US Health System: Most Valuable and Best Performing

  • by: |
  • 06/17/2014
Every year the Commonwealth Fund comes out with a study ranking health care systems and every year the study claims to show that the US health system is, as the headline in states: 

U.S. Healthcare: Most Expensive and Worst Performing
In a new international ranking, the United Kingdom ranks first, while the U.S. performs poorly across almost all health metrics.

This study -- or rather a version of it conducted by the World Health Organization --  has been thoroughly shredded by Scott Atlas in his Commentary article: The Worst Study Ever?  

As Atlas points out: "researchers divided aspects of health care into subjective categories and tailored the definitions to suit their political aims. They allowed fundamental flaws in methodology, large margins of error in data, and overt bias in data analysis, and then offered conclusions despite enormous gaps in the data they did have."

All to make the case for single payer health systems.  

In this case, the Commonwealth Fund measures everything except the quality of care.  It measures lots of process measures that are easily skewed by bias.  So for instance, in measuring "efficiency"  CW ranks countries based on percentage of GDP spent on health and percent of health care spent on administrative services.  Of course the US is destined to be the worst.

Next,  it ranks countries on access.  Again the US is trashed.   And the UK is number 1.   Don't laugh.  CW used "having access to basic medical care the same or next day."   Apparently wait times for cancer care, hip replacements, by-pass surgeries, etc. don't count.  Indeed,  CW ignores the explosion in outpatient same day surgery and walk-in clinics in the US.  

The US is also slammed for unfairness.  CW claims -- surprise! -- that the UK does the best on providing the same great care to everyone rich and poor.   Apparently, despite the exhaustive research CW did, the group failed to come across the Marmot report calling health inequality in the UK a ticking time bomb.   Here's the link in case CW wants to update it's study:  

Meanwhile,  CW ignores the following (courtesy of Scott Atlas again!):

"American cancer patients, both men and women, have superior survival rates for all major cancers.  Removing “lead-time bias,” where simply detecting cancer earlier might falsely demonstrate longer survival, death rates from prostate and breast cancer from the early 1980’s to 2005 declined much faster in the US than in the 15 other OECD nations studied (Australia, Austria, Canada, Finland, France, Germany, Greece, Italy, Japan, the Netherlands, Norway, Spain, Sweden, Switzerland, and UK)."

What about heart disease?

"A comparison of the US to ten Western European nations (Austria, Denmark, France, Germany, Greece, Italy, Netherlands, Spain, Sweden, and Switzerland) showed that 60.7 percent of Americans diagnosed with heart disease were actually receiving medication for it, while only 54.5 percent of Western Europeans were treated (a statistically significant difference)."


"Another comparison study showed that fewer Americans than UK residents die (per capita) from heart attack despite the far higher burden of risk factors in Americans for these fatal events. In fact, the heart disease mortality rate in England was 36 percent higher than that in the US. These superior outcomes from US medical care are particularly impressive, considering that American patients have far more risk factors (diabetes, obesity, chronic kidney disease) that worsen outcomes and death rates after heart attack and after heart surgery.

The US shows a far greater reduction in death rates from stroke, the third leading cause of death and the leading cause of disability in adults in the US and most Western European nations, than almost all Western European nations and the European Union overall."

So why did CW ignore outcomes like mortality and survival and focus on income inequality and how universal a health care system was.

You have to take into account CW's frame of reference.  If someone told you time again that the VA health system is a model of excellence, would you take their study on health care performance seriously? 

And boy does Commonwealth love the VA.

Here's CW president Stephen Shoenbaum gushing over the VA in an interview with Managed Care magazine: 

MC What parts of the health care system are working?

SCHOENBAUM: There are some examples of excellence within the U.S. health system. If we pick any given area, such as quality or driving down costs, we find examples of excellence. Some large systems are doing very interesting things. Kaiser Permanente and the Veterans Administration are managed systems that are trying to improve performance and reduce costs by using a primary care-based system and using information technology creatively. Another example is Geisinger Health System in Pennsylvania.

And here's a CW study of the VA, which it claims is a high performing health system.  I take that to mean it meets the standards CW set in the report dumping on US health care.  The study celebrates how the Memphis and Lincoln, Nebraska VA systems shortened wait times, reduced emergecny room vistis and reduced blood sugar levels in some patients.  

Hmm.. Memphis VA.. where have I heard that before..

VA Hospital Axed Veteran Programs While Approving $1 Million In Bonuses

The Memphis Veteran Administration (VA) Medical Center approved over $1 million in bonuses months before closing a therapeutic aquatic pool citing a lack of funds.

The Memphis VA Medical Center handed out $1,005,644 in bonuses for its approximately 2,000 employees in fiscal year 2010, according to data provided to The Daily Caller by Sandra Glover, the communications officer for Veteran Integrated Services Network (VISN) 9, which includes the Memphis VA Medical Center.."

And this:

Memphis Veterans Affairs Medical Center Flagged in Audit

The CW study is an exercise in confirmation bias, which is the " tendency to search for or interpret information in a way that confirms one's preconceptions, leading to statistical errors. Confirmation bias is a type of cognitive bias and represents an error of inductive inference toward confirmation of the hypothesis under study."

It was designed to reinforce the meme that goverment run health systems are better, fairer and cheaper.   This blog was a modest effort to speak truth to bias. 


Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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