Westminster Kennel Club. In the end, who cares if the judges cite 57 reasons for choosing the Chihuahua over the Siberian Husky? For that matter, maybe the winner should be a mutt. So it is with health-care systems. Views on America's health care reform debate from our panel of experts at Health Care Rx.">

Robert F. Graboyes

Robert F. Graboyes

Robert F. Graboyes is the senior health care adviser at the National Federation of Independent Business (NFIB) in Washington, D.C.

Westminster health-care show

"Best health-care system" is like "best in show" at the Westminster Kennel Club. In both cases, biased judges blend dozens of variables, using arbitrary weights, into a single ranking. One bowtied emcee declares, "The French health-care system!" The other proclaims, "The Chihuahua!" The worst dog-show statistic in existence is the World Health Organization's "U.S. is No. 37" -- a number that means nothing but makes Hollywood health mavens bark and howl.

But since you ask ... America has a better claim than any other country to the title "best health-care system." No other country can match our strengths. But we clearly have weaknesses -- some of them very serious. While the rest of the world is a great place to look for ideas, there's no single model we can or should adopt. We have our problems, and they have theirs.

America's health-care costs are high and increasing steadily. These costs are killing business, particularly small business. A responsible American can find himself uninsured and uninsurable (e.g. lose your job and develop a serious medical condition). And, sadly, some American patients suffer and die unnecessarily due to medical errors (as do people in other countries).

We can learn from other countries if we first recognize their problems. Canada has lower costs than America, but their costs are also rising rapidly. In Europe, few go without health insurance, but cancer patients die more quickly than in America. British hospitals have appalling infection rates. European statistics seriously understate infant mortality rates. Ironically, many countries are adopting American-style elements to solve their own problems.

Knowing all this, other countries do offer success stories we might want to emulate. Switzerland and the Netherlands have achieved near-universal coverage through private insurance markets -- no public option needed. Their insurers willingly cover ill people, thanks to risk-adjustment systems. Canada and the United Kingdom have far better medical liability laws than ours. Health savings accounts have seen some success in South Africa and Singapore. France excels at critical care, while India and Thailand bring state-of-the-art managerial techniques to hospitals serving an international clientele.

The challenge for America is to find multinational best practices and graft them onto America's existing infrastructure. That's harder than looking for a single off-the-rack model to adopt, but it's far more productive.

In the end, who cares if the judges cite 57 reasons for choosing the Chihuahua over the Siberian Husky? For that matter, maybe the winner should be a mutt. So it is with health-care systems.

By Robert F. Graboyes  |  October 22, 2009; 12:07 PM ET  | Category:  Health Care Reform Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   Del.icio.us   StumbleUpon   Technorati  
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you should have said that your data you are presenting to us, come from a private organisation called "National Center for Policy Analysis". It's an organisation fighting for the status quo of high profit and low performance for the vast majority of Americans. One member of the directors board is CEO of a for-profit health insurance company. Do you really think this is an independent survey?

Posted by: liber_murator | November 4, 2009 10:48 AM
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Look, I did not say your cancer survival rate statistics were wrong; I said you were using the wrong statistic to compare cancer treatments between countries. Survival rates reward countries that do a lot of testing, but there is now data to show that for some cancers (breast & prostate), this does not save lives. It does reduce the quality of life for many, and costs a great deal. Mortality rates, while not perfect, are a much better statistic because they do not depend on the number of tests, but simply on the frequency of deaths. To see this data go to the WHO data book or the OECD (not OCED as I wrote before) web site. While you are there, you might see how we compare in the other bottom line public health statisitcs such as life expectency, life expectency after 60, infant and maternal mortality, birth weight, et., etc., etc. While you are doing this remember we spend twice as much per person as these other countries.

Another article with references is

July 17, 2009, NY Times
Forty Years' War
In Push for Cancer Screening, Limited Benefits

PS I am a matheimatician, so you are well to doubt my medical statisics (which I have referenced), but I think you might have a little more trust in what I say about using the correct statistic.

Posted by: lensch | October 23, 2009 8:41 AM
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My article is referenced. It's information taken from the Lancet Oncology 2007, one of the most accurate medical journals in the world. Maby you feel you know more than them to call "fallacy" to what they write?

What you say has no value to me. Refute my statistics with statistics, then we will see who has the accurate referenced information.

PS: and Gina Kolata's expertice in health care is....?

Posted by: cristina1999us | October 22, 2009 10:31 PM
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cristina1999us - Survival rates are very important if you have the disease, but are just plain wrong for comparing effectiveness. They depend on two occurrences. One, the disease has to be detected. Two, the patient has to survive (for 5 years say). If the disease is not detected, then no matter how long you survive, you are not counted. Therefore countries with an aggressive detection program will have better survival than one that does not even if they wind up treating many people who do not need treatment and even though they may kill so many people treating them that their mortality rate for the disease is higher.

Prostate cancer is a poster child for these ideas. Read Gina Kolata's article in yesterday's Times.

As I remarked other countries have better mortality rates for cancer than we do (from OCED). But one thing a reliance on survival rates does, is to encourage a lot of testing and treatment and thus spending a lot of money.

The other points you make in your first statement are just as unreferenced as my original quote of mortality rates. When you go to OCED to check cancer mortality rates you can look at life expectancy. life expectancy after 60, infant and maternal mortality, birth weight, etc., etc., etc. The fact is that in terms of bottom line results we are at or near the bottom in all of these in spite of the fact we spend twice as much per person as other OCED countries.

Ops, I see you just posted a second comment. Let's see. O.K. you are just reiterating the fallacy that early detection is always better. Breast cancer is also treated in the Times article. BTW these facts were well known for years to people who studied comparative cancer death rates between various countries. The Cancer Society is just now coming around to the facts, but not based on epidemiological studies, but on actually case studies.

Posted by: lensch | October 22, 2009 8:46 PM
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Early diagnosis is the key, which gets us to the crucial screening issue:

It is often claimed that people have better access to preventive screenings in universal health care systems. But despite the large number of uninsured, cancer patients in the United States are most likely to be screened regularly, and once diagnosed, have the fastest access to treatment. For example, a Commonwealth Fund report showed that women in the United States were more likely to get a PAP test for cervical cancer every two years than women in Australia, Canada, New Zealand and Great Britain, where health insurance is guaranteed by the government.

* In the United States, 85 percent of women aged 25 to 64 years have regular PAP smears, compared with 58 percent in Great Britain.

* The same is true for mammograms; in the United States, 84 percent of women aged 50 to 64 years get them regularly — a higher percentage than in Australia, Canada or New Zealand, and far higher than the 63 percent of British women.

Posted by: cristina1999us | October 22, 2009 3:06 PM
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Then you fail to mention any of the "strengths" of the U.S. system supposedly unmatched by any other country. What are those strengths? Was is too hard to think of any?

I will mention to you a couple:

The U.S.A. is the country that invest the most in medical research,

Very few foreigners pass the medical test in the U.S.A when they want to validate their degrees,

U.S.A has the most advanced technology produced locally to treat deadly diseases such as cancer, strokes, and heart attacks.

We beat in efficiency, cleaninless and amount of nurses and doctors per patient than any other country.

You are citing a research and do not provide the link. I have a research that says absolutely the contrary, and I can prove it:

Canada’s system of national health insurance is often cited as a model for the United States. But an analysis of 2001 to 2003 data by June O’Neill, former director of the Congressional Budget Office, and economist David O’Neill, found that overall cancer survival rates are higher in the United States than in Canada:

•For women, the average survival rate for all cancers is 61 percent in the United States, compared to 58 percent in Canada.
•For men, the average survival rate for all cancers is 57 percent in the United States, compared to 53 percent in Canada.

American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared to 56 percent for European women.

•American men have a five-year survival rate of 66 percent — compared to only 47 percent for European men.
•Among European countries, only Sweden has an overall survival rate for men of more than 60 percent.


Who lies, then?

Posted by: cristina1999us | October 22, 2009 3:05 PM
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"but cancer patients die more quickly than in America."

if you look at mortality rates for all cancers (the correct statistic), we do worse than Europe. Here are the figures:

Per 1000 people the US has 321.9, Australia 298.9, Canada 296.4, France 286.1, Austria 280, Sweden 268.2 Finland 255.4, and the UK 253.5.

"British hospitals have appalling infection rates."

As do US hospitals.

"Their (Swiss) insurers willingly cover ill people,..."

They are required by law to offer a basic policy written by the government which also sets the price. They are not allowed to make any profit on this basic policy.

And so on. Lies and half truths.

Posted by: lensch | October 22, 2009 2:28 PM
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How easily you gloss over the fact that we have 40 million uninsured and the Europeans have none.

Then you fail to mention any of the "strengths" of the U.S. system supposedly unmatched by any other country. What are those strengths? Was is too hard to think of any?

Posted by: st50taw | October 22, 2009 2:09 PM
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