Published in the San Diego Union-Tribune on June 30, 2008
Bashing the American health care system has become a cottage industry.
On the big screen, we've seen John Q and Sicko. At the bookstore, highly touted best-sellers lambasting the system seem to hit the shelves every month. On the opinion pages and on the cable news networks, pundits declare that the American system is in crisis and an embarrassment.
In making their case, these critics often cite the World Health Organization's rankings of international health care systems, which put the United States at 37th out of 191 countries.
The WHO rankings are highly influential among policy-makers and help drive health reforms around the world. But common sense suggests that when the rankings show the United States has a health care system worse than Morocco's or Costa Rica's, it's clear that the rankings are a poor reflection of reality. An objective assessment would have listed America at – or certainly near – the top.
The criteria by which the WHO ranked countries tell the story. Countries with tax-funded, socialized health care tend to be ranked higher simply because citizens are treated equally – even when the quality of care is extremely poor. Meanwhile, countries in which citizens have unequal access to medical care tend to be ranked lower, even when the overall quality of care is superior.
By the WHO's logic, treating people equally matters more than treating people well. So theoretically, a country with a negligent health care system could improve its rankings just by neglecting everybody more equally.
It's also instructive to consider which countries rank above the United States. Britain is in the top 20. Unlike America, however, Britain has a government agency that historically blocks or delays access to high-quality treatments from those who need them.
Earlier this year, for example, British lung cancer patients were denied access to Tarceva, a drug that is proven to prolong the lives of cancer patients. The government refused to cover the drug because of its cost.
Sadly, such decisions are common.
Britain's lack of access to timely medical care is also worth noting. There are currently more than 1 million British citizens in need of care waiting for hospital admission. And each year, about 100,000 operations are canceled because of shortages of operating rooms, equipment or personnel.
That's not exactly the kind of world-class care one would expect from a country in the WHO's top 20.
Canada also ranks above the United States. Yet the Canadian health care system is plagued by long waits and rationing. Canada currently has more than 800,000 citizens awaiting medical procedures. Many of these patients will die before they get the treatments they need. Those who can, come to the United States for medical care.
And the most crucial reading of a health care system is how well you do if you get sick. Amazingly, the WHO chose not to include that data in its survey.
For key diseases that respond to medical care, an American patient's chances of surviving are much better than a patient in countries with much higher WHO rankings.
The prestigious journal Lancet Oncology compared cancer survival rates. For example:
For American women diagnosed with breast cancer, 63 percent are alive at least five years after a cancer diagnosis, compared with 56 percent for European women.
The five-year survival rate for American men with prostate cancer is 99 percent; the European average is 78 percent.
For 16 different types of cancer, American men have a five-year survival rate of 66 percent, compared with only 47 percent for European men.
The chances of surviving breast cancer are as high as 99 percent in the United States if it is detected at stage 1, which is much more likely to occur in the United States than abroad.
This election season, we'll continue to hear laments about America's “broken” health care system. Rather than buy the rhetoric, however, let's be mindful of the facts. And ask ourselves: When someone in another country is sick, where do they want to come for medical care?