Mirror, mirror on the wall, who’s the sickest of them all? You’ve already heard this:
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.
So perhaps we should emulate our neighbors to the north? Not so fast:
[T]he 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.
Do we in fact aspire to “best of class”?
First, the Canadian system didn’t start off as a federal system and still isn’t a federal system. It’s a provincial system. Second, as a JAMA study I’ve mentioned from time to time points out, administrative costs in the Canadian system aren’t as low as some Americans seem to think they are. About 15% IIRC. That’s better than here but it doesn’t provide the savings it would take to cover everybody under a single-payer system without paying a considerable amount more than we do now.
As close as we came to a “provincial” system in the States was, um, Romneycare up in Massachusetts. It cost a godawful sum of money, to be sure; but it didn’t assume that what’s necessary in New England is also what’s necessary in New Mexico or North Dakota, one of the fundamental flaws of just about any Federal program you can name.