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Debunking myths about the U.S. health-care system

A recent article published in the Annals of Surgery provides a very readable and compelling argument for a single-payer national health plan. Titled “Fact and Fiction: Debunking Myths in the U.S.

A recent article published in the Annals of Surgery provides a very readable and compelling argument for a single-payer national health plan.

Titled “Fact and Fiction: Debunking Myths in the U.S. Healthcare System,” the authors of the article (three physicians at New York’s Mount Sinai School of Medicine and Bruce Vladeck, a former health-care financing official in President Bill Clinton’s administration) focus on five common misconceptions they say are “stumbling blocks” to any kind of meaningful discussion about improving our health-care system.

Whether or not you believe a single-payer plan is a solution to the current troubles in the U.S. health-care system, the article is packed with some startling statistics. I recommend reading the entire article, but for those of you who may not have the time, each day this week I’ll highlight the authors’ key arguments for a different one of the myths.

Myth 1: The U.S. health-care system is the best in the world.

“A different way to present this myth is to state that citizens in other countries experience long waits for healthcare, that they must rely on generalists, and that they suffer worse outcomes as a result,” say the article’s authors. They also call this “the alpha myth because it is fundamentally the root of all other myths.”

Here are the some of the statistics the authors use to debunk this myth:

  • A 2000 World Health Organization analysis found that the United States ranked 32nd for infant survival, 24th for life expectancy, and 54th for fairness. Fairness was determined by comparing the amount of money a person contributes to health care with the quality of care received. Overall, WHO ranked the United States 37th.
  • A 2006 Commonwealth Fund report ranked the United States 15th out of 19 countries with respect to preventable deaths before the age of 75. The U.S. also ranked last in infant mortality out of 123 industrialized countries and tied for last on healthy life expectancy at age 60.
  • Despite its mediocre results in health outcomes, the United States spends more than any other country for its health care. In 2000, the U.S. spent 13 percent of its gross domestic product on national health expenditures. Next highest-spending countries: Germany at 10.6 percent and France at 9.5 percent.
  • The poorest fifth of Americans spend 18 percent of their income on health care, while the richest fifth pay only about 3 percent.
  • About half of personal bankruptcies in the United States are related to medical bills.
  • Three-quarters of Americans who declare medical bankruptcy had medical insurance when they became ill.
  • Hemodialysis offers an example of how the United States spends more and gains less than other countries. The U.S. has more hemodialysis centers per capita than other countries, but not necessarily better outcomes. “When end-stage renal disease patients were matched for severity of disease in Canada and the United States, patients in the United States were less likely to receive a kidney transplant and also had a higher mortality rate while on hemodialysis,” the article’s authors note.

UPDATE: Part 2:

Myth 2: There will always be a certain segment of the population that remains uninsured.

“There is a general misconception that the uninsured are also unemployed, that they represent the marginalized section of society,” say the article’s authors. “Epidemiologcal studies clearly show that this is false.”

  • Two-thirds of non-elderly people without health insurance have jobs, and the number of uninsured people is steadily growing — 46.6 million according to a 2006 Census Bureau Report.

  • People with incomes that are more than 200 percent of the federal poverty level accounted for one-third of the recent increase in the number of uninsured adults, and half that growth was among young adults aged 19 to 34.

  • Fewer employers are offering health insurance to their employees, and employees with health insurance are being asked to contribute at a rate that’s rising more quickly than their incomes.

  • When out-of-pocket payments are high, employees’ health suffers. One study found that people with the highest deductibles used 25 to 30 percent fewer medical services than their peers with free care. But high-deductible plans also had lower health outcomes, including poorer control of blood pressure.

  • Between 1996-1997 and 2001-2002, the average American family’s out-of-pocket spending on health care rose nearly twice as fast as its income.

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UPDATE: Part 3:

Myth 3: The uninsured have equal access to medical care through the emergency room.

The authors write:

  • Many studies have shown that people who are uninsured receive less healthcare and have worse health outcomes that the insured. One study found that after adjusting for such factors as age, smoking and education, lack of insurance alone increases the risk of death by 25 percent.
  • Another study compared insured and uninsured people with diabetes. Those without insurance were less likely to undergo the eye, foot and other ongoing health check-ups recommended for people with that disease to prevent blindness, amputation and other complications.
  • Uninsured people are also less likely to be screened for high blood pressure, a risk factor for heart disease, and to take prescribed blood pressure medication.
  • Uninsured people are less likely to be screened for various cancers—and more likely to die from those diseases.
  • Emergency room care is also more costly. “Relying on emergency rooms to provide primary healthcare for the uninsured is clearly a lose-lose situation,” say the study’s authors.

UPDATE: Part 4

Myth 4: A free market is the best way to get the highest quality health insurance for the lowest cost.

The authors write:

  • Medicare’s administrative costs run less than 3%, whereas private insurance administrative costs are above 16% of budget.
  • The total administrative costs for health care in the United States were more than $100 billion in 2002.
  • Administrative costs are the fastest-growing component of healthcare expenditures.

UPDATE: Part 5

Myth 5: We just cannot afford to cover everyone.

The authors write:

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  • On average, Americans pay more for the same medications than do people in other countries. New-drug research costs do not necessarily explain this higher cost. European nations produce on average the same number of new drugs per year as the U.S.
  • U.S. healthcare has many financial inefficiences. For example, of Medicare’s total healthcare funds, 13 percent are spent on care provided during the final 60 days of life. Also, the rate of coronary angioplasty in the U.S. is 300 percent the rate in Canada — with no associated increase in life expectancy. The cesarean section rate in the U.S. was 26 percent of all births in 2002 — twice as high as the country with the next highest rate.
  • “We’re already paying the health costs of the uninsured,” write the authors. “The Institute of Medicine estimates that the value of covering the uninsured is $65 to $130 billion annually.”