Universal-Coverage Systems Aren't as Good as Moore Says

By Grace-Marie Turner

America's health care woes all could be solved with a government-run universal-coverage system. Or so says Michael Moore in his new film, "Sicko," which claims that even Cuba's health care system is superior to ours.

Although it's easy to dismiss Moore as a radical propagandist, his message is gaining traction in the policy community. The Commonwealth Fund, a prominent health policy research foundation, has produced a study that also portrays government-run health systems as far superior to ours.

Unfortunately, the Commonwealth Fund study and Moore's film are based almost entirely on anecdotal evidence.

Rather than use hard data, the Commonwealth Fund report relies on public-opinion surveys to conclude that Australia, Canada, Germany, New Zealand and the United Kingdom all provide better care than the United States – and for less money.

Patients and doctors were called and asked if they were happy with the quality, access, efficiency, equity and outcomes offered by their government-managed health care systems. But phone calls do nothing to offer scientific data about whether these nations' systems outperform the United States'.

Consider access to timely care. Britain has more than 1 million citizens on its waiting lists for medical care, according to London-based Nurses for Reform. In Canada, a study found that more than 800,000 citizens are in the queue for medical procedures – and some will die, waiting for months and sometimes more than a year to obtain surgeries or treatments they need.

In the United States, we're used to speedy service. So it's hardly surprising that in a public-opinion survey, we would complain about any wait at all. But waiting lists like those in Britain and Canada would be a national scandal here. We simply wouldn't tolerate it.

And what about access to the latest treatments? In government-managed systems, bureaucrats and politicians decide which surgeries and new medicines will be available.

In Britain, for example, two new drugs for kidney cancer are being denied to cancer sufferers because they're too expensive, according to news reports. The Canadian government also refuses to buy newer drugs until they've been on the market for years. >From 1997 to 1999, for instance, 100 drugs were introduced in America, while only 43 of those drugs became available in Canada.

In the interest of national budgets, state-administered health systems have an incentive to put saving money before saving lives. This affects more than just drugs. Each year, shortages of funds, personnel and facilities force the British system to cancel as many as 100,000 operations.

These shortages directly affect a nation's quality of care, yet the Commonwealth Fund study neglects important comparisons of clinical effectiveness among health-care systems.

Consider cancer. In the United States, the survival rate is 90 percent for patients diagnosed with Stage 1 colon cancer. In Britain, it's just 70 percent. For American women diagnosed with Stage 1 breast cancer, 97 percent are still alive after five years. In Britain, it's only 78 percent. Indeed, when adjusted for age, U.S. cancer deaths have fallen 1 percent per year since 1991.

The data show that if you are sick, the United States is where you want to be. We spend more in this country on health care, and we receive more medical care as a result.

But look at America's outcomes, cry the Michael Moores of the world. Despite the highest per-capita spending in the world, Americans die younger. On average, Americans live two years less than Canadians.

But life expectancy is affected by poverty, lack of education, obesity, teen pregnancy, drug and alcohol abuse, and other unhealthful lifestyles – even homicide rates and traffic accidents. What people do or don't do to care for themselves has a much bigger effect on the health of the population than spending on medical care does.

The U.S. health care system certainly has its problems, and we must do much more to cover the uninsured. But if you judge a health care system by how well it serves people when they're actually sick, America's is without equal.

If Moore's waistline ever puts him in the hospital for heart surgery, it will be interesting to see where he goes for medical care – the Mayo Clinic or Cuba?

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By Grace-Marie Turner

America's health care woes all could be solved with a government-run universal-coverage system. Or so says Michael Moore in his new film, "Sicko," which claims that even Cuba's health care system is superior to ours.

Although it's easy to dismiss Moore as a radical propagandist, his message is gaining traction in the policy community. The Commonwealth Fund, a prominent health policy research foundation, has produced a study that also portrays government-run health systems as far superior to ours.

Unfortunately, the Commonwealth Fund study and Moore's film are based almost entirely on anecdotal evidence.

Rather than use hard data, the Commonwealth Fund report relies on public-opinion surveys to conclude that Australia, Canada, Germany, New Zealand and the United Kingdom all provide better care than the United States – and for less money.

Patients and doctors were called and asked if they were happy with the quality, access, efficiency, equity and outcomes offered by their government-managed health care systems. But phone calls do nothing to offer scientific data about whether these nations' systems outperform the United States'.

Consider access to timely care. Britain has more than 1 million citizens on its waiting lists for medical care, according to London-based Nurses for Reform. In Canada, a study found that more than 800,000 citizens are in the queue for medical procedures – and some will die, waiting for months and sometimes more than a year to obtain surgeries or treatments they need.

In the United States, we're used to speedy service. So it's hardly surprising that in a public-opinion survey, we would complain about any wait at all. But waiting lists like those in Britain and Canada would be a national scandal here. We simply wouldn't tolerate it.

And what about access to the latest treatments? In government-managed systems, bureaucrats and politicians decide which surgeries and new medicines will be available.

In Britain, for example, two new drugs for kidney cancer are being denied to cancer sufferers because they're too expensive, according to news reports. The Canadian government also refuses to buy newer drugs until they've been on the market for years. >From 1997 to 1999, for instance, 100 drugs were introduced in America, while only 43 of those drugs became available in Canada.

In the interest of national budgets, state-administered health systems have an incentive to put saving money before saving lives. This affects more than just drugs. Each year, shortages of funds, personnel and facilities force the British system to cancel as many as 100,000 operations.

These shortages directly affect a nation's quality of care, yet the Commonwealth Fund study neglects important comparisons of clinical effectiveness among health-care systems.

Consider cancer. In the United States, the survival rate is 90 percent for patients diagnosed with Stage 1 colon cancer. In Britain, it's just 70 percent. For American women diagnosed with Stage 1 breast cancer, 97 percent are still alive after five years. In Britain, it's only 78 percent. Indeed, when adjusted for age, U.S. cancer deaths have fallen 1 percent per year since 1991.

The data show that if you are sick, the United States is where you want to be. We spend more in this country on health care, and we receive more medical care as a result.

But look at America's outcomes, cry the Michael Moores of the world. Despite the highest per-capita spending in the world, Americans die younger. On average, Americans live two years less than Canadians.

But life expectancy is affected by poverty, lack of education, obesity, teen pregnancy, drug and alcohol abuse, and other unhealthful lifestyles – even homicide rates and traffic accidents. What people do or don't do to care for themselves has a much bigger effect on the health of the population than spending on medical care does.

The U.S. health care system certainly has its problems, and we must do much more to cover the uninsured. But if you judge a health care system by how well it serves people when they're actually sick, America's is without equal.

If Moore's waistline ever puts him in the hospital for heart surgery, it will be interesting to see where he goes for medical care – the Mayo Clinic or Cuba?

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About the author