How does U.S. health care measure up? The N.Y.-based Commonwealth Fund has released a report entitled “A National Scorecard on U.S. Health System Performance.”
The United States ranks 15th out of 19 countries in deaths of people under age 75 preventable by adequate care. It was last in infant mortality out of 23 industrialized countries. For “healthy life expectancy” at age 60, the U.S. tied for last. If the average U.S. 60-year old lived in one of the top three countries, Japan, Switzerland or France, he or she would live almost three more years.
The report establishes five categories — access, equity, efficiency, quality of care and health outcome — and tests them according to 37 indicators scored numerically.
The report is remarkable for both its breadth and succinctness. It transforms anecdote and impression into objective evaluation.
The report’s message is not news to political activists, health workers, sick people and families. However, even the present writer, identifying with all four groups, gained new appreciation of the deformed nature of U.S. health care
The scores in the report are percentages taken from ratios between U.S. performance measures and those of the top countries, HMOs, or states in the U.S. Some examples of U.S. scores:
• Adults receiving preventive care – 49 percent
• Children receiving regular health care – 46 percent
• Sick people seeing a doctor the same day – 47 percent
Other low-scoring indicators are preventable hospital admissions; 30-day readmission rates; duplication of services; use of electronic medical records; effective diabetes and blood pressure control; adults with a primary care provider; and physician-patient communication. The overall score for the U.S. is 66 on a scale of 100.
150,000 preventable deaths
The report documents low levels of insurance coverage and diminished access. The report’s authors say that if all gaps were closed, up to 150,000 deaths would be prevented annually, and up to $100 billion saved in health care costs each year.
Black and white, rich and poor
The Commonwealth Fund report deserves high marks for identifying survival differences between whites and non-whites, and rich and poor. The infant mortality rate for African American babies, for example, is 42 percent higher than that for white babies. Babies in poor families fare 63 percent worse than babies born into relative wealth.
The mortality rate for African Americans dying of heart disease and diabetes exceeds that for whites by 23 percent and 56 percent, respectively. Disparities between low and high-income populations average out to a 38 percent gap.
Remedies are recommended, but suggestions for implementation are lacking. The report calls for universal insurance coverage, coordination of care, “research and investment in data systems,” and the setting of national goals for improvement as a way to “motivate change.”
U.S. health expenditure is $7,129 per capita, twice as much as that of the average industrialized nation. The report notes that U.S. health administration costs are high. According to Physicians for a National Health Program, 31 cents of each patient care dollar goes for administration, much of which is profit.
Health care spending represents 15 percent of the U.S. gross domestic product, compared to 8 percent for other rich nations. Huge profits are concealed in the U. S. figures. How does one “motivate change” in a system that handsomely enriches a few at the expense of the many?
Rx: Universal health care
Dr. Vicente Navarro of Johns Hopkins University long ago pointed out that universal health care has come about only where political parties built upon vigorous labor movements have fought for it. Motivation comes from political power.
In the U.S., where unions are relatively weak and where we lack a mass working people’s party, we clearly face an uphill fight. Navarro and others show it can be done, pointing to a number of countries where health care for all people has been won, and where, not by coincidence, the people are the healthiest in the world.
The long-term prescription, of course, is socialism. How far removed the Commonwealth Report is from such an approach comes across in its language. “Why not the best?” it asks. What about a “high performance health system?” Why not just say, “health care is a human right” and get busy?
“A National Scorecard on U.S. Health System Performance” can be read at www.cmwf.org.