In defense of socialized medicine

Socialized or government run healthcare is often derided by its capitalist critics here in America. But does it really deserve all of the hate and mistrust that it gets from us? So many times I’ve heard people claim that such systems are inefficient, even tyrannical because they limit choices. More recently, I’ve heard and read many people talking about how even people in the Scandinavian countries are turning their backs on socialist principles.

However, much of these claims remain to be proven. Strangely, nobody ever offers evidence that increased choice leads to better health outcomes. As for inefficiency, most people who demonize socialized medicine cry about increased wait times for procedures. And what about citizens themselves turning their backs on socialized medicine? I’m willing to bet that the majority of the people who make this claim have never been to any of these other countries and have never bothered to ask its citizens what they actually think–they’re simply parroting economic and political rhetoric and propaganda.

In reality, it’s actually pretty easy to take a magnifying glass to socialized medicine and hold it up to scrutiny. There are a lot of data one can analyze and compare to determine whether socialized medicine is really the evil and inefficient scourge that people claim. There’s even a way to find out what the people in places like Sweden actually think about their healthcare: by–shockingly–asking them point blank and not relying on American politicians and conservative economists to spoon feed you their own biases.

There are two primary resources that we’re going to be looking at in this post. The first is here. That link will take you to the complete 2014 International Profiles of Health Care Systems released by The Commonwealth Fund. The majority of the information I will be providing comes directly from the report. It’s an excellent read, albeit a long one. The report compares the healthcare systems of Australia, Canada, Denmark, England, France, Germany, Italy, Japan, The Netherlands, New Zealand, Norway, Singapore, Sweden, Switzerland, and the US. That’s a pretty broad base to compare, and I feel it’s an adequate sample to really show genuine reflections in outcomes and costs.

First, it’s worth noting exactly how all of these systems work in terms of how they cover healthcare. Australia, Canada, Denmark, England, Italy, New Zealand, Norway, Singapore, and Sweden all have national health systems that cover all citizens, run by the government, and funded through taxpayers. France, Germany, and Switzerland have a statutory insurance mandate, similar to Obamacare, wherein all citizens are required to purchase insurance; funding largely comes from employee/employer contributions. And finally the US, where 56% of people have private insurance, 13% are uninsured, and the remaining 31% are covered under government run programs (Medicare, Medicaid).

Now, the first thing we can do is look at cost, since that’s currently what we are bemoaning here in the US. Per capita, here is what healthcare spending looks like in each of those countries. I will highlight the highest and lowest numbers.

  • Australia: $3,997
  • Canada: $4,602
  • Denmark: $4,698
  • France: $4,288
  • Germany: $4,811
  • Italy: $3,209
  • Japan: $3,649
  • Netherlands: $5,219
  • New Zealand: $3,172
  • Norway: $6,140
  • Singapore: $2,881
  • Sweden:$4,106
  • Switzerland: $6,080
  • UK: $3,289
  • US:$8,745

The US pays the most, almost double the average of $4592. Now, what about spending as a part of GDP?

  • Australia: 9.1%
  • Canada: 10.90%
  • Denmark: 11.00%
  • France: 11.60%
  • Germany: 11.30%
  • Italy: 9.2%
  • Japan: 10.30%
  • Netherlands: 12.1%
  • New Zealand: 10.00%
  • Norway: 9.30%
  • Singapore: 4.7%
  • Sweden: 9.6%
  • Switzerland: 11.40%
  • UK: 9.3%
  • US: 16.90%

Again, the US spends the most. We get an average here of around 11%, and the US is a good 50% higher than that.

So we spend the most of all of those countries. Surely, then, we get better outcomes for that, right? Well, let’s look at some healthcare quality indicators listed in the survey. The first one is: “Diabetes lower extremity amputation rates per 100,000.”

  • Australia: 4.6
  • Canada: 10
  • France: 7.1
  • Germany: 18.4
  • Netherlands: 13.5
  • New Zealand: 6.7
  • Norway: 8.7
  • Sweden: 3.3
  • Switzerland: 7.1
  • UK: 5.1
  • US: 17.1

Hey, look! The US wasn’t #1! That honor goes to Germany. But just barely, we’re a close second. It’s still worth pointing out that we’re still nearly double the average rate (9.2). So I don’t really know if I would qualify that as a victory.

What about lifespan?

  • Australia: 82.8
  • Canada: 82.2
  • Denmark: 80.6
  • France: 82.4
  • Germany: 81.0
  • Italy: 82.7
  • Japan: 83.7
  • Netherlands: 81.9
  • New Zealand: 81.6
  • Norway: 81.8
  • Singapore: 83.1
  • Sweden: 82.4
  • Switzerland: 83.4
  • UK: 81.2
  • US: 79.3

(Data from the WHO).

We don’t seem to live the longest, which is odd considering how much we pay compared to everyone else. Okay, well what about deaths due to the healthcare system? In other words, how many avoidable deaths in the healthcare system were there (per 100,000)?

  • Australia: 57
  • Canada: n/a
  • France: 55
  • Germany: 76
  • Netherlands: 66
  • New Zealand:79
  • Norway: 64
  • Sweden:61
  • Switzerland: n/a
  • UK: 83
  • US: 96

Yikes. Looks like our healthcare system kills more people.

Now it wasn’t all bad news for the US. We had the highest 5 year breast cancer survival rate (barely) and we were somewhere in the middle of the pack when it came to mortality after admission to a hospital for a heart attack. And that seemed to be the general trend, that the US was either the worst offender or somewhere in the middle.

Okay, what about the long waits and rationing? There were several markers here. The first was “Able to get same or next day appointment when sick.”

  • Australia: 58%
  • Canada:41%
  • France: 57%
  • Germany: 76%
  • Netherlands: 63%
  • New Zealand: 72%
  • Norway: 52%
  • Sweden: 58%
  • Switzerland:n/a
  • UK: 52%
  • US: 48%

Everywhere else but Canada it’s easier to get a same/next day appointment. The next measure was “Very or somewhat easy getting care after hours.”

  • Australia: 46%
  • Canada: 38%
  • France: 36%
  • Germany: 56%
  • Netherlands: 56%
  • New Zealand: 54%
  • Norway: 58%
  • Sweden: 35%
  • Switzerland: 49%
  • UK: 69%
  • US: 39%

Again, the US isn’t the worst, but it’s far below the average (48.7%). Okay, now the one I’m sure you’ve all been waiting for: “Waited 2 months or more for a specialist appointment.”

  • Australia: 18%
  • Canada: 29%
  • France: 18%
  • Germany: 10%
  • Netherlands: 3%
  • New Zealand: 19%
  • Norway: 26%
  • Sweden: 17%
  • Switzerland: 3%
  • UK: 7%
  • US: 6%

Well, well, well. While it’s true that other people have to wait longer to see a specialist, we weren’t necessarily the fastest. And it isn’t as if people those other countries are dying in the streets because they can’t see a doctor. Indeed, it would seem as if this whole issue is really a nonissue–clearly it doesn’t affect mortality, as every other country on the list had a higher average lifespan than America. Also, “waiting” depends on what we’re talking about: we might get people into specialists faster, but other countries do primary care faster than we do. However, there’s one more piece of this issue to look at: “Experienced access barrier because of cost in the past year.”

  • Australia: 16%
  • Canada: 13%
  • France: 18%
  • Germany: 15%
  • Netherlands: 22%
  • New Zealand: 21%
  • Norway: 10%
  • Sweden:6%
  • Switzerland: 13%
  • UK:4%
  • US: 37%

While it’s true we do get people seen faster in some instances, we certainly make them pay through the nose for it. So much so that some people can’t or don’t access healthcare at all. I wrote awhile back about stress in America and the role that Americans said money played: 20% said they put off medical appoints because of cost. That’s worth noting.

Also worth noting before we move on is how much people pay for drugs per capita in each country:

  • Australia: $588
  • Canada: $771
  • Denmark: $295
  • France: $651
  • Germany: $668
  • Italy: $514
  • Japan: $718
  • Netherlands: $450
  • New Zealand: $297
  • Norway: $414
  • Singapore: n/a
  • Sweden: $478
  • Switzerland: $562
  • UK: n/a
  • US: $1,010

Look at that, ours is the only number with a comma in it.

Okay. So we’ve looked at efficiency and outcomes. But what about popularity? You often hear that criticism. “Well yeah, it’s cheaper in Sweden, but the people over there hate it!” Is that really true? Well, luckily for us, we have some sources.

Public views of the health system: “Works well, minor changes needed.”

  • Australia: 48%
  • Canada: 42%
  • France:  40%
  • Germany:42%
  • Netherlands: 51%
  • New Zealand: 47%
  • Norway: 46%
  • Sweden: 44%
  • Switzerland: 54%
  • UK: 63%
  • US: 25%

You can ask the converse, too: “Needs to be completely rebuilt.”

  • Australia: 9%
  • Canada: 8%
  • France: 11%
  • Germany: 10%
  • Netherlands: 5%
  • New Zealand: 8%
  • Norway: 12%
  • Sweden: 10%
  • Switzerland: 7%
  • UK: 4%
  • US: 27%

Well it looks to me like socialized medicine is pretty popular. Meanwhile, a much higher percentage of people don’t like the American healthcare system. In fact, very few people in countries with socialized medicine feel it needs to be completely abandoned. That’s not exactly a stinging rebuke of socialism. As an example, I find it interesting that Canada, the nation with the worst scores when it came to access, had numbers in the single digits with regard to completely scrapping their system. And we can look at other sources, as well.

Eurobarometer conducts public polling in the EU. When asked about the overall safety and quality of their healthcare, almost 3/4 of EU citizens responded that it’s good (71%).

While it’s true that in many other countries people can purchase private or supplemental insurance, those numbers are generally low, with some exceptions. In England, only 11% of people buy supplemental coverage. That number plummets to 7% and 5% in Norway and Sweden. Again, hardly a shunning or abandonment of socialist principles. And where those numbers are much higher (between 50-70% of people) that coverage mostly allows for things like private hospital rooms, elective surgery, optometry, etc–it doesn’t necessarily buy access to better basic care (although in some cases it certainly can buy you access to faster private hospitals and doctors).

Alright, so what can we conclude from all of this? Well, for one, we can say that when politicians call US healthcare the greatest on earth, they’re talking out their asses. It’s not. The data clearly demonstrate that it isn’t. It doesn’t manage to make us live longer, and it puts us in the middle of the pack when it comes to industrialized nations as far as most other health outcomes. We pay the highest prices for mediocre results, basically.

At this point, I don’t really know how anyone can completely bash socialized medicine. It produces better outcomes for less money. That isn’t up for debate, that’s what the numbers indicate. There are some aspects that don’t measure up to the needs of some Americans, like the amount of time one waits to see a specialist. Although, that might be one reason why they pay so much less than we do: they don’t refer people to specialists at the drop of a hat. That probably saves a lot of money in the long run.

These data also seem to speak against the idea that “When the government gets involved everything goes wrong.” On the contrary, we see that the countries where the government is most involved have the lowest costs, the best outcomes, and the highest rate of approval among their citizens.

And as far as the “they’re all fleeing socialism to embrace the free market” lines go, that’s a bunch of baloney. By and large, people are satisfied with socialized medicine, and people are turning to private industry mostly for niche care. And even if more people are embracing some aspects of the free market, they aren’t doing so while abandoning socialism: it seems most countries agree that basic healthcare is a human right, and all citizens should have access to it.

I suspect that the American fear and hatred of socialized medicine is due to several factors. One, for many generations we’ve simply been taught by our government that socialism and communism are dire enemies. Two, here in American we’re used to a corrupt and inefficient government, so we naturally don’t see how centrally planned healthcare can work. But just because our government is inept doesn’t mean that all others are; indeed, it would seem that every other government has found a way to produce better outcomes with less money, which doesn’t exactly prove the “government is inept” theory. Admittedly, socialized medicine wouldn’t work in the current American government. Mostly because the government is bought and paid for in America, where overseas that isn’t the case (or at least not to the same extent as here). Which brings us to three: healthcare, to most of the world, is a human right, while in the United States it remains mostly a privilege.

Most countries see the health of their citizens as something that shouldn’t be considered a for profit venture. We can’t really say the same for the US. We provide healthcare for the elderly, but even that’s questionable now that republicans control all three branches of the government here. There’s a very real possibility that Medicare will be dismantled and replaced with a voucher system where our seniors will purchase private insurance. The problem with that is that insurance companies are in it to make money, and if a senior can’t afford what the insurance companies are charging, tough luck. I guess grandma doesn’t get healthcare.

In reality, having the government run everything allows them to stand up to the pharmaceutical companies and insurance companies (where applicable) and set price ceilings and negotiate. In our American system, we pretty much let private companies write the laws, literally. And now we have a group of people in power who want less government involved, because for some reason the same people who were going to drop you like a brick when you got sick are magically going to have a change of heart once Uncle Sam isn’t looking.

In summation: socialized medicine works. It’s cheaper and it’s more effective. It’s nothing to be afraid of, unless you own stock in an insurance or pharmaceutical company. Anyone who tells you different just isn’t living in a world of facts (or ethics, if you ask me).

I leave you with a meme.

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4 thoughts on “In defense of socialized medicine

  1. I can understand your perception on centralized medicine and centralized planning. However, our system is heavily influenced by our form of central planning. Even more so than before. There is really a lot of evidence that supports some of my claims about the shortages and shortcomings from using the centralized approach. Even the NHS is currently dealing with some hardships. http://www.reuters.com/article/us-brireuterstain-redcross-health-idUSKBN14R089
    This is just a small taste of it. This happens every few years or so.
    Not to mention the scandal with their doctor pay or low RN morale. Even the MD suicide is very high there. Likely due to the mess the centralized approach caused in the first place. Ours is not perfect either.

    1. I wouldn’t argue that socialized medicine is a perfect system. No system is ever 100% efficient or effective.

      My hope with this post waz to try to illustrate that it’s simply not as evil or inefficient as its often portrayed here in America.

  2. Also, I think the stick figure meme is funny in a way but it also does not represent your opposition at all. Most of us who disagree with centralized planning and centralized medicine (socialized) want people to be happy and free with good health. This picture meme just represents the bigotry from liberals that post these ridiculous memes all day.

    1. I suppose that’s one way of looking at it. Frankly, I’m tired of people (not you, but others in general) immediately assuming that anyone who is pro socialized medicine is either ignorant, naive, a bleeding heart, or some combination of those things.

      There’s real data here to objectively analyze, and it seems that conservatives are often willing to overlook that data because they have unfavorable opinions about liberals as people.

      Not that liberals don’t do that same thing with conservative issues. That’s part of an overall problem that the whole country faces: too often we base our decisions on our personal feelings rather than on data.

      I think in particular this set of data show that other countries have done quite well when it comes to integrating free market principles and private business with a socialized medical system. Many countries have shown, at least to my eyes, that it doesn’t have to be an either/or situation.

      Then again, you could say that most situations aren’t a simple either/or, although that’s certainly how our political system and media portrays things.

      As we sort of talked about on facebook, I do think that there’s a bipartisan solution to be found here in America. Whether or not both parties can see beyond their own bubbles and actually do something remains to be seen.

      Personally, I’d love to see a public option for those who can’t afford health insurance or don’t want private insurance, mixed with the ability to purchase a private plan if you have the resources and want access to different care. Nix the mandate idea altogether.

      I think it’s possible to have healthy and productive competition between government and private industry–both system should and could drive each other to do things better.

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