Do we need to reform our health care system?

I’d like to pay more heed to facts than to opinion, but I recognize that the two are hard, perhaps impossible, to separate. After all, as William Jennings Bryan said, “Facts mean nothing unless they are rightly understood, rightly related and rightly interpreted.” And we all know how he screwed that up! Nevertheless, as I find information that seems verifiable, I’ll label it fact.

So, a few facts to begin:

1. The USA is among the richest countries of the world according to Gross Domestic Product per capita. It falls into the categories of “industrialized” and “developed.”

2. The USA is the only one of the top twenty richest countries not to have universal health care—health care available to every citizen regardless of income—except, apparently, the Cayman Islands, the British Virgin Islands, and Equatorial Guinea. I looked up health care in each of the countries. If I missed other universal provider countries, please correct me. The systems vary widely in how they are funded and no doubt in how good the care is.

3. Between 36 and 58 million US citizens are uninsured. The numbers are slippery because the last best count was Census data for 2007, data that didn’t account for the economic downturn this year. However, the Census numbers also included non-citizens. Corrected figures, then, range between the numbers listed. Here is one explanation. And here is another.

4. Many additional US citizens are underinsured, perhaps as many as 25 million. Here is one explanation. And here is another.

The trend in health insurance is higher deductibles—also known as catastrophic insurance. Instead of paying higher premiums, the insured pays a much higher deductible, a dangerous gamble.

5. Health insurance is costing families more. Premiums are rising quickly—by one estimate, the past ten years has seen an increase at four times the rate of inflation. See, for example, the situation in the state of Missouri. See also this analysis on costs.

6. More than 60% of personal bankruptcies in 2007 have been attributed to medical expenses. Most were insured at the onset of illness. Note that this was before the recession hit.

7. The USA spends much more on health care per capita than any other country, despite the fact that not everyone has access. Among the world’s countries, the USA ranks number 52 in doctors per capita and number 19 in acute care hospital beds per capita.

8. Health care outcomes in the USA are not necessarily better than in other countries. The USA is ranked number 50 in life expectancy, number 45 in infant mortality.

Comparison of health outcomes across countries is fraught with statistical challenges. The Organization for Economic Co-operation and Development has been trying to collect and compare health care data across its 30 member countries for several years. OECD has identified a number of indicators of the efficacy of a country’s health care. While comparison problems in the data are addressed in the report, it gives the best cross country comparisons I’ve located. In terms of favorable outcomes on some of these indicators, the USA ranks number 8 in breast cancer five year survival rate out of 21, number 9 in cervical cancer five year survival rate, number 6 in colorectal cancer five year survival rate, number 20 out of 25 in mortality from asthma as a primary cause, number 9 out of 23 in offering annual flu vaccine to those over age 65, and number 5 out of 12 in providing retinal exams for diabetics. Statistics for the USA were not available in such measures as heart attack and stroke.

9. The World Health Organization (WHO) has declared access to healthcare a fundamental human right. In addition, Article 25 of The Universal Declaration of Human Rights, a UN document inspired in part by Eleanor Roosevelt, declares: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.” [bold face added]