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May 2 / Jonathan

Health care compared, one more time

Sure, it’s cheaper and better health care. But it’s un-American. Via Kevin Drum:

Advocates of universal healthcare frequently claim that European-style national healthcare systems, aside from being fairer, are just more efficient than ours. They provide decent healthcare at a lower cost than the jumbled, pseudo-free market system we have in the United States.

But is it true? Do even relatively mediocre, underfunded national healthcare systems like the one in Britain perform as well as American healthcare? A new study published in the Journal of the American Medical Association reaches a pretty unambiguous conclusion.

The researchers studied health outcomes in both countries and controlled for age by comparing only people aged 55-64. They controlled for race by studying only non-Hispanic whites. They controlled for obesity. They controlled for income. They controlled for education. They controlled for everything they could think of. Here’s what they found:

“At every point in the social hierarchy there is more illness in the United States than in England and the differences are really dramatic,” said study co-author Dr. Michael Marmot, an epidemiologist at University College London in England.

….The upper crust in both countries was healthier than middle-class and low-income people in the same country. But richer Americans’ health status resembled the health of the low-income British.

3 Comments

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  1. Don Pettengill / May 4 2006

    That study was based on *self-reported* wellness. Based on my experiences in the UK (raised there > 20 years) and here (since 1974), I call it: rubbish. The average Brit is grossly under-diagnosed for all kinds of stuff, as any dentist here treating ex-brits can attest. In the UK I had OK teeth; the US dentists were appalled not only at what needed doing, but also at the quality of the existing work.

    It’s no different in medicine. Cancer patients die waiting their turn for therapy. Patients can wait 6 months to see a specialist. They wait years for hearing aids, hip replacements, etc. Given the long lines for treatment, it’s no surprise that the NHS is not anxious to tell people what condition they’re really in.

    Example: http://news.bbc.co.uk/1/hi/wales/2704707.stm

    This just scratches the surface. I know; my mother and stepfather lived down the road from this hospital. It’s little different across the country, but the government goes to great lengths to sweep it under the rug.

  2. Jonathan / May 5 2006

    Don, I don’t think anyone is going to hold out the UK’s health system as a shining example for others to follow. The remarkable thing is that as bad as NH is, US outcomes are worse, and this study eliminates a lot of the usual explanations for the difference (including racial and class differences, for example).

    As for self-reporting, that explanation doesn’t hold up. From the NIH press release:

    Because self-reporting of diseases may have differed between the two countries, the researchers expanded their study groups to include samples of similar age groups from the National Health and Nutrition Examination Survey in the United States and the Health Survey for England. Both of these surveys include clinical measurements of risk for heart disease and stroke, including C-reactive protein, fibrinogen and HDL (high-density lipoprotein) cholesterol tests and clinical examination. These measurements confirmed the differences in diabetes and hypertension prevalence between the two countries. The differences in health status by income and education levels also persisted.

  3. Don Pettengill / May 5 2006

    Further comment: did the study control for lifestyle and diet? I find it extremenly suspicious that the factors chose to “confirm” the self-reports, are precisely those in which factors other than the level of medical care, are important.

    What the study finds, essentially, is that Americans are fatter, bluntly speaking. This is hardly “news”, nor is it relevant to the quality of medical care available in the two countries.

    Finally, calling these factors “outcomes” is disingenous. Outcomes of what, exactly? Eating and drinking to excess, which by the way is one (albeit unwelcome) sign of national prosperity, or poor medical care?

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