To justify more government control of America’s health care, ObamaCare supporters frequently assert that access to and quality of health care in the United States are poor. However, the facts from source documents and medical journals show that Americans enjoy superior access to care compared to nationalized systems, the very systems put forth as models for ObamaCare — whether defined by wait-times for diagnosis, treatment, or specialists; timeliness of surgery; access to screening; or availability of medical technology and drugs. The separate issue of quality of care also demands analysis of objective data – and that means data from peer-reviewed medical journals, rather than subjective “rankings” and surveys by advocacy groups.
Even before medical care quality is compared, one should understand that a population’s lifestyle, behavior, and heterogeneity impact health outcomes and life expectancies, even when medical treatment is sound.
For instance, cigarette smoking and obesity are proven to increase risk for serious diseases, worsen outcomes from those diseases, and decrease life expectancy—even with excellent medical care. And their impact is huge.
Cigarette smoking alone accounts for about 443,000 deaths, or nearly one of every five, each year in the US, and is independently responsible for about 35 percent of all heart attacks, particularly fatal ones, and about 20 percent of strokes.
Because smoking harms nearly every organ of the body, it causes or exacerbates many additional diseases, and it worsens outcomes from surgery and innumerable other treatments.
Obesity is now linked to greater risk of death from heart disease, stroke, diabetes, high blood pressure, all of the most prevalent cancers, and worse treatment outcomes after heart surgery, trauma and burn surgery, and transplants. It is not simply that rates of diseases are higher; the treatment outcomes are significantly worse for cigarette smokers and obese patients.
Why would these behaviors have particular impact on US health care rankings?
First, the prevalence of obesity is far higher in the United States than in all other OECD nations. More than one-third of Americans are obese, compared to 15.4 percent in Canada, 10.2 percent in Sweden, and 9.0 percent in Norway. Thorpe separately compared the US to ten Western European nations (Austria, Denmark, France, Germany, Greece, Italy, Netherlands, Spain, Sweden, and Switzerland) and found that Americans were nearly twice as likely as Western Europeans to be obese (33.1 percent versus 17.1 percent). It’s not a fluke that Japan, where only 3.4 percent of people are obese, has the greatest longevity.
Second, the United States harbors a far higher burden of cigarette smoking than other nations. Almost 70 percent of U.S. men born between 1910 and 1930 were regular smokers by age thirty-five. The US had the highest level of cigarette consumption per capita compared to all other developed nations over a five decade period ending in the mid-1980s. Americans are still significantly more likely than Western Europeans to be current or former smokers (53 versus 43 percent). Although some emphasize that smoking cessation rates are higher in the US than in Europe, the WHO was correct when it stated that “current prevalence of tobacco smoking is an inadequate predictor of the accumulated risk from smoking” because “the diseases caused by smoking, particularly cancers including lung cancer, occur after long delays...with an average time lag of twenty- five to thirty years.” Clearly, the high historical burden of cigarette consumption in the US continues to have impact.
Let’s compare data for cancer, heart disease, and stroke, the most common sources of sickness and death in the US and Europe, and the diseases that generate the highest medical expenditures.
American cancer patients, both men and women, have superior survival rates for all major cancers. For some specifics, per Verdecchia, the breast cancer mortality rate is 52 percent higher in Germany than in the US, and 88 percent higher in the United Kingdom; prostate cancer mortality rates are strikingly worse in the UK, Norway, and elsewhere than in the US; mortality rate for colorectal cancer among British men and women is about 40 percent higher than in the US. 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). The inescapable conclusion from objective data is that US patients have superior outcomes from nearly all cancers.
Treatment for heart disease is also superior in the United States.
First, 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).
Likewise, US patients needing surgery for heart disease receive it more frequently than heart patients in countries with nationalized insurance. For example, twice as many bypass procedures and four times as many angioplasties are performed per capita in the US as in the UK. A separate comparison between Canadian and American patients showed the same pattern: of patients diagnosed with coronary heart disease, a higher percentage of US patients actually received treatment.
But is there evidence that Americans with heart disease actually benefit from receiving treatment more frequently compared to patients elsewhere? The answer is yes. Specifically, the US shows a significantly greater reduction in death rates from heart disease than Western European nations, the European Union as a whole, and Japan.
A separate study showed that Americans had a significantly longer five-year survival after acute heart attack than Canadians. The authors concluded that “our findings are strongly suggestive of a survival advantage for the US cohort based on more aggressive revascularization.”
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.
One reason for better results of stroke care is that modern therapy has been more widely available and was available years earlier in the US than in countries with nationalized insurance. Even given the disadvantages inherent to American patients (physically inactive, obese, and with high blood pressure – all significantly higher than comparison countries), studies still prove better medical care for stroke in the US.
What about treatment for chronic diseases like hypertension and diabetes?
To assess the quality of care for high blood pressure, or hypertension, we must look at two sets of data. First, once hypertension is diagnosed, is it treated or does it go untreated? About two-thirds to three-fourths of patients with high blood pressure in Canada and Europe were left untreated, compared to less than half in the US, with England having the lowest level of treatment, followed by Sweden and Germany, Spain, Italy and Canada, all far behind the US in a comparison study. In a different study, 88.3 percent of patients aged 18 to 64 in the US diagnosed as hypertensive received treatment, compared to 84.1 percent of the Canadians with hypertension, a pattern also seen in older patients.
Second, hypertension treatment in the US has been more successful in controlling blood pressure than elsewhere. One comparison showed that control in treated patients at 140/90 blood pressure, as well as at a higher standard of 160/95, was highest in the US, outperforming Canada, England, Germany, Italy, Sweden, and Spain.
In a separate analysis of over 21,000 patients already visiting doctors for hypertension in five Western European nations (France, Germany, Italy, Spain, and the UK) and the US, the best rate of success was in the US (63 percent), compared with 31 percent to 46 percent of patients in the European countries. The facts show that more successful blood pressure control was seen in the US for both women and men under treatment, differences that are statistically significant. As for why, the conclusion by the authors is not surprising: “lower treatment thresholds and more intensive treatment contribute to better hypertension control in the United States” …that is, because of the delivery of better medical care in America.
No disease has more far-reaching and more serious consequences than diabetes, a disease near the top of the list of the world’s most important health challenges, fueled by a relentless rise in obesity. The risk for death in diabetics is about twice that without diabetes, and disease outcomes are also significantly worse. While “type 2” diabetes (90 to 95 percent of diabetes) is preventable by an individual’s own choices (weight loss and increased exercise), medical care focuses on control of blood glucose to limit organ damage and complications.
Receiving diabetes care is the first concern, and then attaining control is the second. In 2011, the WHO determined that of seven countries, the US had the highest proportion of adult diabetics who were actually receiving treatment for their known diabetes, as well as for their hypertension and for their high cholesterol.
A 2007 comparison of Canadians and Americans showed the same -- a higher percentage of American diabetics than Canadian diabetics actually receive treatment. In the same WHO analysis, the US also performed best by several different quality measures, including blood glucose control, as well as effective management for all three key factors in diabetics (blood glucose, blood pressure, and blood cholesterol), approximately twice the success of England and Scotland. Here’s the bottom line: if you had diabetes, you were more likely to receive treatment and be treated successfully for the disease and the important risk factors for its serious sequelae in the US than in any other country studied.
Objectively, the world’s leading medical journals are filled with studies demonstrating the excellence of American medical care in comparison to other systems more heavily controlled by government bodies, the very systems held as models by those asserting the need for radical change to US health care.
These studies verify better survival from serious diseases like cancer, better access to treatment for the most important chronic diseases, and superior control of diseases that cause disability and death and are themselves significant risk factors for other deadly diseases … all this even though US life expectancy and disease outcomes are worsened because Americans harbor more risk factors than all other countries.
Yet another inescapable conclusion is evident – the rationale for President Obama’s radical transformation of the US health care system was incorrect. Combined with the fact that the law does not reduce health care expenditures, it represents one of the most tragic errors of misguided government in modern history. All Americans, as well as children and adults throughout the world who benefit from US health care innovation, will be far worse off for it.
Scott W. Atlas, MD is the David and Joan Traitel Senior Fellow at the Hoover Institution, Stanford University, and author of "In Excellent Health: Setting the Record Straight on America's Health Care" (Hoover Press, 2011).