The Truth About Health Care

Guest Post by The Zman

Humans live in a finite world. The universe may be infinite, but the world of man is finite. There’s only so much stuff. Because there is only so much stuff, there’s always going to be a shortage of the stuff that people tend to like or need. It’s not always a desperate shortage, but there’s never enough so that everyone can take what they want. There’s always going to be one more hand reaching for the last item just after it is gone.

This is a basic axiom of life and one of the foundation truths of economics. It’s even a foundation truth of communism, which assumes scarcity can only be mitigated, but never fully eliminated, by the elimination of profit. Economists of all stripes work from the assumption that scarcity is an immutable fact of the human condition. The question they wrestle with is how to increase supply and distribute the results.

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Trump and Healthcare

Guest Post by Scott Adams

Today we are witnessing one of the most important events in political history. But you probably can’t see it because the news is talking about healthcare, and how Ryan and Trump totally failed to get enough votes.

The real story is happening in parallel with the healthcare story, and that’s what renders it invisible. Something enormous is happening that has nothing to do with anything you are seeing in the news. In fact, you’ll probably read it here for the first time.

I’m dragging this out to see if you can guess the big news before I tell you. It is something I predicted would happen. It is something the country needs MORE than healthcare. It was, until yesterday, perceived as the biggest problem in the United States, if not the entire world.

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How The Government Ruined U.S. Healthcare (And What We Can Actually Do About It)

Authorerd by Alice Salles via TheAntiMedia.org,

Government’s meddling in the healthcare business has been disastrous from the get-go.

Since 1910, when Republican William Taft gave in to the American Medical Association’s lobbying efforts, most administrations have passed new healthcare regulations. With each new law or set of new regulations, restrictions on the healthcare market went further, until at some point in the 1980s, people began to notice the cost of healthcare had skyrocketed.

This is not an accident. It’s by design.

Continue reading “How The Government Ruined U.S. Healthcare (And What We Can Actually Do About It)”

How the Trump Administration Can Lower Healthcare Costs

Guest Post by Scott Adams

For the past year I have been working with the UC Berkeley start-up ecosystem – the largest in the world – to help improve their efficiency. I seed-funded a project to build a website that connects entrepreneurs, advisors, and investors in the Berkeley area. But I’m also going to highlight in this blog some Berkeley start-ups that can substantially lower healthcare costs in the future.

Today’s focus is on DeviceFarm, a start-up that cures toe fungus using a patent-pending combination of plasma gas and a special liquid concentrator. You can see more on their website, here.

Disclaimer: I recently invested in this company. This is not a solicitation for additional funding.

Toe fungus is mostly a cosmetic problem unless you have diabetes. But if you are diabetic, toe fungus greatly increases your odds of amputation. DeviceFarm estimates that an effective treatment for this condition could prevent 45,000 diabetic amputations per year at a collective savings of $1.7 billion in healthcare expenses. (Current treatments are relatively ineffective.)

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Core CPI Highest Since Lehman (Above Fed Mandate) As Rent, Healthcare Costs Soar

Even the world class data manipulators at the BLS can’t hide the crushing inflation impacting middle class Americans as home price soar due to Wall Street schemes, rent skyrockets because people can’t afford homes anymore, and healthcare cost are driven ever higher by the Obamacare disaster. And you wonder why the middle class is supporting Trump?
Tyler Durden's picture

“This is stagflation: the Fed is increasingly f#*ked,” exclaimed one veteran trader as Core CPI – among The Fed’s favorite inflation indicators after PCE – surged to +2.3% YoY, the highest since Sept 2008. This is the 10th month in a row above the Fed’s mandated 2% ‘stable’ growth as shelter and healthcare costs continue to surge.

Core CPI growth above Fed mandate for 10th month in a row.

Continue reading “Core CPI Highest Since Lehman (Above Fed Mandate) As Rent, Healthcare Costs Soar”

The Fed has fueled inflation — and it’s helping the rich

Higher stock and real estate prices don’t benefit average Americans

It may come as no surprise that in the aftermath of an epic single-family housing boom and subsequent bust, millions of more people have been renting — without much new multifamily housing supply until recently.

This situation has let to strong gains for apartment REITs and an astonishing ability for property owners to raise rents.

Now a research paper by Rob Arnott and Lillian Wu of Research Affiliates in Newport Beach, Calif. asks why the CPI doesn’t reflect the inflation that is apparent in places where people spend their money.

Arnott and Wu argue that the four biggest expenditures for most people — rent, food, energy, and health care — have been rising. Since 1995, rents have been rising at 2.7% clip, energy at a 3.9%, food at 2.6%, and health care at 3.6%. Notably, these four expenses account for 60% of the aggregate of people’s budgets, 80% of middle-class budgets, and 90% of the budgets of the working poor.

Research Affiliates

Indeed, these Four Horsemen are galloping along, outstripping headline CPI, but it has taken six years of massive government spending, borrowing, and central bank stimulus for real per-capita GDP to regain its pre-recession peak.

Continue reading “The Fed has fueled inflation — and it’s helping the rich”

LIES, LIES AND OMG, MORE LIES

It’s that time of year again. It’s open enrollment for health plans at my employer. They are biggest employer in Philly and have the most leverage possible with the insurance companies. They have such good leverage that my premiums are going up “only” 9.8% this year for a basic HMO plan. Based on what I hear from others, I should be thankful for just a 9.8% increase.

This isn’t a new development. Since I’ve been tracking all my expenditures using Quicken since 1991, I know exactly what my annual health insurance costs have been every year. Obamacare was passed in 2009 and began to be implemented in 2010. Obama declared that families could expect $2,500 of savings per year. I know for a fact my annual medical expenses were $2,000 higher in 2015 than they were in 2010.

Continue reading “LIES, LIES AND OMG, MORE LIES”

RELENTLESS BULLSHIT

Health Dept Task Force Recommends Mental Illness Screenings for All U.S. Adults

 

“The U.S. Preventive Services Task Force, an influential panel appointed by the Department of Health and Human Services, has released its recommendation that all U.S. adults over the age of 18 undergo a mental illness evaluation as part of their regular health check-ups.”

and

“The report makes a recommendation that all adults should be screened at least once, though the “optimal frequency of such screening has not been established.” Thus the “B” grade; the panel is only “moderately” certain that blanket screenings could bring those billions down. However, that score does qualify the screenings for coverage under Obamacare.”

Article here.

This one comment on the post caught my eye:

 
“Look at the scam going on in schools; almost half the class are often designated “special needs”, which requires extra teachers to be hired and classes to be smaller, which also requires teachers to be hired. If you think this ridiculous mental health “screening” won’t be used to take away gun rights, you need your head examined. Oh the irony!”

Now all those kids that will move into adulthood are already labeled special needs even if they aren’t.

(This entire post lifted from The Feral Irishman…..again. Sorry, I couldn’t improve on it.)


LIES, DAMNED LIES & STATISTICS

The government released their monthly CPI report this week. Even though it came in at an annualized rate of 3.6%, they and their mouthpieces in the corporate mainstream media dutifully downplayed the uptrend. They can’t let the plebs know the truth. That might upend their economic recovery storyline and put a crimp into their artificial free money, zero interest rate, stock market rally. If they were to admit inflation is rising, the Fed would be forced to raise rates. That is unacceptable in our rigged .01% economy. There are banker bonuses, CEO stock options, corporate stock buyback earnings per share goals and captured politician elections at stake.

The corporate MSM immediately shifted the focus to the annual CPI figure of 0.1%. That’s right. Your government keepers expect you to believe the prices you pay to live your everyday life have been essentially flat in the last year. Anyone who lives in the real world, not the BLS Bizarro world of models, seasonal adjustments, hedonic adjustments, and substitution adjustments, knows this is a lie. The original concept of CPI was to measure the true cost of maintaining a constant standard of living. It should reflect your true inflation of out of pocket costs to live a daily existence in this country.

Instead, it has become a manipulated statistic using academic theories as a cover to systematically under-report the true level of inflation. The purpose has been to cut annual cost of living adjustments to Social Security and other government benefits, while over-estimating the true level of GDP. Artificially low inflation figures allow the mega-corporations who control the country to keep wage increases to workers low. Under-reporting the true level of inflation also allows the Federal Reserve to keep their discount rate far lower than it would be in an honest free market. The Wall Street banks, who own and control the Federal Reserve, are free to charge 18% on credit card balances while paying .25% to savers. The manipulation of the CPI benefits the vested interests, impoverishes the masses, and slowly but surely contributes to the destruction of our economic system.

A deep dive into Table 2 from the BLS reveals some truth and uncovers more lies. Their weighting of everyday living expenditures is warped and purposefully misleading. Let’s look at the annual increases in some food items we might consume in the course of a month, living in this empire of lies:

  • Ground Beef – 10.1%
  • Roast Beef – 11.8%
  • Steak – 11.1%
  • Eggs – 21.8%
  • Chicken – 3.7%
  • Coffee – 3.4%
  • Sugar – 4.2%
  • Candy – 4.6%
  • Snacks – 3.5%
  • Salt & Seasonings – 5.3%
  • Food Away From Home – 3.0%

Continue reading “LIES, DAMNED LIES & STATISTICS”

How Healthcare Is Dooming the U.S. Economy (In Just 3 Charts)

Submitted by Charles Hugh-Smith of OfTwoMinds blog,

As it stands now, U.S. healthcare will bankrupt the nation and doom it to permanent stagnation and recession.

That healthcare alone is dooming the U.S. economy is not news to Of Two Minds readers, as I have been covering the catastrophic consequences of our runaway healthcare system for the past decade.
Three charts crystallize the healthcare dynamics that are dooming the U.S. economy. The first depicts the runaway growth of healthcare costs–a rapid expansion that is a permanent feature of U.S. healthcare, regardless of which party is in office or what reforms are instituted.
This expansion of costs has many drivers, most of which result from the system’s perverse incentives for fraud, overbilling, marginal treatments and defensive medicine.Technological and medical advances offer more options for treatment, and can push costs up–but advances can just as readily push costs down, too.
The primary drivers of rapidly increasing costs are:
1. The cartel/crony-capitalist structure of U.S. healthcare
2. Defensive medicine to stave off litigation
3. Profiteering from needless or ineffective tests, procedures and medications
4. Fraud and overbilling
5. The concentration of expenditures in a small sector of the population
6. America’s inability and/or unwillingness to have an adult discussion over end-of-life care for the elderly.
Here is a chart of the rising cost of U.S. healthcare, which is far outstripping the growth of GDP, which is another way of saying healthcare costs are outstripping our ability to pay for healthcare.

Continue reading “How Healthcare Is Dooming the U.S. Economy (In Just 3 Charts)”

Obamacare Architects At Harvard Furious After Learning They Are Not Exempt From Obamacare

My sides hurt from laughing so hard.

The money quote: ” what is really pissing Harvard off, is that as its perennial next door competitor MIT, as expressed by one professor Jonathan Gruber, made it quite clear that only a nation as stupid as America would allow such as an opaque law as Obamacare to be passed. “

Via ZeroHedge

The brain incubator at Harvard, the place which according to legend, and certainly the US News and World Report’s annual paid college infomercial, is the repository for some of the smartest people in the world, is furious.

The reason – Harvard’s illustrious faculty has learned that they too will be subject to their own policy recommendations as relates to Obamacare, which they themselves helped conceive. As the left-leaning NYT reported earlier today, “for years, Harvard’s experts on health economics and policy have advised presidents and Congress on how to provide health benefits to the nation at a reasonable cost. But those remedies will now be applied to the Harvard faculty, and the professors are in an uproar.

Because Harvard’s brilliant ivory tower economists and public policy wonks know precisely how to fix the world… as long as said fix never applies to them.

And sure enough, the faculty did everything in its power to make sure it never had to suffer the consequences of its own brilliance…

“Members of the Faculty of Arts and Sciences, the heart of the 378-year-old university, voted overwhelmingly in November to oppose changes that would require them and thousands of other Harvard employees to pay more for health care. The university says the increases are in part a result of the Obama administration’s Affordable Care Act, which many Harvard professors championed.

… But it was too late:

The faculty vote came too late to stop the cost increases from taking effect this month, and the anger on campus remains focused on questions that are agitating many workplaces: How should the burden of health costs be shared by employers and employees? If employees have to bear more of the cost, will they skimp on medically necessary care, curtail the use of less valuable services, or both?

And it just gets better:

“Harvard is a microcosm of what’s happening in health care in the country,” said David M. Cutler, a health economist at the university who was an adviser to President Obama’s 2008 campaign. But only up to a point: Professors at Harvard have until now generally avoided the higher expenses that other employers have been passing on to employees. That makes the outrage among the faculty remarkable, Mr. Cutler said, because “Harvard was and remains a very generous employer.”

Ah, hypocrisy: exactly the same whether it is at the lowliest of community colleges or the leading bastion of liberal thought.

In Harvard’s health care enrollment guide for 2015, the university said it “must respond to the national trend of rising health care costs, including some driven by health care reform,” otherwise known as the Affordable Care Act. The guide said that Harvard faced “added costs” because of provisions in the health care law that extend coverage for children up to age 26, offer free preventive services like mammograms and colonoscopies and, starting in 2018, add a tax on high-cost insurance, known as the Cadillac tax.

The faculty is enraged, ENRAGED that what it hoped would only apply to the plebian peasantry is just as applicable to the self-appointed smartest people in the world. Here’s Dick:

Richard F. Thomas, a Harvard professor of classics and one of the world’s leading authorities on Virgil, called the changes “deplorable, deeply regressive, a sign of the corporatization of the university.”

And here’s Mary:

Mary D. Lewis, a professor who specializes in the history of modern France and has led opposition to the benefit changes, said they were tantamount to a pay cut. “Moreover,” she said, “this pay cut will be timed to come at precisely the moment when you are sick, stressed or facing the challenges of being a new parent.”

Why the anger? Because Harvard thought that it would be, drumroll, exempt from the Affordable Care Act which it was instrumental in conceiving :

The university is adopting standard features of most employer-sponsored health plans: Employees will now pay deductibles and a share of the costs, known as coinsurance, for hospitalization, surgery and certain advanced diagnostic tests. The plan has an annual deductible of $250 per individual and $750 for a family. For a doctor’s office visit, the charge is $20. For most other services, patients will pay 10 percent of the cost until they reach the out-of-pocket limit of $1,500 for an individual and $4,500 for a family.
Continue reading the main story

 

Previously, Harvard employees paid a portion of insurance premiums and had low out-of-pocket costs when they received care.

Kinda like how America worked before the tax that is Obamacare was forcefully shoved down everyone’s throat thanks to Harvard brilliant geniuses no less who decided it was time to treat the free market like their own socialist lab experiment. But hey, at least it helped “boost” Q1 Q3 GDP by 1%.

It has gotten so bad that Harvard, realizing it is not exempt for socialist utopia, is suffering from “distress” and “anxiety.”

The president of Harvard, Drew Gilpin Faust, acknowledged in a letter to the faculty that the changes in health benefits — though based on recommendations from some of the university’s own health policy experts — were “causing distress” and had “generated anxiety” on campus. But she said the changes were necessary because Harvard’s health benefit costs were growing faster than operating revenues or staff salaries and were threatening the budget for other priorities like teaching, research and student aid.

 

In response, Harvard professors, including mathematicians and microeconomists, have dissected the university’s data and question whether its health costs have been growing as fast as the university says. Some created spreadsheets and contended that the university’s arguments about the growth of employee health costs were misleading. In recent years, national health spending has been growing at an exceptionally slow rate.

We also learn that the only reason why it was called “Affordable Care” is because, apparently, it was unaffordable.

some ideas that looked good to academia in theory are now causing consternation. In 2009, while Congress was considering the health care legislation, Dr. Alan M. Garber — then a Stanford professor and now the provost of Harvard — led a group of economists who sent an open letter to Mr. Obama endorsing cost-control features of the bill. They praised the Cadillac tax as a way to rein in health costs and premiums.

 

Dr. Garber, a physician and health economist, has been at the center of the current Harvard debate. He approved the changes in benefits, which were recommended by a committee that included university administrators and experts on health policy.

 

 

In an interview, Dr. Garber acknowledged that Harvard employees would face greater cost-sharing, but he defended the changes. “Cost-sharing, if done appropriately, can slow the growth of health spending,” he said. “We need to be prepared for the very real possibility that health expenditure growth will take off again.”

 

But Jerry R. Green, a professor of economics and a former provost who has been on the Harvard faculty for more than four decades, said the new out-of-pocket costs could lead people to defer medical care or diagnostic tests, causing more serious illnesses and costly complications in the future.

 

“It’s equivalent to taxing the sick,” Professor Green said. “I don’t think there’s any government in the world that would tax the sick.”

 

But in her view, there are drawbacks to the Harvard plan and others like it that require consumers to pay a share of health care costs at the time of service. “Consumer cost-sharing is a blunt instrument,” Professor Rosenthal said. “It will save money, but we have strong evidence that when faced with high out-of-pocket costs, consumers make choices that do not appear to be in their best interests in terms of health.”

If you aren’t crying with laughter yet, you will now once the sheer idiocy of central planning, even when conceived by the world’s smartest people, is unveiled:

Harvard’s new plan is far more generous than plans sold on public insurance exchanges under the Affordable Care Act. Harvard says its plan pays 91 percent of the cost of care for a typical consumer, while the most popular plans on the exchanges, known as silver plans, pay 70 percent, on average.

 

In many states, consumers have complained about health plans that limit their choice of doctors and hospitals. Some Harvard employees have said they will gladly accept a narrower network of health care providers if it lowers their costs. But Harvard’s ability to create such networks is complicated by the fact that some of Boston’s best-known, most expensive hospitals are affiliated with Harvard Medical School. To create a network of high-value providers, Harvard would probably need to exclude some of its own teaching hospitals, or discourage their use.

 

“Harvard employees want access to everything,” said Dr. Barbara J. McNeil, the head of the health care policy department at Harvard Medical School and a member of the benefits committee. “They don’t want to be restricted in what institutions they can get care from.”

In other words, compared to the rest of the socialist experiment they helped conceive, Harvard has it much, much better. “Although out-of-pocket costs over all for a typical Harvard employee are to increase in 2015, administrators said premiums would decline slightly. They noted that the university, which has an endowment valued at more than $36 billion, had an unusual program to provide protection against high out-of-pocket costs for employees earning $95,000 a year or less. Still, professors said the protections did not offset the new financial burdens that would fall on junior faculty and lower-paid staff members.”

But the punchline comes from none other than a sociologist:

“It seems that Harvard is trying to save money by shifting costs to sick people,” said Mary C. Waters, a professor of sociology. “I don’t understand why a university with Harvard’s incredible resources would do this. What is the crisis?

Indeed: how dare a university with such “incredible resources” be forced to comply with the policy it itself helped create?

Of course, none of the above is the issue at hand: what is really pissing Harvard off, is that as its perennial next door competitor MIT, as expressed by one professor Jonathan Gruber, made it quite clear that only a nation as stupid as America would allow such as an opaque law as Obamacare to be passed. And, by implication, Harvard being subject to this law, makes its faculty about as stupid as the average American voter. And there is nothing more crushing, “distressing” and “anxiety-provoking” for a bunch of wealthy, ivory tower dwellers than seeing their own egos go down in flames.

Or, said otherwise: MIT 1 – Harvard 0.


IT’S EXPENSIVE, BUT AT LEAST IT’S THE WORST IN THE WORLD

And the good news is that Obama ignored his own law and delayed the most expensive and intrusive parts of Obamacare until after the mid-term elections. We wouldn’t want his party to actually run on their record and a law that was passed with ZERO Republican votes. So, even though our healthcare system is the most expensive and worst in the developed world, it will get more expensive and more “worstly” run after November.

The US Healthcare System: Most Expensive Yet Worst In The Developed World

Tyler Durden's picture

One month ago we showed that when it comes to the cost of basic (and not so basic) health insurance, the US is by far the most expensive country in the world and certainly among its “wealthy-nation”peers (in a world in which indebtedness is somehow equivalent to wealth), which in the context of the irreversible socialization of American healthcare, was in line with expectations.

It would be logical then to think that as a result of this premium – the biggest in the world – the quality of the healthcare offered in the US among the best, if not the best, in the world. Unfortunately, that would be wrong and, in fact, the reality is the complete opposite: as a recent study by the Commonweath Fund, looking at how the US healthcare system compares internationally, finds, “the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity.” In other words: most expensive, yet worst in the developed world.


From the report:

The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. underperforms relative to other countries on most dimensions of performance. Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity. In this edition of Mirror, Mirror, the United Kingdom ranks first, followed closely by Switzerland (Exhibit ES-1).

Expanding from the seven countries included in 2010, the 2014 edition includes data from 11 countries. It incorporates patients’ and physicians’ survey results on care experiences and ratings on various dimensions of care. It includes information from the most recent three Commonwealth Fund international surveys of patients and primary care physicians about medical practices and views of their countries’ health systems (2011–2013). It also includes information on health care outcomes featured in The Commonwealth Fund’s most recent (2011) national health system scorecard, and from the World Health Organization (WHO) and the Organization for Economic Cooperation and Development (OECD).

The most notable way the U.S. differs from other industrialized countries is the absence of universal health insurance coverage. Other nations ensure the accessibility of care through universal health systems and through better ties between patients and the physician practices that serve as their medical homes. The Affordable Care Act is increasing the number of Americans with coverage and improving access to care, though the data in this report are from years prior to the full implementation of the law. Thus, it is not surprising that the U.S. underperforms on measures of access and equity between populations with above- average and below-average incomes.

The U.S. also ranks behind most countries on many measures of health outcomes, quality, and efficiency. U.S. physicians face particular difficulties receiving timely information, coordinating care, and dealing with administrative hassles. Other countries have led in the adoption of modern health information systems, but U.S. physicians and hospitals are catching up as they respond to significant financial incentives to adopt and make meaningful use of health information technology systems. Additional provisions in the Affordable Care Act will further encourage the efficient organization and delivery of health care, as well as investment in important preventive and population health measures.

For all countries, responses indicate room for improvement. Yet, the other 10 countries spend considerably less on health care per person and as a percent of gross domestic product than does the United States. These findings indicate that, from the perspectives of both physicians and patients, the U.S. health care system could do much better in achieving value for the nation’s substantial investment in health.

Major Findings

  • Quality: The indicators of quality were grouped into four categories: effective care, safe care, coordinated care, and patient-centered care. Compared with the other 10 countries, the U.S. fares best on provision and receipt of preventive and patient-centered care. While there has been some improvement in recent years, lower scores on safe and coordinated care pull the overall U.S. quality score down. Continued adoption of health information technology should enhance the ability of U.S. physicians to identify, monitor, and coordinate care for their patients, particularly those with chronic conditions.
  • Access: Not surprisingly—given the absence of universal coverage—people in the U.S. go without needed health care because of cost more often than people do in the other countries. Americans were the most likely to say they had access problems related to cost. Patients in the U.S. have rapid access to specialized health care services; however, they are less likely to report rapid access to primary care than people in leading countries in the study. In other countries, like Canada, patients have little to no financial burden, but experience wait times for such specialized services. There is a frequent misperception that trade-offs between universal coverage and timely access to specialized services are inevitable; however, the Netherlands, U.K., and Germany provide universal coverage with low out-of-pocket costs while maintaining quick access to specialty services.
  • Efficiency: On indicators of efficiency, the U.S. ranks last among the 11 countries, with the U.K. and Sweden ranking first and second, respectively. The U.S. has poor performance on measures of national health expenditures and administrative costs as well as on measures of administrative hassles, avoidable emergency room use, and duplicative medical testing. Sicker survey respondents in the U.K. and France are less likely to visit the emergency room for a condition that could have been treated by a regular doctor, had one been available.
  • Equity: The U.S. ranks a clear last on measures of equity. Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick; not getting a recommended test, treatment, or follow-up care; or not filling a prescription or skipping doses when needed because of costs. On each of these indicators, one-third or more lower-income adults in the U.S. said they went without needed care because of costs in the past year.
  • Healthy lives: The U.S. ranks last overall with poor scores on all three indicators of healthy lives—mortality amenable to medical care, infant mortality, and healthy life expectancy at age 60. The U.S. and U.K. had much higher death rates in 2007 from conditions amenable to medical care than some of the other countries, e.g., rates 25 percent to 50 percent higher than Australia and Sweden. Overall, France, Sweden, and Switzerland rank highest on healthy lives.

Summary

The U.S. ranks last of 11 nations overall. Findings in this report confirm many of those in the earlier four editions of Mirror, Mirror, with the U.S. still ranking last on indicators of efficiency, equity, and outcomes. The U.K. continues to demonstrate strong performance and ranked first overall, though lagging notably on health outcomes. Switzerland, which was included for the first time in this edition, ranked second overall. In the subcategories, the U.S. ranks higher on preventive care, and is strong on waiting times for specialist care, but weak on access to needed services and ability to obtain prompt attention from primary care physicians. Any attempt to assess the relative performance of countries has inherent limitations. These rankings summarize evidence on measures of high performance based on national mortality data and the perceptions and experiences of patients and physicians. They do not capture important dimensions of effectiveness or efficiency that might be obtained from medical records or administrative data. Patients’ and physicians’ assessments might be affected by their experiences and expectations, which could differ by country and culture.

Disparities in access to services signal the need to expand insurance to cover the uninsured and to ensure that all Americans have an accessible medical home. Under the Affordable Care Act, low- to moderate-income families are now eligible for financial assistance in obtaining coverage. Meanwhile, the U.S. has significantly accelerated the adoption of health information technology following the enactment of the American Recovery and Reinvestment Act, and is beginning to close the gap with other countries that have led on adoption of health information technology. Significant incentives now encourage U.S. providers to utilize integrated medical records and information systems that are accessible to providers and patients. Those efforts will likely help clinicians deliver more effective and efficient care.

Many U.S. hospitals and health systems are dedicated to improving the process of care to achieve better safety and quality, but the U.S. can also learn from innovations in other countries—including public reporting of quality data, payment systems that reward high-quality care, and a team approach to management of chronic conditions. Based on these patient and physician reports, and with the enactment of health reform, the United States should be able to make significant strides in improving the delivery, coordination, and equity of the health care system in coming years.

* * *

It should, although if the government is in charge of it, as it now appears to be, it won’t.