Steve Lunetta: Some sound bites on healthcare


Lately, I’ve been on a health care kick. As many of you know, I’ve written several columns lately that have been a search for answers to questions that rumble around in my head.

As we all know, Republicans have presented a health care plan that is meant to replace Obamacare. After looking it over, I can almost guarantee that the Dems will take back Congress very soon. The health care plan is political suicide.

Recent polls place public support for the new plan at around 12 percent. There’s gotta be a better answer for this. Someone on this planet must have some way of creating a balanced, fair, and affordable health-care system.

So let’s go find it. To make it easier to remember, let’s create “sound bites” when we find data that seems to make sense.

Here is what I did – I went onto the internet and tried to find data comparing health care systems in developed countries to see who gives the best bang for the buck.

My criteria is simple. I want to know which system is the most effective at (1) creating a healthy population and (2) healing people effectively for (3) the least amount of money.

But, I already have a problem. A “healthy population” can be affected by things having absolutely nothing to do with health care. For example, the French like to drink red wine, which some studies have linked to a lower incidence of heart disease. Eskimos, due to increased fish intake, also tend to have lower heart-related issues.

So “healing people” may be a better measure of a health care system. This is the “outcomes” measure that I have talked about previously. I want to find the system that heals people most effectively for the least amount of money.

The first paper I found (actually, it was recommended by the online crew on The Signal’s website) was an annual report published by a liberal think tank called the Commonwealth Fund entitled “Mirror, Mirror on the Wall; How the Performance of the U.S. Health Care System Compares Internationally” (June, 2014).

Note: it is important to know who is behind the data we look at. Commonwealth Fund is a left-leaning group that publishes this same report every couple of years. They always slam the U.S. very hard. In fact, they have never rated the U.S. above dead last.

It’s also important to note that these guys are also crazy for the ACA, otherwise known as Obamacare.

The United States is ranked last in comparison to other developed nations that combine factors such as quality care, access, efficiency, equity and healthy lives. Also, note that the net expenditure per capita for the U.S. is about 50 percent higher than the second placed country.

This data seems to indicate that we pay more and get less. Wow. Let’s all move to England!

But wait. There are some problems here. This “study” is based primarily on surveys which rely upon questions answered by respondents.

I reviewed the questions and a couple of things jumped out at me. Many questions had to do with how information was shared, availability of patient data, and connectivity.

Sounds like countries with large tech advances in medical records will fare better. This is reflected in the UK data due to an emphasis on a computerized medical approach.

Also, the areas of “equity” and full public coverage were also heavily emphasized. The U.S. will stink in these areas since we do not have a full public health care system like Canada or the UK.

This rating system also ignores medical innovation for which the U.S. is renowned. As I’ve mentioned in other columns, Canadians come here for treatments like stem cell therapy because it is not widely available north of the border.

But there are some good nuggets here. I can’t find much fault in the per capita health care costs. I read some papers written by economists who claim the numbers are not accurate. However, I found their arguments unconvincing.

Sound Bite #1: The United States spends more per capita on health care than anyone else.

This is startling. We spend $8,500 per person on health care per year in the United States. The second-place Norwegians spend about $5,700. We spend 50 percent more than the next-highest-spending country and we don’t even have a national universal health care program.

Next, look at the Effective Care line in the data. We rank #3. Recall that a criteria in this data review was healing people effectively. This study seems to affirm that the U.S. system does that.

Sound Bite #2: The United States appears to create better outcomes on patient care than most first-world countries.

Under Healthy Lives the French rank No. 1 – probably due to all the wine and snail eating. But the French are also horrific at Access, meaning their healthiness may not be connected to their ability to see a doctor.

It may be possible to conclude from this data that even though we spend more, we are getting better than average outcomes.

But what about the other side?

In 2009’s “Health Care Reform: Do Other Countries Have the Answers?” the National Center for Policy Analysis (NCPA) led by John C. Goodman attempts to take on this issue from a different perspective.

This perspective is influenced by the fact that they are a right-wing think tank who has a principal sponsor in Koch Industries. Yep, those Koch brothers at it again.

The paper makes an interesting reference to a study that looked at a study of Britain’s National Health Service and California’s Kaiser Permanente and found that Kaiser proved superior in terms of rapid specialist access and better primary care for roughly the same cost. I buy that.

Sound Bite #3: The United States has examples of superior health care systems that cost less than fully socialized national health care models.

In some areas, the United States has significantly better outcomes than in Europe. For example, U.S. women have a 63 percent five-year survivability rate after a cancer diagnosis versus a 56 percent for Europeans. Breast cancer was 90 percent and 79 percent, respectively.

In diabetics with blood pressure, there is a 36 percent control rate in the U.S. while only 9 percent of Canadian patients have their blood pressure adequately managed.

Canada often brags that outcomes are comparable but less is spent per capita. The NCPA describes a study that shows a 25 percent higher mortality rate for breast cancer in Canada as well as 18 percent higher for prostate cancer, and 13 percent higher for colorectal cancer.

Sound Bite #4: In specialized areas, the United States is more effective at healing people, especially in the area of cancer treatment.

In the paper, the authors confront the issue that the United States is the only developed country that lacks comprehensive insurance for all. The paper attempts to make a weak argument that the numbers quoted for the uninsured are either “transitory” or illusory (some of the uninsured are actually available for public assistance programs and are, therefore, actually insured).

Actually, I don’t see this one. I think we’ve seen numerous studies from others that establish that the United States has substantial numbers of uninsured who radically and negatively influence costs and outcomes.

Sound Bite #5: The United States has a significant number of uninsured people who lack access to regular non-emergency health care services.

A significant amount of the NCPA paper looks into connections between lack of insurance and mortality, bankruptcy caused by medical bills, low-income family disadvantages, and free market applications to health care.

The most compelling piece of information seems to come in the conclusion. The paper states “Switzerland, considered by many to have the most egalitarian health care system in the developed world, relies largely on private (although government-mandated) insurance” (p.13).

Look at the Commonwealth Fund data. Switzerland is ranked #2 overall while costing about $3,000 less per capita than the United States.

Sound Bite #6: The United States might look to Switzerland as a potential model for system reform.

In summary, it appears that both the left and right are desperately grasping for new ideas and pathways forward. While it seems that little common ground currently exists, there is some hope in that think tanks from two different political viewpoints can see that the Swiss may have found a good compromise.

The United States spends a ton of money on health care (a failure by my criteria) but this spending seems to be effective in healing people effectively (a success by my criteria).

Can we afford this level of spending in the future? Or is there a way to spend less and get equal or better outcomes? Let’s look at both Kaiser and Switzerland for answers.

Steve Lunetta is a resident of Santa Clarita and hopes that we all can work together to find answers. He can be reached at [email protected].

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