What You Think You Know Isn't Always the Truth

We hear the rhetoric. What are the facts of the matter?

        The measure of any health care system should be first and foremost, in my opinion, how soon can I get care when I need it? Right behind that is “How good is it?” In other words, “In comparable countries, what percentage of adults have quick access to a doctor or a nurse when they need it?”

         Real data (not partisan bloviation and rhetoric) shows that the average number of persons in comparable countries who were able to make same or next day appointments was 57%. Germany (53%), France (56%), The UK (57%).  Australia (67%) and the Netherlands were above that number with the Netherlands at 77%.  Health care consumers surveyed in the UK were 10% more likely to respond positively than those in the US. US was 51%, below the 57% average.  It is noteworthy that all these nations except the US have some sort of mandatory health care provision, private insurance, national health care. or what have you.

  

        Another survey was run to determine what percentage of initial care necessities was an emergency room visit vice a regular doctor visit. Again, results were not surprising, with the US and Canada significantly more likely for an initial care option being an ER. This is not totally unexpected in Canada, which has a very scattered population in a very large area at just around 10 persons per square mile. The USA, while less dense than most European nations, has more than nine times higher population density at 95 per square mile. This is mentioned because the US still has 16% of initial medical care incidents at ERs, while Canada is at 17%. Sweden, which has a relatively low population density (48 per square mile) with much of it rural, still uses ERs 25% less than the US. The UK has less than half the percentage of initial care ER visits as the US.  

        In another survey using the same countries, of which all but the US have some form of national health care provision, the question was asked (actually data was pulled) “What is the frequency of medical, medication and lab errors.” The period surveyed was 2014-2016. The results, considering that we are bombarded with “the greatest medical care in the world” claim by numerous US sources, were depressing. The US led all surveyed nations. The average percent of adults who have experienced these issues for all comparable nations was 12%. Over the same time span it was 19% in the USA (that’s 40% worse!). UK, Germany, Australia, France and The Netherlands were all below that 12% average figure.   

        For whatever reason, from the same survey, the USA rate of suture ruptures (eew)  per 100,000 discharges was twice as high as the next highest nation – Australia. The UK and Switzerland were even lower.

        Finally, I took a look at what is frequently generally put forth by advocates of comprehensive national health plans as their greatest advantage – preemptive and preventive care by general practices before issues become critical. The question was asked (of hospitals, and medical professionals, not patients), “How does the frequency of hospital admissions for preventable diseases vary by comparable nation regardless of healthcare system?” Again, as a personal note, I would propose that the system, whatever it be, which catches possible medical issues first and treats them earliest is the best.  

        Again, the answers were not unexpected but were sobering to say the least. The form of the survey was to analyze four common diseases common to all surveyed nations on the basis of how many admissions were there per 100,000 population ages 15 and older. Results were tabulated by comparing USA numbers (percentages)  of admissions to comparable nations, specifically Australia, Belgium, Austria. The diseases analyzed were Congestive Heart Failure, Asthma, Hypertension (high blood pressure), and Diabetes. Expressed as percentages of hospital admissions for preventable/controllable diseases the numbers are" Congestive Heart Failure: admission percentage -USA 48% higher, Asthma – USA 110% higher (!!), Hypertension – USA 90% higher. Diabetes – USA 35% higher.

        So. what’s the “takeaway” here? Regardless of the mode by which other nations with comparable economies and population types insure all residents are covered by health care, (and it varies more than most Americans realize), the average nation with some sort of universal health plan or system does far better (and for less in most cases) at providing care and services. This is even clearer when looking at the data. Early and/or preventive care (family practice, GPs, etc.) reduces percentages of emergency interventions required.

        A spin-off the above is that preventive measures are almost always far less expensive than ER visits and reduce hospitalizations, in many cases eliminating them with early intervention.  In like manner, quicker access to care allows early intervention. As for “wait” times: opponents of national health care are quick to cite long wait times to see physicians as if it is universally true. It varies by country and population density. The UK National Health system “shoots” for 15 days or less to schedule a non-urgent doctor’s appointment. At present, this year (2019), the NHS is averaging more like 18 days. Remember, this is to see a doctor in a non-emergency situation.

        I know, you’re thinking, “18 days?” Wow, we sure have it better here! Really? Try this on:  The wait to see a doctor is longer in  Boston, where the average wait is 52 days to schedule an appointment with a family physician, dermatologist, cardiologist, orthopedic surgeon or obstetrician/gynecologist.     

       So, the next time you hear someone blast universal health care, step back, recognize their ignorance, correct them if that’s a reasonable option (which it almost surely won’t be) and smile sweetly, knowing that you know better.

All the summaries and interpretations of data in the above are from a Peterson-Kaiser Health System Tracker, the section titled “Commonwealth Fund International Health Policy Survey.”