Health Care Systems: Satisfaction and Risk

In a conversation with a neighborhood friend last night, I shared my impression that the health care systems in other industrialized countries are superior in many respect to the system in this country.  This topic arose in the context of a series of discussions over the course of the evening that included a comparison of hurricane responses in Cuba and the United States (Cuba has a much more efficient system) and moved on to the more local challenges we are facing with Amy’s cancer and its treatment.

I first became aware of the issue in the early 1990s, when Consumer Reports published a series of articles about single payer health care systems, which highlighted the inefficiencies in our market-based system (at the time, citing 15-20% administrative overhead, due to the complexities created by myriad insurance companies, plans, forms, etc.; a recent report now estimates this overhead to be 31% ) compared with the single-payer health plans enjoyed by all citizens in most other industrialized nations … as well as the elderly population in this country (Medicare has an administrative overhead closer to 4%, though that will increase with the recent Medicare drug bill, which funnels money through private insurers and even the AARP, which was originally founded as an insurance company, and opposed the original legislation to create Medicare, and yet will receive a 4% piece of the action).

Anyhow, in the discussion, I claimed that people in other industrialized countries were generally happier with their systems of health care than people in this country, but didn’t have any specific statistics to cite.  This morning I tracked down a recent study that supports this claim (with statistics), and which concludes:

Across multiple dimensions of care, the United States stands out for its relatively poor performance.With the exception of preventive measures, the U.S. primary care system ranked either last or significantly lower than the leaders on almost all dimensions of patient-centered care: access, coordination, and physician-patient experiences. These findings stand in stark contrast to U.S. spending rates that outstrip those of the rest of the world. The performance in other countries indicates that it is possible to do better. However, moving to a higher-performing health care system is likely to require system redesign and innovative policies.

My friend, who is an independent businessman, is very satisfied with our health care system … or I suppose I should say his health care system, since there really isn’t a single health care "system" in this country.  His health care system is supported through his wife’s employer, HP.  Amy and I are also satisfied with our health care system, as we are taking advantage of the COBRA plan provided through my former employer, Intel.  In general, I imagine that wealthy people, and people employed by large companies or any government institutions, are very satisfied with their health care systems.  However, I expect that those who are not in those categories — the uninsured and underinsured — are not satisfied with their health care systems. 

I find this particularly disheartening In a country that purportedly encourages innovation and an entrepreneurial spirit.  If I continue down the entrepreneurial path beyond the 18-month window of health coverage provided by COBRA — which is expensive but at least non-revocable — I will be risking not only my career and livelihood, but may also be risking the health — and indeed, the life — of my family members.  I wonder whether / how other entrepreneurs who have family members with significant health issues, and who do not have a spouse who is employed by the government or a large company, manage this risk.

[Update, 2005-09-09:] Liz Lawley posted a "must read" link to an excellent New Yorker article on The Moral Hazard Myth, by Malcolm Gladwell.  Here’s an excerpt:

The U. S. health-care system, according to “Uninsured in America,” has created a group of people who increasingly look different from others and suffer in ways that others do not. The leading cause of personal bankruptcy in the United States is unpaid medical bills. Half of the uninsured owe money to hospitals, and a third are being pursued by collection agencies. Children without health insurance are less likely to receive medical attention for serious injuries, for recurrent ear infections, or for asthma. Lung-cancer patients without insurance are less likely to receive surgery, chemotherapy, or radiation treatment. Heart-attack victims without health insurance are less likely to receive angioplasty. People with pneumonia who don’t have health insurance are less likely to receive X rays or consultations. The death rate in any given year for someone without health insurance is twenty-five per cent higher than for someone with insur-ance. Because the uninsured are sicker than the rest of us, they can’t get better jobs, and because they can’t get better jobs they can’t afford health insurance, and because they can’t afford health insurance they get even sicker.