Trent’s written about the hullabaloo that VA diabetes care is better than HMO care, and links to Marginal Revolution’s quotes on health care , claiming the US’s dollars are “more productive” than the UK’s or Germany’s. In effect, each dollar we spend goes further to improving our health.

This analysis can only be true if we ignore the 44 million uninsured, and the money we spend on their health “care;” I have a hard time believing the ER “health care” many uninsured get as a last resort is “productive” or a good use of our resources. I’ve got my own study from the Commonwealth Foundation , and while it’s more qualitative, it presents a very different picture. (It’s also trying to present the patient perspective, instead of an overall systemic analysis.) Bits from the summary:

Patient Safety: U.S. Ranked Last
* Highest reports of medication errors (re-ceiving the wrong medication or dose over the past two years).
* Most likely to say a medical mistake was made in their treatment.

Patient-Centered Care: U.S. Ranked Second-to-Last
* Ranked last (tied with the U.K.) on physicians spending enough time with patients.
* Last on physicians listening carefully to patients’ health concerns.

Timeliness: U.S. Ranked Third
* Best on hospital admission waiting times.
* Next to last on waiting five days or more for physician appointment when last needed medical attention.

Efficiency: U.S. Ranked Last
* Last on being sent for du-plicate tests by different health care professionals.
* Worst on not having medical records or test results reach doctor’s office in time for appointment.

Effectiveness: U.S. Tied for Last
* Last in patients not getting a recommended test, treatment, or follow-up due to cost.
* Last in patients not filling a prescription due to cost.

Equity: U.S. Ranked Last for Lower-Income Patients
* Worst on patients having problems paying medical bills.
* Worst on patients being unable to get care where they live.

We’re great at getting people in the OR for elective surgeries in this country–and that’s really excellent. Lord knows I wanted my tonsils out as soon as possible, after 3 successive throat infections 2 years ago. But, as I’ve written before , the most effective of treatments–procedures or pharmaceuticals–are rendered *completely ineffective* if patients are not able to afford them or have access to them.

From the end of the report:

bq. The U.S. had the greatest percentage-point disparities by income for each measure and, as a result, ranked a clear last on all measures of equity. Moreover, 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, not filling a prescription, or not seeing a dentist when needed due to costs. On all of these indicators, one-third or more of lower-income adults in the U.S. said they went without needed care due to costs in the past year. Americans with below-average incomes also were more likely to report difficulty getting care because of where they lived and more likely to say it is extremely or very difficult to get specialist care when needed. Even among the higher-income population, U.S. respondents often were more likely than their counterparts in other countries to report difficulty obtaining needed care due to costs.

Oh, and just so we’re clear: I’ve never advocated for “nationalized health care.” I advocate for national health _insurance_. Totally different things.

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