If you haven’t read the introduction, go back and read it now. That introductory post also included links to all the posts in this series on how we can rate the quality of the US health care system. Each the pieces discussed another way to look at quality, and how the US compares to comparable countries in that domain.
I expected more arguments for this series than for the cost one did. After all, few dispute that we’re spending a lot of money on health care, but plenty of people think we’re loaded with quality. Quality is important, though, perhaps more important than cost. We can agree to spend a lot of money on health care, but you would hope that we’re getting our money’s worth.
And there’s the rub. If we’re going to spend way more than any other country on health care, then we should absolutely, positively have the best health care system in the world. We don’t. I don’t know how you could have read this series and still believe that we do:
With the exception of available technology, we do not rate well against comparable countries. And that’s the take home message. We can argue about which metric is best to describe the quality of a health care system, but it almost doesn’t matter what you pick. Don’t like population statistics? Fine. Choose another. But unless you think the only important thing is how many MRI machines are available, we’re still going to look bad. Not only does the system not perform up to snuff, but pretty much every stakeholder I discussed agreed that it’s not good.
But even if you still want to quibble, you have to remember that we have a hugely expensive system. Moreover, lots of people may have trouble accessing it. So if we’re going to spend a ton and not provide universal coverage than it should be impossible to argue that we’re not the best. The fact that we can even debate that point (let alone lose the debate) should be enough to convince you that we’re getting too little bang for the buck.
Unfortunately it’s easier to correct access than quality. The PPACA focuses mostly on access, after all. It’s also relatively (and I mean relatively) easy to cut costs. But quality? Hoo boy. Getting all the moving parts to do a better job is not going to be easy.
Some will make the argument that just improving access with improve quality. I think there’s a reasonable chance that’s true. But it’s not going to get us all the way there. And until a significant portion of the United States is willing to stop plugging their ears and trumpeting as loudly as they can that “we have the best health care system in the world!” I fear that things won’t get much better.