What the left gets wrong about health spending and outcomes

What the left gets wrong about health spending and outcomes

Health spending in the United States is high and our medical performance is low, according to the liberals in Congress. According to Representative Pramila Jayapal, “The health outcomes and barriers to care in America are the worst of any industrialized nation.” This is simply a misdiagnosis. Our health access and outcomes are not the worst in the industrialized world.

Writing in the Journal of the American Medical Association, a top level team of researchers reported that on key measures of access to health care, the United States “generally performed better than other countries.” While on certain population health measures, such as life expectancy, infant mortality, and rates of obesity, American statistics (with certain crucial qualifications) are poor, on major clinical outcomes for heart attacks, strokes, and obstetric trauma, our performance is very good.

Americans do spend more on health care, paying more than $3.6 trillion last year, compared to single payer countries such as Britain and Canada. While much of our spending is often inefficient and wasteful, the reason is the absence of serious market competition. That is the conclusion of a wide range of analysts, including those with the Brookings Institution as well as the United States Department of Health and Human Services.

Liberals in Congress often overlook the benefits of heavy investment spending in our advanced medical technologies. The return on that investment is evident in greater rates of survival for patients stricken with deadly diseases. Consider all our progress against heart disease. In a recent significant study, Harvard Professor David Cutler along with his colleagues report that between 1950 and 2015, the cardiovascular disease mortality rate fell by 73 percent. They wrote, “Falling mortality from heart disease and stroke mirrors the rise in medical spending on the aged.”

It is noteworthy that our national decline in mortality preceded the 1966 implementation of Medicare. As the researchers demonstrate, mortality declines occurred among the near elderly persons ineligible for Medicare as well as among the elderly. They observe, “Improved health over this time period appears to be a response to the availability of new treatments as opposed to people being better insured.” Access to health insurance coverage is not the same as the provision of high quality medical care.

We have also made impressive progress in the battle against cancer. For Americans, roughly 55 percent of cancer patient reduction in mortality was attributable to better screening and improved drug therapies. Not surprisingly, out of 15 developed countries, the United States ranked first with the availability of new cancer drugs at 96 percent, while 71 percent were available in Britain, and only 56 percent were available in Canada.

In another important study of cancer care in the United States and several European countries, University of Chicago Professor Tomas Philipson and his colleagues found that the incidence of cancer is more prevalent in the United States, and American cancer spending is higher. American cancer survival is, however, also higher and cancer mortality is lower. From 1983 to 1999, Americans spent $158 billion more on cancer care than all the Europeans combined. Our spending focused on far greater reliance on medical technology, including faster and broader access to new drugs.

The researchers cite Herceptin, a powerful but expensive drug to treat an aggressive form of breast cancer. The life saving drug was available to American women in 1998. British officials, however, did not recommend its use and reimbursement for British women until 2002. Concerning the American overperformance in battling cancer, the researchers wrote, “We found that the value of the survival gains greatly outweighed the costs, which suggests that the costs of cancer care were indeed worth it.”

Americans spend more on health care for many reasons, and many of those costs, often generated by bad government policies, are indeed wasteful and inefficient. However, Americans also rely more heavily on advanced medical technology, and enjoy greater access to new drug therapies. Investments in these areas secure the value for our health care dollars. The United States also pays doctors, nurses, and other medical professionals much more than other economically advanced countries.

The Senate “Medicare for All” bill would sharply reverse that pattern. It would impose an estimated 40 percent reduction in payments to doctors and hospitals, and would surely jeopardize patient access to quality care. The “progressives” in Congress promise that full government control over health care, through a closed system of single payer insurance, would secure universal access to higher quality health care at much lower costs. Experience in other countries, with long wait lists and health care denials, does not support such extravagant promises. Simply do not believe them.

Robert Moffit is a senior fellow in the Center for Health Policy Studies at the Heritage Foundation in Washington. He served as an official at the United States Department of Health and Human Services under President Reagan.

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