The Commonwealth Fund is run by radical ideologues who believe the government should run everything. It is funded by ideologues, run by ideologues and so it produces ideology-driven research. Every piece of research it ever puts out is slanted to justify a complete government takeover of the health system. It is all also complete garbage, methodologically putrid. About once a year they put out a supposed comparison of the U.S. health system with those of other developed countries, most of which are government-run insurance and/or provider systems. Ask the British how well that is working out for them. This most recent international comparison report is the usual bilge water.
Ten countries, including the U.S., were compared on 70 measures in five areas: access to care, care processes, health outcomes, administrative efficiency and, you guessed it, health equity. The only thing that actually matters is health outcomes—if a system is working well, people will be in good health and the treatment of any diseases and conditions they have will have good results. The measures used by this group of single-payer advocates were of course selected to make the U.S. look as bad as possible. And once you do that, you can find that most of the other countries are close on the measures selected, but the “only clear outlier is the U.S., where health system performance is dramatically lower.”
The “research” relies in large part on surveys of patients and providers. Those won’t tell you much of anything about those all-important health outcomes. It is absurd to rank the U.S. 10th on health outcomes, 10th on access to care, and 9th on administrative efficiency, as this report does. The United Kingdom is ranked 2nd on access to care and has waiting lists for almost every service that extend for months or years, as do several other government-run health services, including our neighbor to the north, Canada. Certain treatments that are covered in the U.S. are routinely denied in other countries because they are too expensive. The report doesn’t even consider these widely reported facts in its analysis.
The U.S. does well on care processes but not on actual health outcomes? That is supremely illogical, until you look at the outcome measures. Not one of those measures actually relates to the results of being treated for a particular disease or condition. Instead, items that relate largely to public health efforts, like infant mortality and life expectancy, are used to define outcomes. What do you think patients care most about—those items or how successfully their health issues are treated?
Here is the truth about the U.S. health system—it is exceptional, far and away the best in the world, at diagnosing and treating disease. Those who can afford it come from all over the world to be treated here. Another truth is that our population is terribly unhealthy and engages in extremely bad health behaviors. We smoke too much, drink too much, take too many drugs, shoot and stab each other, overeat and get fat, don’t exercise and on and on. We have to endure woke pro(re)gressivism that makes everyone simultaneously anxious, depressed and mentally ill. And then when we do have health issues, lots of us fail to see the doctor regularly or stick to prescribed treatments. If you don’t adjust your measures for all manner of demographic, socio-economic, health status and health behavior variables, you are doing a bullshit analysis. Voila—the Commonwealth Fund work.
Despite the obvious fact that we as a nation are in poor health and disease ridden because of a lack of personal responsibility for health and health behaviors, the Commonwealth Fund doesn’t mention this critical factor once, much less suggest the equally obvious solution—we need to incent good health behaviors and punish poor ones. It is just that simple—engage in poor health behaviors, you pay more for health insurance and health care. Engage in good health behaviors, you pay less.
The U.S. system is expensive. I have explained why before. We pay our providers a lot more than other countries do. Want to pay them less? Think that will help quality and health outcomes? We also pay our non-profit health system and health plan executives and managers a lot and let them waste money on marketing and fancy buildings. It is disgraceful for non-profit, tax-exempt institutions to do this and it should immediately be legislated out of existence. We have a patent system that allows drug companies to make grotesque profits on drugs that are sold for far less, but still at a profit, everywhere else. We should reverse the consolidation in and among the provider and health plan sectors that has eliminated competition on price or quality.
And government, of course does its part, with excessive and ridiculously useless laws and rules that drive up administrative costs with zero benefit. The public health part of the health system is a government responsibility—and that is the worst performing part of the U.S. health care system. The federal, state and local governments are supposed to create an environment in which people engage in healthy behaviors. They have completely failed. That is government at work, and this is who the Commonwealth Fund wants to take over the entire system.
If you are sick, the U.S. is where you want to be; where you will get the best treatment. And if we want to get healthier, it is as simple as re-instating that long-lost value of personal responsibility. Want to make the system less expensive? Eliminate obvious excessive cost drivers. But the vested interests spend a lot of money on campaign contributions and lobbying so don’t expect it to change any time soon.
Kevin Roche runs The Healthy Skeptic, a website about the health care system, and has many years of experience working in the health care industry. If you have health care-related questions, you can contact Kevin at xuebpur@urnygul-fxrcgvp.pbz and he may answer the question in a column.
Read more from Kevin Roche at his website: healthy-skeptic.com
Kevin Roche
Kevin Roche runs The Healthy Skeptic, a website about the health care system, and has many years of experience working in the health care industry.
