Posted by
Andrews on Wednesday, June 17, 2009 6:04:43 PM
I have seen several times articles reporting the WHO rated the UK and Canada "above" the US in terms of health care, and, more important, that citizens of those nations were more satisfied with their health care than the US.
I will ignore the first part today (though I am going to come back to it when I am in shape to write more). Such studies are often more informative about the biases of those performing the rating than the actual condition of the various national systems. By rating "access" and defining it in terms favoring nationalized health care it is very easy to create a study where the US scores very low, despite the fact that many from both the UK and Canada come here for care. It is akin to those "top 10 college" reports that come out every year, where the lists vary widely from magazine to magazine depending on the bias of the writers. It may be meaningful if you agree with the presumptions, but it is hardly definitive,
However, that second figure often confuses those who oppose national health care. How, they wonder, could people waiting 10 months for an MRI be happy?
The answer is "make them wait eight months".
You see, in the US we have been told we deserve totally free health care providing everything we could ever want. Our expectations are so high that we are disappointed even when we get perfectly good care. On the other hand, people used to socialized medicine have come to expect long waits, denial of care, and other limitations, so if the state system operates half as well as the US system it is considered a triumph.
Let me draw an analogy. Suppose you are living in Brezhnev era Russia. You are used to waiting in line for everything. When polled, you rate the system "adequate", even though anyone form another nation would call it abysmal. But you expect no better, have known nothing else.
Now, suppose the Soviets decide to open up some warehouses in which they have been hoarding various odds and ends and put extra goods on the shelves. You get lucky and can buy some substandard goods without a wait. Admittedly, they are still pretty shabby, but they are things you would normally not be able to get, so you now rate the system "very good". Again, a citizen of any western nation would find the conditions utterly intolerable, but from your past experience it is heaven on earth.
Now, let us look at the US. Under Ford people are relatively happy, times are rough, with some inflation, but the war is over, the government is stable, and generally they are content, and rate the system adequate. Then comes the Carter era, fuel lines and shortages, double digit inflation and rising prices, and the citizens of the US rate their conditions "abysmal".
But let us take our Russian and let him defect. He arrives in the US, and despite fuel lines, is utterly stunned at all the goods available. To him the US is a land of unthinkable bounty.
You can see the problem here. if we go only by the rankings of the citizens based on their subjective impression, people used to very mediocre systems will rank quite highly systems which, by any objective measure, are inferior to systems which rate lower due to citizens with higher expectations. The opinion of citizens about their own health care systems tell us not so much about the system itself, but about the expectations of those citizens. So a high rating may tell us a system is performing well, or the citizens don't expect much. Likewise a low rating could tell us a system is troubled, but it could also tell us the citizens have high expectations, or even that it performed even better in the past, and so is disappointing by comparison.