The health care debate has been very vigorous, both in the country and on this website. The Right claims the US has the best health care system in the world. This belief is undoubtedly due to the very low government involvement in US health care system. More government involvement or at least more restrictive government involvement will undoubtedly (the classic argument goes) lead toward worse health care, as the government moves slower than the free market does. The free market is the best solution for all things economic. To be sure, a single provider system, like the US military enjoys or like the United Kingdom has would exemplify the philosophy the Right espouses. In these systems the government is the only provider. If you wanted to go to school, get a medical degree and start your own practice you’d be blocked by the government from doing that in the UK. But what the Left proposes is a far cry from a single provider system. They’re instead proposing a single payer system, similar to medicare. This still leaves competition available in the actual health care market: doctors, hospitals, clinics; albeit the long term effects on the health insurance industry are unclear.
In earlier articles we discussed the effectiveness of the health care system, precisely to test the Right’s hypothesis. The measures for effectiveness we’ve used are: longevity, infant mortality, 5 year cancer survival rate and preventable death rate. In all but one of these the US has ranked last, and interestingly, on the other the US ranked first. This is a somewhat confusing result, so in this article we’ll combine all 4 of these measures into a single “health care effectiveness” metric and see how the US compares to other countries.
Before we begin it is important to note that we’ll give up some things to get a single measure of “health care effectiveness”. One thing that we’ll give up is meaning. The very nature of combining a cancer survival statistic with a longevity statistic means that the resulting number will be just a number. It will not have any simple connection to the real world. The number won’t mean percent of people living past a certain age, it won’t mean years of life after cancer, it won’t mean anything other than higher scores are better than lower scores. Again the point of doing this isn’t to get a number it’s to get a sense of how the US compares to other similar countries around the world. And with this in mind, an arbitrary or a meaningful number will do equally as well.
How to combine these 4 quantities? For any given country, we could just add them all together and divide by 4. But there are problems with this approach. Let’s take a broad look at all the numbers:
Instead of simply averaging, we’re going to first scale each individual quantity to make it fit from 50 to 100. The worst score in each category will be assigned a value of 50 and the best score will be assigned a value of 100 and the remaining values will be linearly scaled to fit in between. Note this also “flips” those scores where the best score is a lower one (like infant mortality). After we’ve done this then we’ll average the scores. Why a low of 50 and not 1 or zero? No real reason except to not lead the casual reader astray. Recall many of the earlier articles included the rankings of less developed countries. Even the lowest scoring developed country scored significantly better than the average developing country. So we’re going no lower than 50 here merely to remind the reader that other countries not on this list may well score lower than 50.
For those interested in the details, a few tables at the end of this article include the data used. Note here we are using the “adjusted infant mortality” number, where we ignore infant deaths occurring less than 24 hours after birth. This was discussed in an earlier article. Without further ado let’s get to the results.
The graph below shows the results for the 11 countries that were in all 4 studies. By this Combined Score Japan ranks first, with France and Sweden close together for second place. In last place is the United Kingdom with the US in the 2nd to last place. Some may have been expecting the US to score last, some may find a measure of vindication that the UK is in fact in last place. But is there anything to be learned from this ranking?
Let’s examine this by looking more closely at the components of the combined scores. The graph below is a little busy but it’s worth studying. It shows for each country the value of each component of its combined score. Japan has excellent marks in 3 of the 4 quantities and a moderate mark in cancer survival. Contrast this to France and Sweden. Each has an excellent mark in one area and moderate marks in 3 of the other areas. Japan really seems to be doing something right here and we’ll see just how well they stand out in a moment.
On the other end of the scale we have the US and the UK. The UK scores poorly (below 65) in all 4 areas, while the US scores dead last in 3 of the 4 areas (all 3 marks are in the same location so they’re impossible to distinguish) and first place in one of them. It is this first place showing that catapults the US above the UK. Indeed, a score of 83 on the scaled cancer survival rate would have left the US tied with the UK, so a score of 100 really pushes it ahead. But, for health care, which of those 2 countries would you prefer to live in, the US or the UK? It may depend on what stage of life you are in. Adults with grown children may prefer the superior cancer survival feature of the US and ignore the only slightly better longevity score the UK has. But by this measure my answer is neither.
And let’s drive this point home by concluding with a “dot plot” comparison of these results. Here the lead that Japan has over France and Sweden is very clear. Similarly the lead the US has over the UK is quite noticeable, but also noticeable is how far the US and UK are from the rest of the pack. To be sure, this is only 11 countries. Remember that only countries that showed up in all 4 measures are reported here. There are several countries that scored poorly on 3 of the 4 measures (Portugal and Denmark for example) which may fill in the gap between 2nd to last place US and 3rd to last place Netherlands. So don’t read too much into the size of the gap.
In terms of health care effectiveness, Japan, France and Sweden should be our role models. And anyone using the UK as a typical example of what “socialized medicine” will bring, is intentionally choosing the worst example.
Just today the US released a new report that ranked the US infant mortality rate a bit worse than the data used above. This article points out that most of the poor showing of the US is due to premature births. Indeed we discussed this very fact several months ago because there was a conjecture that the US counts live births differently than other countries. The statistic we used above removed all infant mortality data for infant deaths occuring within the first 24 hours to offset this possibility. This updated study includes information on which countries count live births similar to the US. In short most of them do. (It also included infant mortality rates for premature births, data that wasn’t available to us earlier.) How does this affect our conclusions?
Recall that on two of the 4 statistics we used, we “leaned Right”. The cancer survival rate statistic may have a significant component due to the “lead time bias” where people aren’t really living longer, just having their cancer detected earlier. We acknowledged this possibility but since we had no way to quantify it we ran with the data as is. Also, as mentioned earlier, the infant mortality statistic was altered to adjust as best we could adjust, to varying reporting measures in different countries. It just turns out that this had a favorable result for the US. But it also may have masked some legitimate health concerns in the US.
Adjusting for these factors and adding in the new infant mortality statistics would undoubtedly lower the US ranking. But look at the charts above one more time. It’s unclear if the US would be reduced below the UK’s ranking, but that’s beside the point, isn’t it? If you’re on the Left, aren’t the reported statistics bad enough? If you’re on the Right, can you really come up with more reasons that will significantly improve the US’s ranking? For both, isn’t the US already sufficiently bad to be worthy of a change to its health care system vs the status quo?
Table 1 – Original Scores (sorted alphabetically by country)
Table 2 – Scaled Scores (sorted by rank of Combined Score)