Best Most Expensive Care Anywhere

The century-old Commonwealth Fund has published its findings comparing the U. S. healthcare system with those of other OECD countries:

The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. underperforms relative to other countries on most dimensions of performance. Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity. In this edition of Mirror, Mirror, the United Kingdom ranks first, followed closely by Switzerland (Exhibit ES-1).

Read it and weep. Even more importantly from my point of view the second-worst system is Canada’s while the third-worst is France’s. Since Canada is the OECD country that most closely resembles ours culturally and from a lifestyle standpoint, I think that’s a significant finding, suggesting that even if we were to adopt, say, a single-payer system that would be merely the beginning of the reforms that would be needed here if we truly want to have the best of class healthcare system to which we aspire.

It won’t be enough to change who writes the checks. Under the circumstances we might want to consider figuring out what we’re doing wrong and what policies would foster the other changes we’d need to make. The politically-impossible change to a single-payer system could turn out to be the least of our problems.

6 comments… add one
  • michael reynolds

    See this?

    In every state that’s shared details thusfar, it appears there will be more choices in Obamacare, year 2:

    Michigan’s exchange is going from 13 participating companies in 2013 to 18 this fall.

    At least one additional carrier has filed to sell plans through Kentucky’s exchange.

    Several more insurers may join the plans participating in Virginia, Washington, and Indiana’s exchanges.

    United HealthCare may jump into Georgia’s market.

    And the surge in carriers means that there will be many more actual options at the point of purchase, too. Peter Frost at the Chicago Tribune notes the number of companies competing on the Illinois exchange next year will inch up from six to eight—but the number of available policies will almost triple, from 165 to 504.

  • jan

    This piece has an interesting perspective. However, comparison of countries overall health services oftentimes are in conflict with equality of medical standards exercised in given countries. The U.S., for instance, has one of the highest standards in the world relating to infant mortality, which then makes it more susceptible to higher recordings of deaths being reported than other countries.

    Also, this report’s optimist predictions, of the PPACA’s impact on medical record access, and patient access to care by low/moderate income people, remains obscured due to ensuing flaws/problems in this policy — the ongoing problems of subsidy verification, reliability of HC premium payments being paid, insurance company sustainability after government-promised bail-outs expires, the fiscal load to states under the groaning medicaid expansion program, and the number of physicians not actively participating in government HC exchanges, leading to dwindling numbers of doctors available to a number of people, resulting in rationing of care and longer wait times.

  • steve

    jan- No. You are wrong about the infant mortality thing. That has been well studied. For OECD countries, the rates are determined pretty much the same way. Our rates really are higher.


  • michael reynolds


    Can you spring me from moderation?

  • CStanley

    @steve- the OECD reports that I’ve looked at contain a caveat about the differences in the way live births are counted. If the data doesn’t exist to make direct comparisons, then how can it be that studies could have validated our rate being higher?

  • Andy

    I agree that our infant mortality is worse, but I think it’s complicated. For instance, unintuitively, immigrants in the US have lower infant mortality than native born. Ethnic Chinese have very low rates while non Hispanic blacks have a very high rate. Such differences probably have more factors behind them than the health care system.

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