Monday, February 14, 2005

Apples to Oranges

Dylan cites a report from the Spectator comparing English and American Health Care:

The answer is clear. If you are a woman with breast cancer in Britain, you have (or at least a few years ago you had, since all medical statistics are a few years old) a 46 per cent chance of dying from it. In America, your chances of dying are far lower — only 25 per cent. Britain has one of the worst survival rates in the advanced world and America has the best.

If you are a man and you are diagnosed as having cancer of the prostate in Britain, you are more likely to die of it than not. You have a 57 per cent chance of departing this life. But in America you are likely to live. Your chances of dying from the disease are only 19 per cent. Once again, Britain is at the bottom of the class and America at the top.

It goes on gleefully comparing cancer survival rates and concludes that American medicine is better managed than English:

But the curious thing is that the new, improved, simple state system of Britain does not work as well as the American muddle. You have a better chance of living to see another day in the American mishmash non-system with its sweet pills of charity, its dose of municipal care and large injection of rampant capitalist supply (even despite the blanket of over-regulation) than in the British system where the state does everything. It is not that America is good at running healthcare. It is just that British state-run healthcare is so amazingly, achingly, miserably and mortally incompetent.

It's not a fair comparison, though.

The British system ensures everyone while spending 7.6% of GDP (as of 2001). The U.S. system manages to spend 13.9% of GDP while leaving close to 50 million people uninsured. The per capita spending is even more stark: England spends about $1992 per capita, to the U.S. $4887. Yes, the average outcome for a U.S. cancer patient is much better, but we spend more than twice as much per capita and still leave 50 million people with charity coverage or no coverage at all. The Spectator talks up Medicaid, but doesn't mention the horror of trying to get an urban hospital to take charity cases, particularly at the end of financial reporting periods when budgets are squeezed.

The English system almost certainly has waste in the system, but it seems that the differential health outcomes are just as likely to be caused by rampant underfunding, which probably has the collateral effect of contracting supply of medical services.

Stats here. (pdf)

Post script: I don't mean to suggest that the original Spectator piece doesn't acknowledge these difficulties, but it certainly minimizes them.


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