Wednesday, February 2, 2011

Health Care Satisfaction Around The World

A new quest of mine is to get conservatives to face reality instead of simply spinning plausible sounding theories out of their heads. One plausible sounding theory is that socialized medicine is a real nightmare that Americans want no part of. For instance Bob Dutko confidently informed me that the American people don't want something like single payer health care. HP dismisses the World Health Organization rankings of health care around the world because they are "politically charged."

There's pretty decent polling data related to health care satisfaction that we can use to inform ourselves on these questions. You can get a full report from the Commonwealth Fund in 2010 here. I offer a few slides below. Polling is of 11 first world nations.

I'll start with a slide related to cost. I think most people, even conversatives, understand that the cost in the US is off the scale. Here's how far off the scale as contrasted with the other nations in the survey.

What's amazing is that despite the exorbitant amount spent, here in the US we are the worst in terms of cost related problems. One might think with as much as we spend people don't have to skip care or people don't have trouble paying bills. That's not the case.

Here are some additional details on cost related problems.

Do Americans have a higher expectation for receiving effective treatment if they get sick? Not really.

One thing conservatives frequently talk about is wait times. In Canada it's a nightmare. People can't get an appointment. Have to sit in waiting rooms all day. Is that true? Let's see.

It's a little tough to see and you can click it to expand it, but basically only in Canada does a person have more difficulty getting an appointment for the same day. Note that this question was from the 2007 survey because I didn't see the results in the 2010 survey, so in this case it's a 7 country comparison.

What about waiting time in the emergency room?

Better than Canada? Sure. But overall about the middle of the pack.

How about seeing a specialist?

Once again, pretty good. 3 out of 11. But let's not pretend beating out Canada is all that matters. We're paying twice what Germany does as well and we're not beating them.

So finally what are the perceptions of the residents overall?

The highest percentage of residents that think their system needs a complete over haul is in the US. We are second worst amongst those that think only minor changes are needed. It leads me to think that the World Health Organization has taken the time to look at the real world in crafting their rankings. Maybe it's not a conspiracy after all.


HispanicPundit said...

For the record, I dont think anybody - left or right - defends the status quo on healthcare in the United States.

The question is which way to take it. One can make an argument that the United States method is the worst of both worlds. The "capitalist" method has yet to be tried.

Oh and, regarding my point on the WHO ranking, this is what I said:

And don't put too much emphasis on the WHO ranking, its politically charged. It puts a heavy weight on universal coverage and so therefore begs the question: it argues that because our healthcare system does not have universal coverage it should have universal coverage. Hardly an objective metric.

Darf Ferrara said...

So someone produces data that you think supports your argument, and now there isn't a conspiracy? Who claimed that there was a conspiracy? As an American, I don't want more socialized medicine because I know some basic economics. And, by the way, I do think that the US health care system needs a complete overhaul.

Unknown said...

In my opinion, part of the increased cost of healthcare, here in the U.S.,has to do with multiple/relatively unnecessary tests, etc. caused by skittish doctors practicing defensive medicine. If the predatory plaintiff attorneys were banished, there may be some chance at remission.

Jon said...

Well, though it may not seem so, this post was actually inspired by a conversation I had with someone who really did pooh-pooh the WHO rankings as a kind of liberal conspiracy. Also by your comment I linked to. I think you lean in that direction, but not as far as this person.

Also when I say people act like socialized medicine is a horror I mean they intend that as contrasted with what we have here. If that's not your view then that's a good thing.

What I think this shows is that the WHO rankings are not surprising based on people's indicated preferences. One would generally expect that if people regard only minor changes as necessary to their system then they have a pretty good system and if they think a complete overhaul is necessary they have a poor system. Based on that gauge we find that the UK, Netherlands, and Sweden are pretty good, with France mid to high. Norway, Canada, and Germany are sort of middle of the pack. The US, Australia, and New Zealand bring up the rear. Then when we look at WHO rankings we find that this is consistent with what they find. So there's nothing surprising about what WHO is giving us. Note also that New Zealand is behind the US according to WHO.

If knowledge of basic economics prevents you from accepting socialized medicine one wonders what the Nobel Prize committee was thinking awarding people like Krugman and Stiglitz Nobel Prizes in economics. Don't you have to know some basic economics before they give you that award?

Jon said...

Lisa, I think tort reform is right wing distraction. So for instance here.

Darf Ferrara said...
This comment has been removed by the author.
Darf Ferrara said...

The Nobel Peace Prize was given to Kissinger, Arafat, and Obama. You would that a person that won that prize wouldn't be responsible for the deaths of thousands.

Jon said...

So Stiglitz and Krugman don't understand basic economics and you do?

HispanicPundit said...

Here is the CBO on tort reform:

CBO concluded that tort reform would lower costs or health care both directly, by reducing medical malpractice costs, and indirectly, by reducing the use of health care services through changes in the ractice patterns of providers; the agency estimated that enacting a package of roposals outlined in that letter would reduce federal budget deficits by about $54 billion during the 2010–2019 period.

Here is the real problem with the United States healthcare system:

Finally, the real problem in health care is not now, and never has been, prices. It is the suppression of real markets. Third-party payment prevents providers from competing for patients based on price and quality. Wherever third-party payers are absent (cosmetic surgery, Lasik surgery, walk-in clinics, surgi-centers, concierge doctors, medical tourism, etc.), the price system in health care works just fine and dandy.

IOW, it's that the true price is shielded from us by third party insurance companies.

Jon said...

Regarding tort reform, that's my point. We spend something like $2.5 trillion in health care expenses every year. This would save about $5 billion a year. That's a lot of money in terms of raw dollars, but in terms of the share of actual health care expenses it's nothing.

Your solution sounds great, but that's not what the insurance companies want. So since we don't have democratic government, but instead of crony capitalist government, the insurance companies write the laws. Your strategy for solving the problem is weakening the government's ability to resist these companies. Take off caps on lobbying. Allow unlimited corporate contributions on political campaigns. What they will then do is continue on the present course. So your solution is the status quo. My solution is to be democratic. That means single payer for now. That's better than the status quo.

Darf Ferrara said...

You don't seem to see the distinction between a solution and a method to achieve that solution. HP advocates a market system as a solution, while you advocate socialism as a solution. You advocate democracy to achieve this solution, while HP hasn't put forward a method.

By the way, your definition of democracy sounds a lot like whatever you want, supported by whatever poll you can find that supports what you want.

Jon said...

If you have polls that show something different I'd like to see them.

My argument is that hp's method of support for corporate lobbying should be expected to lead to the status quo.

Darf Ferrara said...

My point is that when it comes to global warming, you're much less favorable to democracy. Those polls don't fit your thoughts about what should be done.

I don't see where HP has advocated corporate lobbying. Possibly that is a separate argument that he has made elsewhere, but you haven't addressed the substance of his posts here.

Jon said...

I support democracy as a strategy in politics. This doesn't mean I always agree with the majority.

If there's substance from HP I've yet to cover I don't know what it is.

Darf Ferrara said...

HP mentioned lack of market in health care. He never mentioned taking off caps on lobbying or allowing unlimited corporate contributions on political campaigns. Without arguing about the effects that those changes would have (you are wrong about them, btw) you didn't address whether a market system wouldn't function more efficiently than a socialist system.

Jon said...

I responded to his claims about markets with a question about how, strategically, that can be achieved. I said that he may be right in his solution, but I see no mechanism to bring that about, whereas I see a mechanism available to bring about a much better system than we presently have (UK style care), and that is democracy. My presumption about his strategies is based on other conversations, but it's also an effort to prompt him to offer a strategy if I understand him wrong. The ball is in his court. I've addressed the substance of his statements.

So I didn't address how a market system would be more efficient than a socialist system because I didn't dispute it. I'm not sure I agree, but it doesn't matter. As far as I can see it's not in the cards, so there's no point in bringing it up. It's like saying we should all live in peace and love each other. Fine. How do we do that? We have a major problem here. We have sky high deficits that are largely the result of our health care system. We have a system that doesn't satisfy the populace. It's a major problem, so how do we address it? I can't see how this isn't just ivory tower recommendations with no contact to the real world. "Don't get sick" might be another recommendation. Since there's no strategic means to bring that about effectively I say it's time to look elsewhere.

Darf Ferrara said...

I guess HP could simply dismiss your entire position because it's not possible to achieve within our current government, but instead he talks about what the problems with our system are, and how they could be fixed. Your position of giving up because bringing positive change is impossible is easier though.

Jon said...

You say HP talks about how the problems can be fixed, but just a couple of posts earlier you had said that HP hasn't even suggested a method for achieving the changes he suggests. Which is it?

Then you say my method is to give up, and yet I've repeatedly suggested democracy as a method, meaning we need to make efforts to push our government towards democracy and away from plutocracy. I've repeatedly offered concrete steps for achieving that.

Your method is to caricature my position, which usually describing it in ways that are exactly the opposite of the truth, and then offer snarky and derisive put downs based on the misrepresentation. Why don't you either learn to read and learn to drop the derision or stop posting here. It's been much more pleasant around here without you over the last few weeks talking about how those that know "basic economics" don't subscribe to my views. I'm not interested in conversing with you in this way. It's one ill founded insult after another.

Darf Ferrara said...

I've tried in this post to be somewhat civil and only a little bit snarky. I don't see where I've insulted anyone here. And if you think I've misrepresented your views I really hope that you can clarify them for me, because I really don't think that I understand them. For example, what are some concrete steps for achieving democracy that you have advocated? Mostly you point to polls and claim that the government should do what you think that the poll says. That is not very concrete to me. It looks like there is as much strategic means to achieving HP's solutions as yours.

And with regard to HP's method for achieving the solutions he advocates (tort reform, markets in healthcare) you might ask him. I'm pretty sure that he prefers changing the laws through the democratic process.

Jon said...

Here's an example of me offering specific policy changes.

Misrepresenting my views is saying that my advice is to give up. That's the opposite of the truth. Or saying I oppose democracy when the majority disagrees with me. I don't. I still support democracy as a method even if that means the implementation of policies I don't prefer.

You say I don't understand the distinction between a solution and a method. The point of the post you were replying to was in fact to distinguish between his solution (market based health care) and his method for achieving it (since he supports policies that strengthen the corporate hand in governance). HP's strategies lead away from his preferred solution. I was making the very distinctions you chide me for ignoring.

He can say he prefers changing laws via the democratic process, but my point is that he doesn't oppose the very policies that lead away from democracy. See my specific policy changes I linked to above.

Darf Ferrara said...

I did caricature your views, and I apologize for that. I thought it was about as fair as dismissing HPs suggestions because "that's not what the insurance companies want".

I missed the discussion that you linked to. Those are specific suggestions, but somehow you assume that your suggestions are possible within our current governing framework, where HP's are not. I don't understand how that is possible.

And I still think you don't understand the distinction I'm making between a solution and a method.

Jon said...

HP has policy preferences and so do I. We both presumably have to do the work (persuasion) to implement them. HP wants to persuade people to back off the regulatory apparatus and also to continue to treat corporations as persons. He generally does not accept Chomsky like suggestions, such as taxes on trading to reduce or eliminate day trading. My argument is that if he were successful in persuading people and he were to get those policies implemented the effect would be to move in the opposite direction of his stated aims in health care. The reason is because it has the effect of increasing corporate control of governance, and insurance companies don't want to do anything like what he is suggesting. They did write Obama's health care legislation after all. They write it to suit their interests, not the interests of the public of course. That's the very nature of a corporation.

So my claim is even granting that his solution is a good one the policies he advocates undermine his stated goal. He must consider strategy for implementing his preference in health care.

My strategy is generally to strengthen the democratic institutions that we have. This would generally be expected to push policy in a direction that the public favors. So single payer, public option, etc. Half the cost as the status quo, better outcomes. Near elimination of the deficit. Pretty darn good. Market care might be better, but how to achieve it? It isn't popular as far as I know so you don't get it via democracy. It isn't preferred by the most influential corporations, so you don't get it via Citizens United. How do you achieve it? Stating it as a preference and acting like you've done something worthwhile is like saying we should have world peace.

Jon said...

And perhaps I'm not understanding your point regarding solution and method.

Darf Ferrara said...

Ok, you had skipped some steps in dismissing HP's suggestions. I disagree with most of your analysis, but your train of thought is now clear to me.

To get back to the original point of your post I'm going to caricature the gist of it, and reply.

US health care system isn't good. (Most people agree)

Some conservatives claim that European systems are a disaster (Some Rush Limbaugh types do. I think most serious people would claim that European models works relatively well for what is paid, while the US has better high end treatments, and has some more flexibility, but is outlandishly priced).

The US should emulate European models. (Here is where we diverge completely. There are theoretical and empirical reasons for believing that a market system works better than a socialist system. Other, probably more relevant reasons for rejecting the European model include my belief that systems that work for relatively small, homogeneous populations wouldn't be transfered over to the US without bringing the worst from those systems while maintaining the worst things about our present system).

Jon said...

My point in this post was two-fold. First, it's not true that people subjected to socialized medicine are unhappy with it generally speaking or that they are more unhappy than we are. Second, the WHO rankings are quite consistent with the data available and should not be dismissed as a liberal conspiracy.

Now, to your point about market care being preferred to socialized care I can only repeat what I've already said. I see no plausible strategic means of implementing it. It's not wanted by the public as far as I know, so democracy is not an option. It's not wanted by the powerful insurance companies. Since it can't be implemented we must choose between status quo (the corporate preference) or popular alternatives (socialized medicine). Would you prefer socialized medicine given those alternatives?

Are you saying you don't think socialized medicine would work here because of ethnic variation?

Darf Ferrara said...

Not ethnic variation, per se. I think that cultural and other considerations are important here. Socialism in general creates a commons problem, and a larger population creates a larger problem. I also think that a population that is more trusting would suffer less from socialist policies, and my guess is that Americans are less trusting of government in general.

In other words, ceteris paribus, socialism is worse for larger populations than smaller, and also socialism is worse for populations that don't trust the central government than trusting populations. But, ceteris paribus, a market system works better than a socialist system.

Jon said...

I don't see a market solution in the cards.

It's the same for the Israel/Palestine conflict. Many on the Palestinian side demand a right of return. I might agree that they are in the right. They were evicted from their homes. Why shouldn't they get their own property back? But here's the reality. We have an international consensus for a 2 state settlement at the '67 borders and compensation for the refugees. We have no major movement for a right of return. Theory is great, but in order to rise to the level of advocacy you need to sketch a path showing how we go from here to there. I see no path for peace outside the international consensus.

So since I see no path for imposing a market based system I put the question to you again. Status quo or single payer? Just curious which you would prefer if you are limited to those choices.

Darf Ferrara said...

You seem to think that if you can't imagine it then it can't be done. There are more possibilities than are dreamt of in your philosophy. Marginal improvements in a market direction include allowing prepaid medical care companies (known as "Health Insurance companies" for some reason) to compete across state lines, getting rid of the "health insurance" deductibility for companies, removing the barriers to entry caused by medical guilds and other regulatory agencies, expanding medical savings accounts, and making catastrophic coverage more easily available. Any of these options are possible, and several have been discussed seriously.

As to which system I would prefer, you haven't given enough information. If the question is would I rather have my current health care or, e.g. British health care (that is, living in England), then I would go for my current health care, since my health care plan is ok. If the question is would I rather have no health care legislation passed, or have a law that transformed the US into a single payer system, then I would prefer that no law be passed. This is because I think that anything that could get through congress would make our system worse. For example, Obamacare, (do you support Obamacare over the previous status quo?) will probably cost more and deliver worse health care as compared to the old system, but it was the best deal that could get through.

Jon said...

I suppose you mean that Obama Care will deliver worse health care for the affluent. Obviously for tens of millions of Americans that couldn't afford our cost prohibitive system Obama Care will deliver for them an improvement. I'm not sure I agree that the affluent will suffer, but it's possible.

I would have voted for Obama Care. Not because I'm happy with it. The worst part of our system is the crony capitalist nature of it, which makes it so costly. Obama retained that in a cave to the corporate interest. We can expect our health care costs to continue to skyrocket under this or under the prior system. On the other hand tens of millions of poor people now can do better than just running to the ER at which point it's possibly too late. That's a good thing as far as I'm concerned even though it's not a benefit to me personally.

Darf Ferrara said...

I'm not an expert on Obamacare, but it doesn't deliver 100% coverage, so many of the poor will still be left out. Also the "Cadillac" plans will still be available, so I assume that the rich will still be able to get better coverage since they can afford it. It will likely cost more though. I just assume that either the cost will be much higher than previously thought, or care will be more limited than it would otherwise be.