Friday, August 18, 2017

"America First" and quality of health care

Bannon is returning to head up Breitbart News, loosed to pursue his America First agenda. Fundamentally, we believe in America First. The way we look at it, though, it's not caring less about the world, therefore more about America. That's just raising yourself by tearing others down. The question is, how to keep America in first place. And if we're not in first, how do we get there?

Take health care

Where does Bannon and his America First stand? That the Republican health care bill, which even President Trump called "mean," did not go far enough in removing government from health care. That approach taken to its logical conclusion would only return us to the era of cheap policies for the healthy and which accomplish little, and for those that need ongoing care, policies which are unaffordable. Health calamities are the majority cause — over 60% — of bankruptcies in the U.S. "Access" to health care does not imply affordability.

There is also the question of quality of care. Are we in first place, the best?

If we turn back the clock 5 years, Republicans leaders were predicting the ACA, upheld by the Supreme Court, would, in John Boehner's words, "bankrupt our country and ruin the best health care delivery system in the world." Mitch McConnell said the U.S. has "the finest health care system in the world."

Yes, we have good cancer survival rates. Yes, there is the image of wealthy foreigners, to whom money is no object, coming to the U.S. for medical treatment. America is also a leader in medical research. Or was, until the Trump administration proposed cutting the CDC budget by $1.2 billion. Every dollar spent at the CDC saves $3 in future medical costs, and $10 in societal costs.

Looking through the 2010 WHO report, it notes that both America and Norway spend over $7,000 per person per year on health care. At the other end of the scale, four countries spend less than $10 per person per year. The report makes the point that meaningful health care is a significant expense for which governments should plan appropriately. That includes protecting its citizens against the financial risks of illness. Even Rwanda, where annual income is only $400 a year, offers basic health services to everyone through health insurance that costs $37 per person. While international aid subsidizes Rwanda's health system, its government has also committed nearly 20% of its budget to health care.

The issue for "America first" in health care is that it may be first in spending, but it lags all the major industrial countries numerous areas. The World Health Organization measures health outcomes by:[1]

  • "Health level, as defined by a measure of life expectancy, which shows how healthy a country's population is. This factor gets a 25 percent weight."
  • "Responsiveness, which includes factors such as speed of health services, privacy protections, choice of doctors and quality of amenities. This factor gets a 12.5 percent weight."
  • "Financial fairness, which measures how progressive or regressive the financing of a country's health care system is — that is, whether or not the financial burdens are borne by those who are economically better off. This factor receives a 25 percent weight."
  • "Health distribution, which measures how equally a nation's health care resources are allocated among the population. This factor receives a 25 percent weight."
  • "Responsiveness distribution, which measures how equally a nation's health care responsiveness (which we defined above) is spread through society. This factor gets a 12.5 percent weight."

Based on these factors, the U.S. ranks 15th place in health care attainment. And if you factor in what kind of care we should be receiving based on our level of education and economic resources, we are delivering at far below our potential, dropping to 37th place.

Oher studies, for example, comparing the U.S. with Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom, found the U.S. comes in last or next to last across the board in health system performance:

  • quality,
  • access,
  • efficiency,
  • equity, and
  • healthy lives.

While we do have shorter waits for surgery, that is one our few advantages. However, even that isn't a valid comparison, because in countries with universal health care, people do not put off going to the doctor until their health issue becomes a crisis. We are not first, or best, in health care. Until health care is universal and Americans don't need to choose between going to the doctor and food on the table or paying for the roof over their head, we will not achieve the health system outcomes we deserve and, which by all measures, we are already paying for.


[1]Quoting their 2010 report
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