The U.S. vs. Other Systems of Health Care

Jane Galt says:

I have a new bloggingheads up with Jonathan Chait, during which I complained about the general tendency for health care books to engage in "argument through anecdote", where the data plays a distant second fiddle to the heartrending stories about x person who didn't get good treatment. So single-payer advocates drag out some American woman who didn't get a breast exam until it was too late, and opponents counter with the Canadian guy who died on the waiting list to see an oncologist.

I'm sympathetic to the data-based versus anecdote point she is making, but in this case I wondered if her impression wasn't partly due to what she chooses to read. Ezra Klein comments along these lines, and he also gives some useful comparisons between the U.S. and single-payer systems - the main reason for the post:

Arguing Health Care, by Ezra Klein: Is Megan's problem with health care writing really that the literature is too narrative-driven? Yikes. She should read some issues of Health Affairs, or the Annals of Internal Medicine, or the New England Journal of Medicine. This is not a debate that lacks for data.

Meanwhile, Megan actually gets a few things wrong in her argument with Chait. She suggests that waiting lines are longer in Europe. That's, uh, untrue. France and Germany don't have waiting lists. Americans do, by the way, with around 40% of patients waiting one month or more for elective surgery. She then suggests that moving to a French or Canadian system would require walking back the medicine we actually provide, telling people they can't have MRIs anymore. That's similarly incorrect. Care utilization in France and Germany is as high -- and in France, higher -- than it is in America. But they pay less per unit of care. And the technology isn't radically different. Germany actually has more CT scanners per million than we do, while the French have three less. The French and the Germans both have more physicians per capita and more acute care beds. Oh, and the French and Germans pay less, and don't have 47 million uninsured.

All this information -- and more! -- can be found in various data-heavy books on the subject, like Thomas Bodenheimer and Kevin Grumbach's wonderful Understanding Health Policy. The thing is, they tend to point towards the same conclusions Jon Cohn's book does, albeit with fewer anecdotes. One reason I spend less time arguing health care with libertarians these days is that it doesn't seem productive. If you really don't want to believe that other system's in the world are better, you won't. If the costs, outcomes, access, and equity advantages offered by the French, German, Japanese, Scandinavian, or Veteran's Affairs systems don't convince you, you simply don't want to be convinced. There are issues, like card check, where I see how the counterargument could be convincing and understand it is, to some degree, a values judgment. Health care isn't one of those issues.

There's a bit more here.