Not many health writers -- not many writers of any ilk, for that matter -- can match T.R. Reid's ability to bring a light, witty touch to really serious topics. Like health policy around the globe.
Tom (that's what the "T" in "T.R." stands for) was the featured speaker at the Peterson Institute of International Economics today. Not the usual venue for the book tour for his best-seller, "Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care." Before his talk, he told me he was planning to stress the moral case for covering everyone. Not the approach, perhaps, that this particular crowd was used to hearing. Go ahead, I told him. It is, after all, a roomful of economists eating a free lunch.
And that's what he did.
The Swiss might eat more chocolate per capita than people from any other nation in the world, but you wouldn't know it by looking at their health care stats.
Some say that Switzerland's health care system can provide inspiration, or serve as a model, for the restructuring of the U.S. health care system. Switzerland spends 10.8 percent, or $7,076 USD per capita (30 percent less than the U.S. spends per capita), of its gross domestic product on health care. They boast excellent health care service and enjoy long and healthy lives. Moreover, according to several indicators, the Swiss are healthier than Americans and are, as Nelson Schwartz of The New York Times reports, "generally happy with their system." (Switzerland does, however, still have high health care costs -- exceeded only by the United States and Norway.)
Harvard University's Regina Herzlinger, whom I listened to speak at an AARP and Swiss Embassy event last week, has done extensive research on Switzerland's health care system. In an article for the Journal of the American Medical Association (subscription only), she selects three U.S. states that have similar socioeconomic and population characteristics to Switzerland and demonstrates how the Swiss have lower health care expenses but equal or better health outcomes than the U.S.:
The U.S. lags behind other leading industrial democraties in primary care, according to a new study from the Commonwealth Fund. The report, A Survey of Primary Care Physicians in 11 Countries, 2009: Perspectives on Care, Costs, and Experiences, surveyed doctors in Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States. It found the U.S. falls behind significantly in access to care, the use of payment incentives to improve health care quality, and utilization of health information technology.
Health IT. The U.S. lags behind every surveyed country except for Canada in health IT adoption. In the Netherlands, New Zealand, Norway, the U.K., Australia, Italy, and Sweden, over 90 percent of doctors use health IT, while in the U.S., only 46 percent of doctors use health IT. (It's worth noting that the U.S. has prioritized funding for health IT through economic stimulus package, and approximately $1.2 billion in grants has gone out to health IT development and implementation since data collection for this study concluded in July 2009.)
When the health care conversation heated up a year or so ago, a spate of articles focused on the Dutch health care system. In the Netherlands, everyone receives health coverage through a network of private insurers, and there is strict government regulation to ensure that everyone competes on a level playing field. We heard very little about the Dutch system for awhile -- but recently, there's been another round of reporting, including this piece from the NewsHour with Jim Lehrer.
Do we have the best health system in the world? That's a complex question. A majority of Americans say the answer is ‘no,' but many are also terrified of the alternatives. Rather than let fear stifle the reform conversation, let's look at the facts -- just what are the alternatives? In The Washington Post this weekend, journalist and author T. R. Reid debunked myths about health care in the rest of the world.
Extrapolating from the Kevin Bacon theory of health care and the economy one arrives at the fortune cookie corollary of international affairs, which states that any major issue is made more interesting simply by adding the phrase, ‘In China.'
For example, fixing the economy means fixing health care. It's true in the U.S. and as a piece in the current issue of Newsweek argues, equally true in China.
With an economic crisis of increasingly global proportions, the article argues China must boost its domestic consumption to maintain a desired level of economic growth. But efforts to stimulate the Chinese economy have been stymied by the country's high rate of domestic savings. The World Bank estimates the average household savings rate to be around 25 percent in China, substantially higher than most developed countries. The disparity is even more apparent when you look at net national savings rates across the G-20 (Below. Hat tip, Alejandra and New America's Asset Building Program)
Why is China too scared to spend? The answer Newsweek argues, is health care. As Cornell professor Huang Ming tells the magazine, the "‘[Chinese] save because they are frightened of getting sick.' The costs of illness can be ruinous. A better health-care system would unleash domestic spending and thereby boost employment."
Those fears are all too familiar to Americans for whom more than half of all bankruptcies and home foreclosures are caused by the high cost of health care.
It is not every day the U.S. loses to the Dutch. Heck, even when our wooden-shod friends were favored in soccer over the U.S. in group play at the Olympics this summer, the U.S. came from behind to tie.
But when it comes to the quality of health care services, particularly taking care of people with chronic disease, the Netherlands runs way ahead of us.
So do Australia, New Zealand, France, Germany, the United Kingdom and Canada.
The Commonwealth Fund and Harris Interactive's 2008 survey of access and efficiency of health care services offered to chronically ill adults in eight industrialized countries provides yet more evidence that we in the U.S. do a terrible job of caring for patients with ongoing conditions. Despite far outspending the other seven countries surveyed, and despite high cost sharing even for insured patients, the U.S. was the hands-down survey loser. It's another reminder that our anachronistic system is designed to respond to acute, episodic illnesses, not prevent complications or deterioration of patients with chronic conditions.
NPR's recent "Health Care for All" series went beyond a lot of the comparative reporting we've seen before, not just describing how various western European countries achieve and finance coverage for all, but also doing a few very specific case studies—comparing how a multiple sclerosis patient might fare in the U.S. versus Britain or how France treats cancer patients at home, or what the Dutch are doing about diabetes. They did take a good look at the Swiss system—often cited as a potential model for U.S. reforms. Our thanks to the Kaiser Family Foundation for assembling this list.The links will take you to both audio and text versions.
If you think we've got problems here in the U.S. developing evidence-based medicine, just think about the challenge in a place like Russia. Health writer and blogger Merrill Goozner just spent two weeks reporting in Russia, and we were fascinated by his piece on the Scientific American website.The problem, he writes, begins in the medical schools, where "young doctors receive almost no instruction on biostatistics, epidemiology and methods of decoding the evidence generated by clinical trials." Russian doctors make about $800 a month, meaning getting access to western medical literature is often out of reach (besides, it's in English). So while neither our health system nor our lawmakers have yet figured out how to stimulate more comparative effectiveness research (and how to get the research acted on), at least we aren't treating pulmonary patients with aerosolized salt dust in "cave-like rooms"—a practice that's been common in Eastern Europe for two centuries, but according to Goozner, never systematically studied.
The Tour de France doesn't start until July, but Americans have already opened a substantial lead over some European compatriots when it comes to dissatisfaction with their home country's health care system, according to a new Harris Interactive poll, reported in today's International Herald Tribune.
Asked to describe their overall view of their country's health care system, 33 percent of Americans felt "the health care system has so much wrong with that we need to rebuild it," 50 percent believed there were some good things but "fundamental changes are needed to make it work better," and 12 percent said the system worked well and "only minor changes are necessary," (5 percent weren't sure).
Respondents from the five largest European countries were also dissatisfied with their health care systems, but they weren't as ready as some Americans to throw it all away and start over. This nifty little graph from the Tribune helps illustrate the comparison:
The poll also focused on issues of cost, standards, and efforts to improve health and wellness. Some quick highlights: