What experts say about who has the world’s best health-care system | Opinion
– I want to start
with a simple question. Which country in the world
has the best health care system? – Yeah, so,
I hate that question. Here’s where you should ask me
why I hate that question. – I knew you were gonna start
with that question. I think it’s a question
that a lot of people ask — which country has
the best health care system? – I don’t think there’s
a correct answer to it. – It depends on what it is
that we value. – I’ll give you an answer,
but then I’ll tell you why the answer
might not be applicable. If you look at the world
health rankings, the country that
came out on top is France. I think, in general,
starting from France and working northern, you tend to get
the best health care systems. But the reason why it’s not
entirely applicable is that what works
in one country may not work in another country. – So, just a few years ago, I wrote a piece
in “The New York Times” with my colleague,
Aaron Carroll. We actually did a tournament
of health systems. It was like a bracket tournament
the way March Madness
is a bracket tournament, or a tennis tournament. And we had me and Aaron,
Uwe Reinhardt, Ashish Jha — a physician,
now Dean of Brown — and Craig Garthwaite —
an economist at Northwestern. And we each voted
in each of the brackets — in each of the pairings — for which system
we liked better. And we ultimately got a winner,
but one of the important take-aways
from that whole process is that in no pairing
did any country win 5 to 0. There were five of us, right? We were not unanimous
in any decision. There was always at least
someone who disagreed, and in many cases,
it was 3 to 2. And we each had
different reasons. Someone was very big
on the cost, equity, access, or the quality. Look, this is five people
who know health care pretty well and know these systems
pretty well, and we couldn’t even agree. So, there’s just no
clear winner, actually. – But the one thing
that stands out is that among all major developed nations,
it’s pretty clear that the United States
comes in dead last. – On the other hand,
I think everyone — especially experts — should be skeptical
that they know “the” answer. Because what works in
one country or one setting doesn’t necessarily
work in another. – So, there are aspects
of the Australian system I like. There are aspects
of the English system I like. But I don’t think that
there’s a system we could just bring over here
and install like a new fridge. – So, maybe the better
question is, what would the best system
for the US look like? – And what would that look like? – So, a good health care system
or a good — Yeah, let’s just call it
a health care system. A good health care system has,
to me, several attributes. One is — -How does it affect our health
as a country? – How long is it that people
are living? What is the infant
mortality rate? What is the rate
of certain types of diseases, and how well are they doing
in prevention? – And the second question
I’d want to know the answer to is, were the benefits
of the treatment greater than the cost of the treatment? – A bad health care system
could have overspending on care that’s of really questionable
health benefit at the same time that it has under-spending
on health care that’s of vital importance
to people. So, when people say, “Do we
spend too much on health care?” We spend way too much
on some things and way too little on others, so a good system
would fix both problems. – And the third dimension
for a health care system is, how well does it reflect
our values as a society? – And by values, I mean — What are the rich
willing to do for the poor? What are the healthy
willing to do for the sick? The answer to that doesn’t
come from economics. It’s an answer that
we all have within us. But that answer profoundly
effects how you answer questions about what’s good and bad
about health care. – And I would hope that,
going forward, as we think about the learnings
from other countries, we can take a hard look
at what it is that we have and whether they align
with our core principles that we otherwise hold so dear. – So, my goal is,
have a health system that does the most it can
to improve our health, that protects people
from financial ruin, and that conforms to our values
as a society. – So, yeah, that would be the
right thing to do in principle. The next question should be,
can we get there from here? And I just don’t see it. – What we’ve seen over time
is that the costs of health care have gone up,
but outcomes have also improved. So, if we take some measure —
and the measure that I like to use
is life expectancy at age 40 — and then I look on
the other axis at the cost of health care per person —
And what you find is, if you look back to 1976 —
-All of these countries — the US, Germany, Canada —
look similar in terms of what share of GDP
goes to health care. – And people are living about
35 years after age 40. Okay.
– Fast forward 20 years, and the US is spending a lot
more of its GDP on health care, and its life expectancy
increases have not kept up with the life expectancy
increases in other countries. – So, the US becomes
increasingly an outlier both in terms of outcomes — that is, life expectancy —
and in terms of spending. – Now, you can put the two
on the same graph, but that doesn’t mean
that they’re related in any way. I think we’re simplifying
the other health care system to the point
of getting it totally wrong. But a lot of it depends on
who you’re talking to, right? I think there’s a view
that some Americans have that, in other systems,
care is terrible. There’s very long waiting lines
and waiting lists; that the latest
medical technologies are routinely not available. I think for a lot of other
Americans, there’s this view
that other countries have just figured it out, and what we should be doing
in the United States is copying what
they’ve already figured out. And I think both those views
are not right at all. – So, I think people mix up
this term called “socialized medicine” with what I would call
“universal health care.” – One is the insurance part —
that is, who runs the insurance. And you can have socialized
insurance — where the government
is running the insurance or private insurance
or private companies, or both — and then, second, there’s
the providers of medical care, who could be either
government-run employees or private employees. – There are some methods
that one could classify as being socialized medicine, meaning that the government
is the single payer. The government operates
all the health care, and people belong to
a single government system. – So, Britain has socialized
medicine, because the hospitals
are government institutions, and the physicians and nurses
are government employees. – And France has yet a different
kind of a system, also not government-owned. And Switzerland, Netherlands,
Germany — these are places that have
universal health insurance, but they have active
and important private health insurance companies
that administer it. So, very different structures
of these systems. The thing that they share
in common is that they’re universal. –
So, I think, coming full circle, my great worry with health care
reform in America is that it has collapsed
to the level of fighting and arguing about these slogans, and the slogans have nothing
real behind them. – These slogans have become
so politically charged and tied to a particular candidate
or a particular viewpoint that has become
completely partisan and will shut down
constructive debate. – And if you go back to what
I was talking about — how do you evaluate
a good health care system — you don’t evaluate it by the share of government
in the system. You evaluate it
by whether patients want the care that they get and whether the care
the patients get is worth it. I think that other countries
have great hospitals, cover a lot
of medical treatments, have fantastic doctors. And at the same time,
they have not figured out a bunch of things
that we have not figured out. So, if you are the kind
of person who’s going
without health insurance in the United States —
-I hate to say it, but I think they are better off in many other countries
than here in the US. – But for a lot of diseases —
for a lot of people, regardless of income —
this is probably the country where you would like
to get your health care.
The U.S. health-care system is broken, but do other countries have it better? Seven leading health economists and public policy experts reflect on one of the hardest questions facing them — and us — today.
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46 Comments
The "experts" have spoken, so there you have it folks. After covid, these guys' opinions no longer prove credible.
A better question is “if other countries can do better than the US in caring for its citizens what is the US doing wrong”. Well firstly countries with good health care are socialist (to Americans communist) democracies and of course their public health care systems are not shareholder owned and profit driven.
The fundamental flaw in my view of the US healthcare system is that insurance is, for no logical reason (now), is distributed via employers and is not portable. Its also not usually available to non FTE employees, hence at lot of "part time" 35 hour a week jobs. This seems normal in the US, but I think its pretty unusual elsewhere and has created a piecemeal system that is impossible to change given the lobbying influence of insurance companies and the AMA.
Fun thing to do – ask an American if they would like to estimate how many cases there are of medical cost triggered bankruptcy per year in France or the UK.
Spoiler: in most European countries the answer is zero.
The USA should look at the Swiss system
Much talking in circles. Conclusion: Let's do nothing about this problem; we are smug Americans.
In the united states the only party that wins consistently is united healthcare 😂
Preventative treatment and free low cost prescriptions makes itself back ~10.000 times by removing the need for 97% of emergency surgeries, bankruptcies ect.
But long term savings lose out to chasing quarterly bonuses.
cof cof Brazil`s SUS cof cof
Hell no I wouldn’t go to the USA for healthcare! The lobbying on your healthcare is outrageous, for me it means that Americans a way too selfish to believe that it would be better for the majority.
Healthcare system in western countries is a joke compared to some Asian countries.
The US on average costs twice as much with worse health outcomes compared to pretty much every other developed country with some form of socialized or single payer healthcare.
And yet almost everyone single one of these "experts" won't come out and say the US system is a disaster.
There is no such thing as a perfect system if you don't move to what is clearly the better system you just prolong the suffering and codem more people to oovery and life long problems.
A very interesting video with about healthcare and as many answers as a cereal box has to offer us on quantum mechanics
Does KP still exist in California?
Some 25years ago when we looked at alternatives for the English Health Service it seemed an amazing system but for reasons outlined in this clip and a peculiarity of English Health Care where the nurses were Florence Nightingale (upper middle class and upper class) and Medical Doctors using the tradesmen’s entrance this didn’t come to pass.
I suspect that we will be treated by holograms pretty soon
What an absolute waste of time watching that video. Essentially nothing was said. Not a single real comparison. 🤷♂️
Thanks for the rational discussion.
Remember, folks.
Just because universal healthcare is a thing, doesn't necessarily mean that private insurance and healthcare don't exist. They just have to compete with the government run version. So, even if the government's system has stupidly long wait times, you still have the option to go private, and that private clinic may not charge as much as an American clinic, because they have to compete with the government. Even if they do, the alternative is for no one to have a choice but to go to the private clinics, as opposed to a government run one.
The US health care system is a disaster. It's all about money, profits and high salaries. It fails patients every day. I spent 40 years in the business. At almost 20% of GDP it is also a competitive issue since we spend at least twice as much as any other industrial country.
The question is, which system is worst? The USA may me better than say Rwanda, but maybe not.
I suspect that, had I lived in the USA, I would be bankrupt by now. I had a pulmonary embolism some years ago, which was fixed. Later, I had a quadruple heart bypass. 3 years ago, a tractor accident left me with a flail chest (most ribs broken, mostly in more than one place, punctured stomach, punctured lung, spleen removed, broken scapula and clavicle. I was in ICU for 2 months, and of course follow ups). Cost – well, I paid National Insurance contributions for all my working life, but otherwise nothing. The doctors and nurses were fantastic. The care was excellent. So grateful to the NHS.
What I never hear anyone point out is that private insurance is socialized medicine. It’s just done by a private company for a smaller population set than the govt would for the entire country. I also don’t know many people who are aware the Medicare and Medicaid are both run more efficiently than private insurance. Two of the large drivers of this are executive pay and shareholder dividends that have to be paid out of premiums.
There are so many important and nuanced observations in the video by earnest and well educated authorities. However, NOTHING will ever extricate that vast majority of human beings in this nation of my birth and residence, the USA, from constantly being MONETIZED IN THEIR MISERY RATHER THAN THEIR MISERY BEING MINIMIZED WITH HEALTHCARE. WIDESPREAD DISTRIBUTION OF ACTUAL HEALTHCARE WILL NEVER, EVER REPLACE THE CONSTANT CASHFLOW OF THE PROFITEERING HEALTH INSURANCE TRILLION DOLLAR INDUSTRY IN THE USA!
What a nothing of a presentation. So, the conclusion is a shoulder shrug? And not even a mention of Medicare expansion? What a load of nothing.
As somebody said in the video: it depends on the values you hold. In the USA, it seems to be money…but how does that work out? not paying results in having to pay more. Not paying results on people not able to get care, and therefore not able to get back to work. By allowing moeny to be siiphoned by rich insurance companies means the less well off become even less well off.
A good healthcare system ensures longer lives for ALL, with better quality of life for all. No, the financial intricacies behind this is the job of the government, and it is in the government's interest to be backing/looking for solutions which are price-worthy, while also leaving some funds for research. It is not easy, but governing is not easy. And of course, they need taxes.
The fact that some people might want to get their healthcare in the USA means they are badly informed or come from really badly served countries.
No health care system (HCS) imaginable can save people from themselves. If people do not want to live healthy, there is nothing a HCS can do to change that. You cannot judge a HCS by infant mortality if mothers are living a very unhealthy lifestyle. Trying to compare longevity among countries is not meaningful because different countries compute this statistic differently. For example, some countries do not count neonatal deaths within the first 24 hours. They are counted as miscarriages. A longevity of one day vs not even counting it as a death will wildly skew the statistics.
US doesn’t give a f*** about the well being of its population and now, a stronger proportion of the world population knows that. This is a big reason why we believe in Europe the American dream is scam. The US is a very hypocrit system, they ban abortion in the name of saving the newborn’s life but they don’t give a s*** for the lives and well being of the ones already here.
The arrogance of the final statement says a lot.
$500 for an asthma inhaler that costs $3-$7 in Philippines or Australia.
There isno way, in this political climate, for a debate to not turn into two competing partisan slogans
You cannot just look at the actual level of treatment, but also to the availability regardless of how much money a person has.
If you look at it that way, you'll clearly see that about every country in NW Europe has a better healthcare system than the US.
Also preventing people from getting ill, is part of healthcare and looking at the lvl of obesity in the US, prevention is not high on the list in the US.
Donald Trump adds this to the debate:
“Experts!? What do they know.”
It's obvious none of those people has lived in Europe and needed medical attention.
from what I understand, a significant part of America's healthcare spending does not go directly to healthcare but to administrative work. Significantly more so than in other countries. The amount of time doctors have to fight with insurance companies to get treatments approved, for example. Correct me if I'm wrong.
People only really know their own systems and due to negativity bias always think the grass is greener elsewhere.
What doesn't work in the United States won't work anywhere. Ask Australia. Australia had the genius idea to copy the U.S. healthcare model and they are reaping the problems it creates.
The editing here is very strange. I would have loved to hear these experts actually given the opportunity to go into detail about what policies they want America to implement or at least try. The way this was edited, all we really get is a vague sense of "American healthcare is weird and probably bad…but we can't say anything about what good healthcare policy is! Maybe American healthcare is good actually, but we can't tell you why! Good healthcare is when people have good health!" I'm pretty sure any of these experts would be easily able to say more than that.
When you cannot make a decision, your decision making process is flawed. They went on to discuss the criterion. Why would you not simply score the criterion for each country and rank it accordingly?
Correct me if I’m wrong but not one of them talked about access to healthcare.
There are three fundamental thing a government needs to achieve for a country to progress and successfully prosper. 1 A well educated society 2 A healthy society both physical and mentally. 3 Be able to protect that society from threats.
I'd then ask, Best for whom and why?
The US health care is the best, the best for insurers and hospitals because they profit the most from it, by far than any other country.
As for patients, I think that might depend on a lot of factors, and yea, culture, prevention, etc do play a part.
As far research on health topics, I think the US probably wins there, at least…until now.
Mr Chandra believes the US is the country most folks would prefer to receive treatment in. I totally disagree. My total cost so far, in the UK and France is around $500. For a stent, 2 angiograms, 4 days in hospital. Private room. What would that have cost me in the USA?
Having heart disease I had an angiogram and received a Stent in the UK, where the technology in the theatre was absolutely leading edge, many years in advance of the technology in the French hospital where I had a further angiogram 8 years later. However the care I received in both the UK and France was absolutely top quality. Also FYI the UK has private hospitals as well as the Government owned ones. Plus many UK hospitals are now owned by facilites providers, not the UK Govt. In terms of equipment, it depends on the hospital you happen to arrive at, both in the UK and France. In terms of knowledge and care, however, both countries are excellent. And more to the point, free at the point of use, and affordable for those parts that are charged for later. I don't believe I could have afforded to have 2 angiograms and a stent in the USA.
Look there is a MAJOR factor to all of those talks. It's obesity rate. In France its super low for one of the most developed countries.
They can spend a lot less money if they dont have so much cardiac patients.
For countries that view access to healthcare as a basic human right, the most meaningful question is "How do we make sure that our citizens and residents recieve an acceptable level of quality (as measured by a combination of outcomes and satisfaction levels), at an acceptable price?
The United States views access to healthcare as a privilege rather than a right, so the most meaningful question for those in the private financing loop has become "How can we extract as much revenue as possible from all who need or who expect to need care, while providing a standard of care that is acceptable to those who are shouldering the cost burden?"
Viewing it as a privilege rather than a right radically reduces any motivation to try to cover those who are unable to pay, or unable to get coverage due to unemployment or previous conditions. It also shifts focus to outcomes for those covered, while minimizing attention paid to outcomes for those not covered. Another painful reality is that it places overwhelming cost burdens on individuals that could be much more easily borne by universal coverage, but it does so without lowering overall or per-capita costs.
The result, as shown in this video, is that the US pays significantly more for healthcare on a per-capita basis, but covers a lower percentage of its citizens and residents than other countries, with meaningfully lower levels of quality as measured both by outcomes and satisfaction levels. It also makes citizens and residents of the US more subject to bankruptcy due to health care costs than those of any other developed nation.
It seems ironic to me that those in the US who claim to be fiscally conservative are the biggest advocates of a system that provides less value for money than any other system on earth.
I’m not impressed with these experts. They look like priviliged people with healtcare insurance who have no experence with how a working healthcare system really works and feels
Erica s are too greedy, self centred and money oriented to actually have a constructive national debate on universal healthcare. The entity who shouts the loudest and/or has the most money wins out and people only have empathy for their own socio economic but not for their fellow Americans in general. They are just too much selfishness and lack of empathy in their society and that’s hard to change. Americans are hard wired to say “ I shouldn’t have to pay someone else’s healthcare” where the balance of the civilized world says “I don’t mind because they are also paying for mine.”