the 'messiah?' (lower case intentional) his feet of miry clay will become apparent soon enough.

Obama means well.....and he cannot change the world in a day.

He must cooperate with evil people to get a little bit of progress. He must make concessions to them to buy cooperation.

Let's face it.....he's an improvement over Bush......it's just that America is such a powerful destructive force that even a president cannot make much difference.

And let's keep in mind.....Obama is actually doing quite well considering that he's a rich half-white-man who wears a suit and tie at work.

I wouldn't be so sure on this, Logos..

If we want to use the "My Aunt Emma" scenario, it is true that there are many folks like yourself who do not 'swamp' the offices of healthcare providers. At the same time, however, I figure at least a minimum of 1 out of ten folks who come into my office don't really need care, having some sign or symptom which they feel might be a serious condition, but is in reality a normal bodily response to some stimulus or another, and it will usually resolve within a couple of days.

With these cases, I have to take the time to teach them the difference between health problems that need care versus those which are usually self-limiting. And explaining all this to them in a way that they can understand, thus reducing their fear and concerns, usually takes longer to perform than a regular office visit.

So in my world, these individuals create a kind of 'bottleneck' that tends to create a waiting list...and I think all this may have something to do with all the damn commercials on T.V. where a different medicine is pushed for every little sign and symptom a person might develop...cuz nine out of ten times these folks say something like: "I heard this could be a serious problem, so I figured I better get it checked out."

I strongly suspect that the people who go to chiropractors are a bit on the nutty side anyway.

Most of them I know are obsessive, compulsive and filled with bizarre health nut theories. They get addicted to their chiropractor and are constantly going back for new and exotic "treatments."

Sad part is......they never seem to get better.

Let's not judge the rest of the world by people who are crazy enough to show up at your office, doc.

And let's not judge 'em by thinking they're all like you either...