by Ralph Silverman, MD, FACS, FASCRS
I am tired of the comparisons people make between health care in the United States and other countries. For instance, there are those who think that we should have universal health care because some European countries and Canada do.
It is true that those countries do have universal health care, but is it a fair comparison?
Who does Canada rely on to defend its borders? When the Germans invaded France in World War II who stormed the beaches at Normandy? The point is, these countries rely on the United States for security when peace is compromised. America allocates trillions of dollars to defend both itself and the rest of the world. No other country does this. That money could easily be used for universal health care.
Furthermore, President Obama has consistently said that health care costs are rising and we aren’t any healthier. The White House uses statistics that demonstrate that, in the U.S., childhood disease is more rampant than in European countries, and that people die earlier Stateside. They ask the question, “Why are we not healthier than other countries when we spend more on health care?”
The answer may lie with American patients, who are more obese than patients in other countries. We eat a diet high in fat and carbohydrate content. As a population, we smoke like there’s no tomorrow. We drive everywhere we go and don’t get any exercise. Instead of exercising to control our blood pressure or diabetes, we sit on the couch and take a pill. We eat ice cream and cake, and then take some insulin to bring down our sugar levels.
Consider Asia. People there eat mainly rice and fish and walk everywhere they go. Smoking is a problem there, but it is worse in the United States. How many 300 pound Asian men and women do you see walking into Burger King in Tokyo? The same is true in France. And guess what? People in these countries are healthier than we are. It’s not surprising.
If anything, the United States should give itself a pat on the back. We have managed to treat our bodies like trash, and yet, the length of life is comparable to other countries that live a much healthier lifestyle. Just imagine if we kept health care at the same level and we, as a population, decided to really change our way of life for the healthier.
The White House and the rest of the government need to make fairer comparisons when contrasting our health care system with those of other countries.
After doing so, perhaps things may not be as bad as they appear.
Ralph Silverman is a colorectal surgeon who blogs at The Colon Doctor.
Submit a guest post and be heard.
Related posts:
- If health reformers want to emulate Canada and Europe, can we copy their malpractice systems too?
- Countries with worse health care systems than the United States
- Government-run health care
- Will integrated systems become a reality in American health care?
- Single-payer and the American patient
- The cold war of American health care
- A major obstacle impeding universal coverage in the United States
{ 44 comments }
← Previous Comments
Does someone have a legitimate link to that claim that the NHS won’t cover dialysis after age 65? I’ve heard it in several places, but nothing official.
Average GP salary in the UK: 118,000 pounds (Daily Mail, January 2007).
Better pay that primary care in the USA.
> Does someone have a legitimate link to that claim that the NHS won’t cover dialysis after age 65?
That is not true in the spaniard NHS… limits to treatment efford are based in clinical judgment (avoiding overtreatment without quality of life expectatives), at least for life threathing illness (that have a cure available).
There are of course some rationing… for example NHS dermatologists do not treat cosmetic problems, for recieving in-vitro fertilization you need to try for one year with your partner… A back pain does not recieve automatically a MRI (that is not clinically relevant in most patients) but only if conservative therapy does not work. Psycologists for daily problems (as for example family therapists on divorce) are not covered… and so on.
‘Does someone have a legitimate link to that claim that the NHS won’t cover dialysis after age 65?’
It’s a lie, like so many other things propagated by the Palinites and Birthers. The scale of the lies of the right is truly breathtaking – and for what? To protect the profit of the insurance industry. Nothing to do with health.
By the way, what is true is that many over-65s won’t get a kidney transplant, but that’s down to medical reasons (you have to be in good health otherwise) and is the same anywhere. And by the way, 30% of Americans with renal failure don’t make it past the first year of dialysis.
Does someone have a legitimate link to that claim that the NHS won’t cover dialysis after age 65?
Age 65? It used to be 50.
Berlyne GM: Over 50 and uremic equals death. The failure of the British National Health Service to provide adequate dialysis facilities. Nephron. 1982; 31(3):189-90
They’re cleaning up their act in that regard, but it used to be true, not all that long ago, and the cutoff was as low as 50. I don’t know where their rates are now, compared to USA or the Continent.
Here’s the full letter:
http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ArtikelNr=182644&Ausgabe=241630&ProduktNr=223854&filename=182644.pdf
http://www.bapn.org/assets/clinical_standards/dialysis-manifesto.pdf
Treatment rates for end-stage renal failure are lower in England than in other comparable countries and this is considered an indication of unmet need. (NSF, 2004) There is also variation in treatment rates in different parts of England that cannot be fully explained by demographic differences.
Inequalities of access based on socioeconomic status continue in the UK, same as here. Google the phrase “Postcode lottery” to see it discussed in their own press. Earlier in this thread, I referenced one such study that just came out in the BMJ, with respect to infant mortality.
In the UK’s own age discrimination organizations, they have talked about it continuing to this day, with respect to dialysis and cancer treatment. Looking at the number of people receiving such treatments in Germany, compared to the USA. See: “Age discrimination: an historical and contemporary analysis” By John Macnicol. Cambridge University Press, Page 59
And any of a number of newspaper articles, easy enough to access.
http://www.independent.co.uk/life-style/health-and-families/health-news/dialysis-shortage-exposes-failings-of-nhs-601353.html
With respect to Canada, I can’t do any better than the court ruling in Chaoulli v. Quebec. “Access to a waiting list is not access to health care….[T]here is unchallenged evidence that in some serious cases, patients die as a result of waiting lists for public health care. Where lack of timely health care can result in death, section 7 protection of life itself is engaged. The evidence here demonstrates that the prohibition on health insurance results in physical and psychological suffering that meets the threshold requirement of seriousness.”
Unwittingly Anon makes the case for state medicine, as of course the US passed a law in 1972 guaranteeing a large percentage of dialysis costs for anyone with renal failure.
No one is denying that all heathcare systems are under great pressure and in the UK’s case more resources are being allocated – much more since Labour took over from the wilderness years of Thatcher and co. In the US, many more people die of preventable conditions per capita a year – the Commonwealth Fund puts the toll at 100,000 a year I believe – and no American is in a position to lecture any western country on inequalities given the the third world conditions that exist in too many urban and rural settings. But as you ask, yes inequalities in the UK are unacceptable. But that’s what we get from apeing the US much more than our European neighbours.
Talldoc,
Thank you for a reasoned comment.
re:
“As an oncologist in the UK I can see the downside of the UK system very well-many people do not have access to the best treatments because of rationed healthcare.”
and
“On the other hand the 90% of our population who are uninsured seem to have a much better standard of medical care than uninsured patients in the US”
I am an American physician and this is my suggestion for the solution?
Primary care is much CHEAPER than disease-associated care. A yearly PE with all the basic screening studies (barring infrequent screens such as colonoscopies) is very cheap, relative to on-going care for diabetes or leukemia. I suggest we start to view health insurance in the same way as any other form of insurance: the benefits are provided in illness/catastrophe. Our car insurance does not provide for oil changes & tires. No wonder the system cannot sustain itself in a cost-effective way; there are too many users.
Americans should pay for their own primary care–out of pocket. If the US govt wants to spend money, let it spend money on changing our attitudes about health & savings. I feel certain that, over time, non-profits & charities (i.e. breast cancer societies, churches, etc.) could provide preventative care to those unable to pay. Then, insurance would be available & affordable for catastrophic illness.
Our entire perspective has to change, in that Americans must start taking personal responsibility for their health. The days of smoking & eating ding dongs all day, while letting the VA system or the tax payer fund your CABG should be over.
“Dont forget to mention that in UK, as in US, if you want to pay a private insurance (or just directly the treatment) you will recieve it no matters how expense it is”
A point I believe I made in the next line of my comment!
As for examples:
Drugs:
No access to bevacizumab for patients with colorectal lung or breast cancer.
No access to cetuximab or panitumumab in colorectal cancer Limited access to erlotinib for lung cancer.
Limited or no access to sorafenib in hepatocellular cancer.
Limited access to sorafenib/sunitinib for renal cancer.
Very limited access to temozolomide for brain tumours.
No access to lapatinib for breast cancer
No access to pemetrexed in non small cell lung cancer.
Almost any new agent takes approximately 2-3 years from licensing to approval even if it is approved by NICE (except in breast cancer where hordes of middle class women have to assault politicians physically and verbally to get their way). Then another 3 months before it will be funded, once of course you have made an individual business case for introduction for each regimen in each individual hospital.
And don’t get me started on radiotherapy where there is a major shortfall incapacity and therefore unaccepotable waiting times or inappropriate fractionation in wide swathes of the country
I do think you can compare the US and the UK. The UK has a similar obesity epidemic, worse smoking statistics, and a lifestyle that is becoming more and more “American”- and their life expectancy is higher than that in the US! Talldoc is right that the latest cancer drugs may not be on offer, but better primary care coverage does make a difference.
To place all the blame of a broken healthcare system on obese patient is unfair and a gross oversimplification.
How much money is spent on Aids research? Is that not a behavioral disease? And the rise in other sexual transmitted diseases that have become resistant to antibiotics. Let us be careful when speaking of behavioral reasons for health care costs. Let us not forget illegal immigrates. I can speak first hand because we took a neighbor to the er with her child that was sick, no insurance, illegal. Of course no one in this country will ever deny a child of medical help but her parents are responsible for not having insurance and being here illegal. And why is it our government leaders make enough money to afford good health care when they are suppose to be civil servants of the people. Read the Constitution, love country fear government! Politicians have pitted Americans against each other for their own political whims of power and to make sure they have a good job and health insurance. Does anyone think Senator Kennedy would choose government health care especially at his age? Or any government civil servant? It should be mandatory that all government officials should be enrolled in any government health care before imposing it on any American!
>>But as you ask, yes inequalities in the UK are unacceptable.
Oh, so the inequalities do exist. It was a breathtaking lie a few posts ago.
You’re right, Med Student “….The UK has a similar obesity epidemic, worse smoking statistics, etc…..” and lifespan is longer. In a population. Population statistics have little to do with the healthcare you will be providing. You don’t treat populations, you treat individuals. Africans have a shorter life span than whites, and it marches through if that African is an Afro-American or an Afro-Briton. The Japanese have a longer lifespan even when they move to the USA and their progeny are born stateside. For me, when I’m looking for healthcare, meaning I’m sick, I want the place with the best chance of getting better. Lifespan statistics reflect population genetics.
As pointed out before, if one wants to play the game of comparing populations, at least compare apples with apples. European Scandinavians compared to American Scandinavians. African Americans compared to Afro Brits and native Africans. Japanese versus Japanese-Americans.
When their own statistics show inequality of outcome for certain deprived populations in the UK, it’s called a result of poverty, ignorance, drug abuse, deprivation, the inevitable problems associated with poverty. Same population in America, it’s the evil Capitalist system.
Of course we can’t lecture anyone else. Not that it stops others from lecturing us.
Interesting point talldoc – “…..Almost any new agent takes approximately 2-3 years from licensing to approval even if it is approved by NICE (except in breast cancer where hordes of middle class women have to assault politicians physically and verbally to get their way)…….”
Political pressures continue to influence healthcare. Not that I wish breast cancer on anyone, but cancer is cancer, and it’s not the only thing that harms women (and a few men for that matter, Richard Roundtree comes to mind).
On par with Anon & Talldoc,
If a UHC system is the panacea, then why does the medical literature still detail “health care disparities” in these countries?
The British Heart Foundation discusses disparities in care in their current document on CHD (www.heartstats.org).
(see here: http://www.heartstats.org/temp/2008.Chaptersp1.pdf)
An interesting comment I saw on a page for the British National Health Service, while perusing their entry on CHD:
“If Coronary Heart disease is the ‘UK’s biggest killer’ why does it take so long to get a first appointment to see a cardiologist?
Surely, on the basis that ‘prevention is better than cure’ it would be more efficient to quickly diagnose and treat cardiac problems thus reducing the number of heart attacks and the resultant strain on ambulance and A&E services!!
My current wait to see a cardiologist is my first contact with the NHS for 10 years and quite frankly I’m not impressed!!!”
http://www.nhs.uk/conditions/Coronary-heart-disease/Pages/Introduction.aspx
Do you ever study history in school? If yes, it sure seems like you may have been sleeping during the class on WWII?
Timeline of US and Canada’s involvement in WWII is below.
5 September 1939 – US formally becomes a neutral country (this means they chose NOT TO ENTER THE WAR).
10 September 1939 – Canada Declares war on Germany
23 December 1939 – The first Canadian troops land in Britain
13 November 1941 – US Congress revises the Neutrality Act of 1939 to allow US merchant ships to unload munitions in British ports
7 December 1941 – Japanese launch surprise attack on U.S. fleet at Pearl Harbor [United States]
8 December 1941 – United States declares war on Japan [United States]
11 December 1941 – Germany and Italy declare war on United States
27 January 1943 – American 8th Air Force conducts its first raid against Germany HOW MANY YEARS AFTER CANADA?
6 June 1944 – D-Day, the Allied Invasion of Normandy, France [France]
1944
June 6: 14,000 Canadians land on Normandy beaches apart of ‘Operation Neptune.’ 1,000 Canadian casualties.
June 8-12: Canadians repel fierce German counter-attacks and hold the Normandy beach head
As to who protects the Canadian borders? The answer is Canadians! Have you ever been to Canada? Were you questioned by a US Immigration and Customs officer that allowed you into Canada? Use some common sense if you have any. You probably also think 911 terrorists were let into the US by Canada – The US Customs and Immigration Service is the correct answer.
I would seem that the largest correlation is between detractors of UHC and their profession – and guess what, the biggest detractors are in fact DOCTORS.
Doctors in UK, Canada and US are all against UHC. Patients, on the other hand, are in the majority in favour of UHC.
The fact is, UHC does place some real conditions on doctors. It becomes the determinant in what treatments doctors may offer. Doctors do not like this. They would like to treat you the way they see fit, and any universal system will get in their way in some fashion.
However, none of the anti-UHC doctors I have heard have anything to say for those who are not insured. The fact is, for those people, any system at all, even the least efficient system out there is better than what they have, which is NOTHING. I think it behooves the US to come up with the BEST system, not to sit around making excuses for the worst system (no system at all, and yet still more costly per person than any of the UHC systems out there).
Sigh.
“America allocates trillions of dollars to defend both itself and the rest of the world. No other country does this. That money could easily be used for universal health care.”
Imagine if people actually had some fundamental knowledge of the facts before pretending to knowledge.
In 2007, the USA spent 16 % of its GDP on health care. Its military budget was 4 %. (which, incidentally is half a trillion, not “trillions”) The nearest OECD country in health care spending is Switzerland, with just over 11 %.
The difference in health care spending between the US, and the second worst performer is bigger than the US military expenses.
The average first world country spent 9%. The difference between the US medical expenses and the average is nearly twice the US military budget.
Of course, saying that “That money could easily be spent paying for UHC” isn’t wrong. The US government already has an expense of almost 9 % of GDP on health care. The money already paid in taxes could pay for UHC.
Of course, countries such as France and the UK already spend about 2,5 % of GDp on their military budgets. So the difference between the US and UK military budgets is 1,5% of GDP. The difference in health care spending is 5 times as large.
US medical overspending is so large that it dwarfs the military budget into insignificance.
Defend its borders from what? The only nation that could possibly threaten Canada is the United States.
Who did the United States rely on to place its Early Warning defense system.
The idea that somehow the United States was defending Europe altruistically is basically a false argument. After WWII, even in free elections, the communist parties were winning majority seats in the parliaments of many European elections. As usual the United States kept military forces in Europe, often against the will of the electorate in those nations, to protect our own business interests and our own economic markets, not to defend Europeans from anything they were all that concerned about to begin with.
One of the primary causes of the Great Depression was that the U.S. industrial capacity had outstripped our internal markets. Everybody in America had purchased everything they could purchase or use.
After WWII, the United States economy plunged right back into recession. We needed Europe as a market for American goods.
That was our reason for “defending Europe” Indeed, we defended them so much that we had the government in France throw the party that won the most votes in the first national election out of office and denied the seats they had won in that election, It was the French Communist Party that won 25 percent of the seats in their parliament, the largest single party to win seats. Combined with the seats won by the Socialists, the far left had a majority vote. That would not do for U.S. policy makers so we had the right wing militarists remove them from office.
This occurred all over the world. In Iran the U.S overthrew the legitimately elected Mossadegh. In Guatemala we had the military remove Arbenz and in Vietnam we simply cancelled the agreed on free elections of 1956.
This defense argument is one that is usually given, but is also usually false. The people in most of the countries we were “defending” didn’t want us to be defending them. In fact all we were doing were defending pro American political parties that could not legitimately win free election in countries all over the world
The good doctor makes an extremely dumb statement in trying to make an extremely dumb case about national defense versus health spending. He says: “When the Germans invaded France in World War II who stormed the beaches at Normandy?” The implication being that the U.S. heroically invaded while the Canadians and others cowered and waited to be rescued by the Americans.
First of all, the invasion of Normandy was in no way contemporaneous with the German invasion of France; the two events were years apart.
Second, and more importantly, Americans were not the Lone Rangers the doctor ignorantly portrays.
In fact, D-Day began with a late-night air assault by landing of American airborne troops — along with a GREATER NUMBER of airborne troops from Britain, Canada, and the Free French.
There was then the famous beach landings to which the doctor refers — and again gets wrong. The U.S. committed about 78,000 troops to the D-Day effort. The British, Canadian and Free French, far from sitting idly by as in the doctor’s fantasy, committed MORE troops than than the U.S.
It is also worth noting that Canada and Britain started fighting against Nazi aggression in 1939, when Hitler invaded Poland. The brave and mighty Americans, far from leading the way in the fight for freedom, avoided the fight altogether until late 1941.
Finally, the doctor’s implication that Canada is free to lavish funds on health care because it hides under the American umbrella is grossly misleading and wrong. As every study has shown, Canada spends LESS on health care than the U.S., both per capita and as a percentage of GDP, yet provides care for all residents and has better outcomes.
← Previous Comments
Comments on this entry are closed.