The Many Myths Of European Health Care

The New Republic: Statistics Show That Arguments Against Universal Coverage Are Weak

(The New Republic)  This column was written by Jonathan Cohn.

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You hear it over and over again, in casual conversation and in serious debates among experts: If we create universal health insurance here in the U.S., then we'll end up with less responsive, less advanced medical care. Few arguments have done as much political damage to the cause of universal health care. And, as wonks like me have been arguing in recent months, few arguments fall apart more quickly under scrutiny.

After all, if universal health insurance means long queues for treatments, then why aren't patients in Paris or Hamburg waiting months for routine services — while patients in Boston and Los Angeles are?

If it means getting rushed, impersonal treatment, then why do France and Germany give new mothers more than four days to recover in the hospital, while insurance companies in the U.S. push new mothers out before two?

If it means making do with less advanced technology, then why does Japan have more CT and MRI scanners per person than we do?

And if it means worse health care overall, then why do so many studies show the U.S. scoring so poorly on international comparisons, including those examining "mortality amenable to health care" — a statistic devised specifically to test the quality of different health care systems across the globe?

Still, there's one part of this argument that hasn't been quite so easy to rebut. It's the suggestion that countries with universal health insurance lag in one crucial area of care: "high-end" treatment. As the argument goes, all of those general statistics comparing national health care performance are interesting but ultimately insignificant. What we should really care about, these critics of universal coverage say, is how well each country does at taking care of people with the most serious diseases — particularly cancer.

It's tougher to rebut this claim on the merits because, in at least some respects, the U.S. really does seem to be a world leader in curing cancer. And it's a powerful argument politically because cancer is such a truly frightening disease. But it's one thing to say the U.S. is one of the best countries in the world for curing cancer. It's quite another to say the U.S. is unambiguously the best of all — and that government interference keeps other countries from keeping up with us. It's the latter set of claims that the opponents of universal health insurance, particularly on the right, love to make. And, thanks to a new study, there's good reason to think they are wrong.

The study, from April's edition of the Annals of Oncology, comes from Swedish researchers Bengt Jonsson and Nils Wilking. It begins with a premise about the nature of cancer care: Recent advances in survival rates, the two researchers say, have a lot to do with the development and use of new drugs. So if you want to see how well a country is treating its cancer patients, they suggest, one good test is to measure how quickly that nation approves the latest treatments and gets them out to people that might benefit from them.

The rest of the paper reveals the result of that test. And, if you only glanced at it quickly, you might think it validates the conservative worldview — since, compared to Europe as a whole, the U.S. indeed delivers new drugs more quickly. Such a thought process seems to have gone through the head of Paul Howard of the Manhattan Institute, when he cited the Jonsson-Wilking study in a washingtonpost.com article championing the U.S. health care system last week.

But wait a minute. That comparison is between the U.S. and Europe as a whole — including countries like the United Kingdom, which, because of their extremely low spending levels, restrict the availability of new equipment and treatments pretty rigorously, and former Eastern Bloc nations like Poland, which remain technologically behind the rest of the continent.

If you really want to know how universal health insurance per se affects the diffusion of cancer drugs, a much more logical comparison would be between the U.S. and some of the countries that more closely resemble us in terms of economic development — and that don't spend quite so little money on their own medical care systems. And guess what happens if you do that? A very different picture emerges: We may be atop the world when it comes to getting new cancer drugs to our patients, but we're hardly alone on that perch. Three other countries — Austria, France and Switzerland — are right there with us.

I'm still looking into the details of Austria's system, but if you know anything about the health care systems of France and Switzerland, it's easy to see why this might be the case. Although those two countries have markedly different insurance systems — France's is much closer to a government-run, single-payer system than Switzerland's, which relies more on private insurance — both spend more than their European counterparts (but still less than the U.S.) to guarantee patient convenience and access to cutting-edge care. France, in particular, has an abundance of cancer radiation equipment — more even than the U.S., according to Victor Rodwin of New York University.

Admittedly, the paper is vague on one key point: It doesn't indicate whether, among those four world leaders, the U.S. stands out as the best. If it did, the argument against universal health care might still have some small merit. Fortunately, Jonsson and Wilking have e-mail addresses. And they were kind enough to respond when I contacted them. "Overall," I asked, "was one country significantly and consistently better than the other three?" Wilking's response: "Not really."

Does this settle the question of which country has the best cancer care? Hardly. Measuring the success of treatments for serious disease is inherently complicated and ambiguous. As conservatives rightly point out, the U.S. really does seem to have the highest cure rate for some cancers — including breast and prostate cancers. But it's not at all clear these figures reflect the nature of insurance here in the U.S.

It's possible — indeed, many experts would say more likely — that those statistics ultimately reflect a cultural preference for aggressive treatment, sometimes to the point of over-treatment. That seems particularly true of prostate cancer, given mounting evidence that many patients receiving treatments — which come with serious side-effects — actually have slow-developing tumors that don't really threaten them. (In other words, they'd die of something else long before the cancer gets them.)

Also, it's not as if the U.S. is the leader at treating every cancer. The Swedes — among others — are better at cervical and ovarian cancer. The French have superior numbers on stomach cancer, Hodgkins disease, and non-Hodgkins lymphoma.

And this is consistent with other new evidence, dispelling the myth that Americans get more high-tech, advanced care than their counterparts across the world. Earlier this year, a report by McKinsey & Company — which nobody would mistake for a communist front — showed that while Americans get the most knee replacements per person over 65, Germans get the most hip replacements. (Besides, as Paul Krugman recently noted in his New York Times column, here in the U.S., Medicare pays for the majority of hip replacements. Medicare is one of those dreaded government-run programs, so it's not clear why the hip replacement example would validate conservative faith in private insurance.)

Truth be told, if you really care about which country has the best health care system, you may have to answer a far more complicated question — namely, whether paying for the newest treatments, which are frequently the most expensive, is really the best way to spend money on health care. Some would argue that it makes more sense to spend that money on other treatments, like preventative care, that yield much greater improvements in health at much lower cost. This seems to be what countries like England, among the lowest-spending countries around, are trying to do. (For more on new cancer drugs, and exactly what benefits they yield, I highly recommend Merrill Goozner's "The $800 Million Pill.")

Still, that particular question — whether countries should invest so heavily for what may be marginal extensions of health — is an ultimately philosophical one. This issue of universal health care and how it affects cancer drugs, on the other hand, is strictly empirical. And thanks to this new study from the Swedish researchers, we can answer it a little more definitively than before — with the arguments against universal health looking even less convincing than before.

[improveamerica]

One thing I'm tired of seeing the American news media propagating is how slow or crowded other health care countries are. BUT I never have seen a picture of this problem. When is the last time you saw such picture displayed by the media? I expect never. Yet media risk their lives in the battle field with bullets zipping over their heads about how dangerous it is to be there but they can't walk into allied country's hospital lobby and show how "crowded" it is? If they can't show it then that's Hollywood news.

I have been to Spain (ranked 7th in health care) and they are well fitted to taking care of their patients. Here in the states I have to wait an hour for a doctor and then another hour in a room. Two hours wasted. In Spain, few minutes in, and in a few minutes out. No bills, nothing. There are taxes of course, but my girlfriend who lives in Spain pays only 2% in taxes.

Immigrants came to America to leave oppression. I might move to Spain to leave the American oppression until it wakes up.

Do I endorse the coming US Health Care plan? No. Why? Because it is not evening implementing European health care. It is going to be a waste here in the States. Why? Because we vote in a one party system (DemRep party). We vote in corruption because we are told by the "experts" that that is the only option. That option has equated into a continuous growing multi-trillion dollar debt; our jobs leaving the US; Dollar value now 1.60 to one euro; currently American soldiers are dying in foreign countries; unemployment growing; The average American college debt has grown to $20,000. College tuition in Spain for one degree is easily under $10,000. Looking at the US economic system it is being stained and it is to get worse supposedly before it gets better. I do not know how it's supposed to get better for the American people when less than the top 1% of the wealthy few already own 95% of this country's wealth.

Continue voting for the Dem/Rep to see all your rights and possibility of a real health care system be removed from you.

Vote for a party or someone who believes in what you believe in and will follow through and if they don't then keep voting for someone who will. Don't be stuck with servants who swindle America and foot you with the bail out bill. Talk about a scam that media won't even invest time in investigating like "Your Money Matters."

[i2care4usa]

okay, once again, HEALTHCARE, is the topic. If you read my comment, it clearly states, "amoung many other things here in America are in America because of people, and not all the people are Americans"... America because of people!!!! GET IT, NOW? I never once stated anything about RACIAL issues!!!! DON'T be IGNORANT!! But its people like you that take a topic of any kind, and turn it into a RACIAL issue. Healthcare, here in America, which most agree, need improvement, but not Governement take over. Yes, America was founded on many people coming together, helping one another, doing for one another, the "GOLDEN RULE"! But over the years, we have been told by our Government to take this out, add this in, take this out, add this in, and look at our United States!!!! It is DIVIDED!!!! If the Government is over the Veterans Hospital, and its so poorly ran, The Veterans that died, or that has fought for our freedom, what do you think is going to happen when Government takes over all healtcare? HUMMMMMMM!!!!

So again, as I stated before, "So before you want to correct our damaged America, lets first get back to the basics, because that is really what this boils down to, right? If we didn't allow free healthcare, food, housing, college, loans, so "FREELY" then we would NOT have to fix most things in America." I am an AMERICAN, yes, my blood runs through many different lines of all backgrounds! ITS HEALTHCARE, THAT IS THE TOPIC!!!

As an American, I pay taxes, I pay for food, housing, college, along with millions of others. But, if I was not a tax paying citizen, but in America, THE UNITED STATES, I would still get "free" food, housing, college, and HEALTHCARE, while along not having to abide by all the American RULES, like paying taxes, obeying the law, that American CITIZENS living here all the time have to do!!!! So, while I work, pay taxes, and other people from all over that is not considered a legal citizen, gets free food, housing, college, and HEALTHCARE, yes, I have a big issue with that!!!!!

HEALTHCARE, in regards to speaking your opinions on matters, because they involve my family, well, HEALTHCARE, involves everyone's family!!! YESTERDAY, TODAY, AND TOMORROW!!! So get over your RACIAL views, and get educated on the HEALTHCARE system that the government will do no good at taking over. THAT IS THE TOPIC!!!!!

[bazzerk]

It's strange how ones comments (monkfellow) can turn a debate from one topic to the next! In each of your googles regarding 'Euthanasia in Europe', did you notice that most countries in Europe do not advocate this policy? It is wrong to mask the entire European Union as one which provides euthanasia to the entire population of Europe! Also has anyone ever mentioned that you should take some of the things you read on the World Wide Web as FACT! Anybody can write what they want and then leave you believing it to be FACT! Did you know that 'Wiki' that beloved online encyclopedia is not allowed to be used as an official source of information in education?

Is it not true that the state of Oregon provides Euthanasia too? If this is still the case how can you mention Europe and not mention the state of Oregon, a U.S state. Just like states within the U.S, European countries are allowed to vote upon laws for their country, its called democracy. You may not realise it but some of these countries are not primarily christian countries (its a shame though)a factor that does play a part when creating and voting upon laws for that country.

As you may have gathered I am originally from Europe, but now live in the U.S, my wife is an American lady. I can assure you that some of the stories you hear about the European healthcare systems are mostly scare stories to be quite frank. Some may react and say why dont you go back to Europe, well I am not goin to do that because this is where my home is and where my family are. All I want is for my wife and children to receive healthcare that they need, and not to be wondering each time whether or not an injury or illness needs hospital treatment!

Take a look at official figure provided by the World Health Organization (WHO) and see where the U.S is ranked in the world! We spend more on our healthcare per person every year yet we are ranked down in 37th place! For those who are wondering who 'WHO' are, well they deal with all the health issues in the United Nations. They are not some dodgy website whose figures are not to be taken seriously.

Another point I would like to make is regarding hospitals within Europe. While countries provide a national healthcare to their citizens, there are also private companies that provide private healthcare to individuals who wish to pay for it. The entire healthcare system is not national healthcare system it has options, something that I have not seen being mentioned by anyone.

[cmankey777]

If the author likes it so much mabye he should move there. A friend of mine recovering from a major car accident in England. He was infected with a nasty virus that took him months to get over,

My mother had hip surgery in a american hospital. She too got a bad case of strep in the surgical areas of the hip. She didn't take months to recover because she DIED.

[usbrit-2009]

Hober Mallow - does your sis-in-law have any idea how much 4 doctor's appointments will cost in this country? $300 - $500. God forbid if there's anything wrong.

Having been under the tender care of both the UK and US systems I have to say that there must be a happy medium. I had a similar kidney operation under both regimes. The first in GB in 1974; two weeks in hospital, 14-person ward with 1 TV set, no electric beds, good follow-up, no further probs, $0. Second 1981 US (L.A. Cedar Sinai) 1 week, private room personal TV, bed that would do anything at the press of a button, good follow-up, no further probs, $13,000 out of pocket (inc. $5 for a cup of water!!). Now there are better hospitals in GB and cheaper ones over here than LACS but over all, the fact that your average street person in GB can afford healthcare while they can't over here would suggest the GB/Europe system is fairer if not much better.

[©APPLE©]

And when your taxes come, please have 15 thousand on hand. The government is highly inefficient and are incapable of doing things cheaply(almost every branch...the Armed Forces do not have this problem as much).

[hober_mallow]

I don't think we'd be too happy with the English style of universal health care.

I recently visited my sis-in-law in England, along with her husband and two small children. She was none to happy with the state of the English health care system.

Once you get INTO the system for a particular ailment, it works pretty well.

Getting INTO the system for a condition is tedious and takes a long time.

My sis-in-law is planning a vacation back to the U.S. this summer. For each of her children, and herself and hubby, she's made doctor's appointments and a list of things to have checked.

If English health care was all that good, then my sis-in-law wouldn't be needing to do that.

[huanaco]

THERE IS A MISUNDERSTANDING ABOUT THE WORD " SOCIALIZED MEDICINE ". IT DIESN,T MEAN A LEFTIST TENDENCY . IT MEANS SOCIETY , SO DON,T GET SCARE ABOUT THIS WORD THAT IN HEALTH TEND TO COVER EVERYBODY WITHOUT HIGH COST. I RETIRED IN CHILE,SOUTH AMERICA, HERE THE SYSTEM IS PUBLIC WHICH COVER 75% OF THE PEOPLE AND PRIVATE FOR THE REST. THOSE WHO DON,T HAVE THE MEANS QUALIFY FOR SPECIAL CARD. ALL BEGIN AT COMUNITY MEDICAL CENTERS, IF THE PROBLEM IS SERIOUS, SPECIALISTS. NEXT STEP , HOSPITALS . AS A RESIDENT I PAID THE AMOUNT 40 BUCKS EVERY OTHER MONTH , IF THIS LITTLE COUNTRY COULD DO IT WHY DON,T WE DO IN THE RICHEST COUNTRY IN THE WORLD ?

[alaprst]

God forbid if the author of this piece gets hit by a medical bill that costs him tehs of thousands of dollars that he can't pay because the United States is the only industrialized country in the world that doesn't provide health insurance for all its citizens. All his claims are nothing more than sorry excuses to keep the same old, morally irresponsible, and fatally flawed for profit health insurance system we've had that the insurance and pharmacertical companies (along with the Republican party and the Bush White House) want to preserve. It's time we had a system that put people first and the profits of insurance and pharmaceutical companies dead last.

[annefrank10]

I've never met a Republican willing to opt out of Medicare. Have you?

[annefrank10]

We already have socialized police and fire departments that freely respond without requiring a fee because it's in the community's best interest.
A healthy populace is also in the community's best interest. Most bankruptcies are due to medical bills - not shopping at the mall as rightwingers would have us believe.

John Edwards has the most viable health care plan - www.JohnEdwards.com/issues/health-care - and has fought for the little guys and WON! against the powerful Insurance and Pharma industries - CORPORATE sponsors of the CORPORATE media.
Oh and btw - Hillary spent $3,000 in campaign funds for 2 hairdos (per WaPo) - and Romney spends $300 for haircuts (Politico).

[©APPLE©]

"Most bankruptcies are due to medical bills - not shopping at the mall as rightwingers would have us believe."
I have many friends who have just been shoved out of their "nests" and due to excessive spending habits, are now well over 10k in debt. What did you say again?

[taxguydave]

I wonder how many of these critics of "socialized medicine" are going to pass on their Medicare benefits when they reach the age of eligibility.

We already have "socialized medicine", and it provides quality care at lower cost. It just isn't available to everyone, even though it could be made so fairly easily.

[mango30518]

Just another move to make us the United Democratic Socialist States od America.

[©APPLE©]

As long as our country is called United States of America, I will continue to resist any change to centralize Government! Notice even the name speaks out against socialism! We were designed to be a loosely bonded group of states with only 3 branches of government and a army(not including a militia operated by THE PEOPLE!-in case the government decides to "act up" as we see today)

[terrapin78]

It is widely known that the future debt obligations of the federal government's entitlement programs (Medicare, Medicaid, Social Security) are upwards of $50-75 TRILLION, and these programs will likely bankrupt the country sometime in the not-too-distant future.
Posted by JT_Lancer at 11:19 PM : Jul 29, 2007

You don't mention the Bu$h war of choice in Iraq is costing us $10 billion/month. As is everything Bu$h has done. It is all damaging the long-term prospects of the US.

[©APPLE©]

and id rather pay that much more in taxes then have my head shot off by an invading muslim jihadist army!

[l8c6]

monkfellow: "If you want to know greed and power, just wait until"government funded" healthcare comes about and the small army of lobbyists for all sorts of health care consultants and pharmaceuticals and hospitals are lined up outside the doors of CHS and congressmen."

I'll tell you what happens, we the people should have a stronger voice instead of this privatizing BS which is weakening representative government and replacing it with increasingly concentrated pockets of ruling wealth. The U.S. wasn't meant to be sold to the highest bidder. The Saudi Royals are kept in power because in that world he who holds the gold rules...that's what many with money and power want in this country...welcome new world order, old european world order warmed over.

[l8c6]

monkfellow: "If you want to know greed and power, just wait until"government funded" healthcare comes about and the small army of lobbyists for all sorts of health care consultants and pharmaceuticals and hospitals are lined up outside the doors of CHS and congressmen."

I'll tell you what happens, we the people should have a stronger voice instead of this privatizing BS which is weakening representative government and replacing it with increasingly concentrated pockets of ruling wealth. The U.S. wasn't meant to be sold to the highest bidder. The Saudi Royals are kept in power because in that world he who holds the gold rules...that's what many with money and power want in this country...welcome new world order, old european world order warmed over.

[sjc_1]

I think it is a really good idea to get the facts on a topic as important as this one. If other countries have done a better job and at least some of what they have done could be applied to this country with favorable results, then it deserves our attention.

But the money/power structure does not want anyone to think in these terms. The oil industry might be $1 trillion dollars per year in revenue, BUT the so called health care industry if over $2 trillion dollars per year in gross annual revenue.

That is a pot of gold WAY too big to give up and they will not do so if they do not have to and so far, they do not have to.

[briannorwood]

Socialized medicine? I'm scared! What will they want to socialize next? Social Security?

[©APPLE©]

No. Your workplace. They will rip your check in half and give it to that janitor who works half as much time. You won't own a car, house, or computer. That will be "timeshared" out for everyones use.

[mike71067]

This can't possible be true! If it were, Michael Moore would certainly have put it in his "documentary". Right?

[Ed0719]

It doesn't take long for people like monkfellow to start spouting the myths against "socialized medicine". Sorry, monk, but the typical Faux News tactic of repeating a lie over and over and over in order to make it seem true just doesn't work anymore.

Quality healthcare is something that EVERYONE deserves, not just those who can afford it. Anything less is simply inhumane and cruel. Other countries have done it, and do it much less expensively than our current system. The only thing keeping the USA from implementing a working universal system are the industry lobbyists pressure and constant FUD.

[adian1-2009]

The problem is a cultural problem. Here we worship money and profit. That is what we are taught from kinder on. So, why not think of health as another object to trade with and make money? Europe goes on a different path. Children there, even in England, are taught about social duties. Money there --big corporations-- doesn't have as great an influence in what politicians must do if they want to extend their tenures. Here they better keep things the way they are or they risk not returning to congress, etc. And we are the best in marketing. That brings the false impression that medicine here is the best. That is simply not true.