In September, the Commonwealth Fund released its eighth comparative report on health care systems in 10 wealthy and comparable nations: Mirror, Mirror 2024: An International Comparison of Health Systems | Commonwealth Fund. The Commonwealth Fund, established after the First World War to promote the public good, has devoted itself in recent decades to bettering health care and health care systems. Since 2004, it has published annually a study comparing health care in (initially) 11 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway (withdrawn this year), Sweden, Switzerland, the United Kingdom, and the United States.
The study covers five domains: access to health care (affordability and availability), aspects of the care process (including prevention, safety, patient engagement, patient preferences, etc.), administrative efficiency (what we might call the rigmarole of a visit and its payment), equity (does wealth or gender or race affect care?), and outcome. These five domains are investigated through some 70 distinct measures that are gathered in surveys of doctors and patients in each country, broken down by age, gender, wealth, etc. These findings are supplemented by data from the World Health Organization, the Organization of Economic Cooperation and Development, Our World in Data, etc.
The statistical findings generate rankings in each domain, and an overall ranking of a nation’s performance results. Each year’s report summarizes the findings of the three previous years (so this year’s report includes the Covid years).
As in previous nears, this year’s Mirror, Mirror finds the US health system at the bottom of the list. Not only is it 10th out of 10, but while the other 9 countries are all close to each other (with Australia, the Netherlands, and the UK leading in that order), the US is so much lower that it is a statistical outlier.
Broken down by domains, the access to health care in the US (affordability and availability) ranks 10th. In health care process (prevention such as mammograms and flu vaccinations, respect for patient preferences, etc.) we rank a great 2nd; but in administrative efficiency we are 9th because of all the confusion about the thousands of different plans with their different coverages, copays, deductibles, and requirements that cause all doctors to hire specialists for billings. We are 9th in equity (the wealthier you are the better care you get; urban areas get better care than rural areas) and 10th in outcomes because we have the shortest life spans among peer nations by many years and because we have the most avoidable deaths (overdoses and gun violence figure here).
We are the only country of this group that does not have universal health care in some shape or other (and the countries all vary in their systems), but even those who have insurance in the US (about ¾ of us) compare unfavorably with other countries because of the large numbers of under-insured and the high deductibles and copayments.
We are the only country in this group whose government fails to protect the health of its people.
If you go to the Commonwealth Fund site, you can find other studies on our health care system, for example, here is one on costs: High U.S. Health Care Spending | Commonwealth Fund . It seems that we spend twice as much as anyone else (to buy a failure of a system), and the primary reason is that billing rigmarole which requires doctors’ offices to be run by a team of specialists in insurance coding which also requires the insurance companies to hire a team of similar specialists to process claims.
But there are other reasons for inefficiency and high costs. Here is a personal story of our health care unavailability and inefficiency. I drove a spade bit into my thumb and had to go to the emergency room at Sierra Vista Hospital. Had I a primary care doctor in TorC, I might have gone there for stitches, but I don’t have one, and according to the Commonwealth Fund’s study, large numbers of people not having a primary care physician is the reason the country does so poorly in the availability of health care. People like me simply don’t have accessible primary care facilities and therefore can’t even get into the system. This is the reason for our low ranking in access, not, as some people repeatedly opine, because the system is clogged by illegal aliens.
A week after my inefficient and expensive use of the emergency facility, I went to the clinic in the hospital to get the stitches taken out. Not possible. The clinic refused. I was not its patient, and besides, it had no one to do that. So I could not have been sewn up there even if the clinic were my primary facility. Back I went to the emergency room for another inefficient use of their facility, clogging up their system.
But that system was already grossly inefficient. The doctor who stitched my thumb together lives in Potsdam, New York. He also handles an emergency room in Las Cruces while he is in New Mexico. But, that is a lot of plane tickets Sierra Vista pays for (or should I say, we pay for).
I’m grateful for the care I got, but as long was health care depends on the “market,” doctors and other health care people would rather go to populated areas where their “business” can thrive. Unless a more equitable system is set up, Sierra County can only grin and pay up. People in other countries, though, don’t grin and pay up. They have created efficient systems that cover everyone for a lot less money. Why can’t we? Why do we not even want to?
As another rural resident, my experiences have been similar although they were significantly better before obamacare was the law of the land. The added layers of bureaucracy made cost and efficiency a thing of the past although many otherwise unemployable college graduates did find work. Physicians will tell you that they spend more time on the computer than with a patient. Each state having their own regulations makes every insurance company, be they medical or vehicle or homeowner, hire more people to simply deal with the paperwork of billing and government regulations. Blah, blah. I am sure we all have heard this story and it will continue for a long time until self inflicted chronic health issues are eliminated. https://x.com/mtgrepp/status/1839018989424681462?s=46&t=Ug65k2rxoJNE8t9kWp737g
Make America Healthy Again!
I’m surprised that after reading the article you still think the Affordable Care Act is responsible for the mess of health care. You blame the wrong people; though I understand that blaming the government is easy and traditional in the US. While all the other 9 governments in the study have taken responsibility for their national health care systems, our government, decidedly — and you can see who has decided — that it is not responsible, but the insurance companies are. So, if you have to make a blanket blame, blame the insurance companies. It was very explicitly stated in the article why so much of the doctors’ time is taken up with billing confusions: namely, the variety of insurance policies and their varieties of rules, regulations, etc. concerning what they pay for, why, and how, as well as the different scales of copayments and deductibles.
The Affordable Care Act did not screw up the screwed-up system. It, if you follow the criteria used in this study, made the system better overall by increasing enormously availability and affordability not only by getting people insured but capping premiums for seniors. It addressed and reduced the inequity problem by helping people who could not afford insurance to get some.
You might say that it put a strain on the system by getting more people to doctors, but that would mean that you favor fewer people getting attention so that others who can afford it benefit. That may be an individual’s opinion, thinking of oneself, but it is not a topic of general, public interest for public discussion, where the issue is always how to benefit the whole society.
The problem with the Affordable Care Act is not that it supports the insurance industry which is the one responsible for and the one to blame for our mess, because it has turned medicine from something benefiting people’s health to just another business whose bottom line is profit, not health. Health is just another commodity.
I can’t help but believe that you are totally out of touch. I am a veteran but choose a medical insurance plan. I was a merchant seaman with USPublic Health coverage and chose an insurance plan. I have Medicare part g and other than the less than first world medical coverage in Sierra County am happy with my plan as I go to Las Cruces for competitive and competent coverage. Universal coverage as you seem to be advocating is simply the lowest common denominator of coverage. Sorry, not buying your ideas, will stick with part g and my insurance company. I don’t mind health care being another commodity as long as it is competent.
The discussion is, as you yourself said, “make America healthy.” Whether I am out of touch or you are happy with your Medicare plan (though previously you expressed complaints about health care you received), are both irrelevant since as the Commonwealth Fund study shows, the system, whether there are individuals who like it or not, is not doing well for the country, as a whole. Take another read of my second to the last paragraph above.
As for universal care, all the other countries that have better systems than ours in the study have some form of it, whether a national medical system or a form of universal insurance coverage. Since these all do better than our system, you don’t seem to have any basis for asserting as a fact that universal care means lowest common denominator. The assertion seems to suggest that you are unfamiliar with the study of these examples of universal care.
As a case in point, one of the universal care ideas floating around in the US is Medicare for all. Since you like Medicare why are you also knocking it?
In my discussion, as in the article, health insurance refers to private, for-profit companies. I didn’t say so directly, but I did speak of their for-profit bottom line. They are the ones who commoditize health care by having a profit for their bottom line. That is not true of Medicare. You confuse the discussion by speaking about your Medicare plan as one of these insurance companies. Medicare is a public insurance and a big step towards universal health care.
If you are happy with Medicare, you are happy with health care which has your health as its bottom line, not its profit. You seem to be saying the same thing as I am but disagreeing just the same. You are happy to benefit with Medicare’s non-commodification, but you are fine with commodification? You are happy to benefit with Medicare, but you don’t want others to benefit because then that would mean reduction to a common denominator? Which is it, or is this what middle of the road means?