What experts say about who has the world's best health-care system | Opinion

Summary

The discussion delves into the complexities of ranking global healthcare systems, with France noted for its top position. It emphasizes there's no one-size-fits-all solution due to varying national needs and values. The U.S. is criticized for its high costs and mixed outcomes, suggesting a reevaluation of its healthcare system in line with societal values and cost-effectiveness. The conversation also clarifies misconceptions about 'socialized medicine' versus 'universal health care,' advocating for a nuanced approach to healthcare reform.

Takeaways

• 🌍 The question of which country has the best healthcare system is subjective and depends on what values are prioritized.
• 🏆 According to world health rankings, France is often cited as having a top healthcare system, but this doesn't mean it's universally applicable.
• 🤔 The concept of 'best' is not absolute; it varies based on individual perspectives on cost, equity, access, and quality.
• 📊 A tournament-style comparison of healthcare systems conducted by experts showed no consensus on a single 'best' system.
• 🇺🇸 The United States is often noted as lagging behind other developed nations in healthcare outcomes relative to its spending.
• 💡 A good healthcare system should improve public health, provide value for treatment costs, and reflect societal values.
• 💼 The debate often confuses 'socialized medicine' with 'universal healthcare,' which are distinct concepts.
• 🏥 Countries with universal healthcare have diverse structures, but they share the common goal of providing coverage for all.
• 🔍 The discussion on healthcare should focus on patient satisfaction and the value of care received, rather than slogans or political affiliations.
• 🌱 There's a need for a constructive debate on healthcare reform in the United States that aligns with core societal principles and values.

Q & A

What is the speaker's initial reaction to the question about the best healthcare system in the world?

The speaker expresses dislike for the question, suggesting that there isn't a straightforward answer and that it depends on what values are prioritized.

According to the speaker, which country ranks at the top in world health rankings?

France is mentioned as the country that comes out on top in world health rankings.

Why does the speaker argue that the answer to the best healthcare system might not be applicable?

The speaker argues that what works in one country may not work in another, highlighting the importance of context and adaptability in healthcare systems.

What did the speaker and his colleagues do to evaluate different healthcare systems?

The speaker and his colleagues conducted a tournament-style evaluation of healthcare systems, similar to a bracket tournament, to determine which system they collectively preferred.

What was a significant takeaway from the healthcare system tournament mentioned by the speaker?

A significant takeaway was that there was no unanimous decision in any pairing, indicating that opinions on the best healthcare system vary even among experts.

How does the speaker describe the United States' position among developed nations in terms of healthcare?

The speaker states that the United States comes in dead last among all major developed nations when comparing healthcare systems.

What are the three attributes the speaker believes a good healthcare system should have?

A good healthcare system should improve the health of the country, ensure that the benefits of treatment outweigh the costs, and reflect societal values, such as equity and access for all.

What does the speaker suggest is a common misconception about healthcare in other countries?

The speaker suggests that there is a misconception that healthcare in other countries involves terrible care, long waiting lines, and limited access to the latest medical technologies.

How does the speaker differentiate between 'socialized medicine' and 'universal healthcare'?

The speaker differentiates the two by explaining that 'socialized medicine' refers to government-operated healthcare, while 'universal healthcare' refers to healthcare coverage for all, which can be provided through a mix of public and private entities.

What is the speaker's main concern about healthcare reform in America?

The speaker's main concern is that healthcare reform in America has become overly politicized, with slogans taking precedence over constructive debate and meaningful evaluation of what constitutes a good healthcare system.

What does the speaker suggest as the criteria for evaluating a good healthcare system?

The speaker suggests evaluating a good healthcare system based on patient satisfaction with the care they receive and whether the care provided is worth its cost, rather than the extent of government involvement.

Outlines

00:00

🌍 Debating the Best Healthcare System

The paragraph begins with a discussion on the question of which country has the best healthcare system. The speaker expresses dislike for this question due to its subjective nature, emphasizing that the answer varies based on what one values in a healthcare system. France is noted as leading in global health rankings, but the speaker cautions that what works in one country may not be applicable elsewhere. A 'tournament of health systems' was conducted by the speaker and colleagues, where no system was universally favored, indicating the complexity and subjectivity of evaluating healthcare systems. The United States is highlighted as consistently ranking low among developed nations, yet the speaker advocates for skepticism about definitive answers, given the diversity of effective approaches across different countries and settings.

05:01

📊 Healthcare Outcomes and Spending

In this paragraph, the focus shifts to the relationship between healthcare spending and outcomes, specifically life expectancy. The speaker uses a comparison of life expectancy at age 40 against healthcare costs per person to illustrate that while the US spends a significant portion of its GDP on healthcare, its life expectancy improvements have not kept pace with other countries. The speaker critiques oversimplifications of foreign healthcare systems and clarifies misconceptions about 'socialized medicine' versus 'universal health care.' The paragraph concludes with a critique of the polarized debate in the US, which often revolves around slogans rather than substantive evaluation of healthcare systems based on patient satisfaction and value for care received. The speaker suggests that while some individuals without insurance might be better off in other countries, the US remains a leader in treating certain diseases and providing access to advanced medical technologies.

Keywords

💡Health Care System

A health care system refers to the organization and management of health care services, including preventive, curative, rehabilitative, and palliative care. In the video, the discussion revolves around evaluating the effectiveness and efficiency of different countries' health care systems, with France being noted as a top performer in world health rankings.

💡Universal Health Care

Universal health care is a system that provides health care coverage to all citizens, regardless of their ability to pay. The video script mentions that while many countries have universal health insurance, the structure and providers can vary significantly, from government-run to private entities.

💡Socialized Medicine

Socialized medicine is a system where the government owns and operates health care facilities and employs medical staff. The script distinguishes between socialized medicine and universal health care, noting that countries like Britain have socialized medicine, while others have universal coverage through different structures.

💡Health Outcomes

Health outcomes are measures of the end results of health care, such as life expectancy, infant mortality rates, and disease prevalence. The video discusses how the U.S. lags behind other countries in health outcomes despite higher health care spending, indicating inefficiencies.

💡Cost-Effectiveness

Cost-effectiveness in health care refers to the value for money spent on medical treatments and services. The script emphasizes the importance of evaluating whether the benefits of treatment are greater than the costs, suggesting that a good health care system should optimize this balance.

💡Equity

Equity in health care means that services are distributed fairly among different groups in society, regardless of their socio-economic status. The video touches on the importance of equity, questioning whether the rich are willing to support the poor in health care.

💡Access

Access to health care refers to the ability of individuals to obtain appropriate and affordable health services. The script highlights that a good health care system should provide access to care, suggesting that the U.S. system has issues with access for the uninsured.

💡Quality of Care

Quality of care pertains to the standard of health services provided, including safety, effectiveness, and patient satisfaction. The video implies that while some may view other countries' health care as inferior, quality can be high in systems that balance cost and access.

💡Health Insurance

Health insurance is a type of insurance that covers the whole or part of the risk of a person incurring medical expenses. The script discusses different models of health insurance, from socialized to private, and how they impact the overall health care system.

💡Partisanship

Partisanship refers to strong political bias or commitment to a particular political party or viewpoint. The video script criticizes the partisan nature of health care debates in the U.S., suggesting it hinders constructive discussions on improving the system.

💡Socioeconomic Factors

Socioeconomic factors encompass elements such as income, education, and social class, which influence health and access to health care. The script implies that a good health care system should consider these factors to ensure equitable access and outcomes.

Highlights

The question of which country has the best health care system is subjective and depends on what values are prioritized.

France is often cited as having a top-ranked health care system, but its applicability to other countries is limited.

A health care system's effectiveness can vary widely, even among experts, as seen in a 'tournament of health systems' conducted by The New York Times.

The United States is often noted as lagging behind other developed nations in health care outcomes despite high spending.

A good health care system should improve public health, have cost-effective treatments, and reflect societal values.

The concept of 'socialized medicine' is often confused with 'universal health care,' which refers to insurance coverage rather than government operation of care.

Countries like Britain have socialized medicine with government-run hospitals and employees, while others have universal health insurance through private companies.

The debate on health care reform in the United States is often hindered by politically charged slogans that shut down constructive discussion.

Evaluating a health care system should be based on patient satisfaction and the value of care received, rather than the extent of government involvement.

For those without health insurance in the US, other countries may offer better care, but for many diseases, the US is a preferred destination for treatment.

Health care costs have risen over time, but the US has not seen a proportional increase in life expectancy compared to other countries.

The US is an outlier in terms of both health care spending and life expectancy, indicating a potential misalignment of resources and outcomes.

There is a perception among some Americans that other countries have inferior health care with long waiting times, which is not universally true.

The interview suggests that while other countries have strengths in their health care systems, they also face challenges that the US has yet to solve.

The goal for the US health care system should be to maximize health improvement, protect from financial ruin, and align with societal values.

The interviewee expresses skepticism about the feasibility of achieving an ideal health care system in the US given current political and economic challenges.

Transcripts

- I want to start with a simple question.

Which country in the world has the best health care system?

- Yeah, so, I hate that question.

Here's where you should ask me why I hate that question.

- I knew you were gonna start with that question.

I think it's a question that a lot of people ask --

which country has the best health care system?

- I don't think there's a correct answer to it.

- It depends on what it is that we value.

- I'll give you an answer, but then I'll tell you

why the answer might not be applicable.

If you look at the world health rankings,

the country that came out on top is France.

I think, in general, starting from France

and working northern,

you tend to get the best health care systems.

But the reason why it's not entirely applicable

is that what works in one country

may not work in another country.

- So, just a few years ago,

I wrote a piece in "The New York Times"

with my colleague, Aaron Carroll.

We actually did a tournament of health systems.

It was like a bracket tournament the way

March Madness is a bracket tournament,

or a tennis tournament.

And we had me and Aaron, Uwe Reinhardt, Ashish Jha --

a physician, now Dean of Brown --

and Craig Garthwaite -- an economist at Northwestern.

And we each voted in each of the brackets --

in each of the pairings --

for which system we liked better.

And we ultimately got a winner, but one of the important

take-aways from that whole process

is that in no pairing did any country win 5 to 0.

There were five of us, right?

We were not unanimous in any decision.

There was always at least someone who disagreed,

and in many cases, it was 3 to 2.

And we each had different reasons.

Someone was very big on the cost, equity, access,

or the quality.

Look, this is five people who know health care pretty well

and know these systems pretty well,

and we couldn't even agree.

So, there's just no clear winner, actually.

- But the one thing that stands out is that among

all major developed nations, it's pretty clear

that the United States comes in dead last.

- On the other hand, I think everyone --

especially experts --

should be skeptical that they know "the" answer.

Because what works in one country or one setting

doesn't necessarily work in another.

- So, there are aspects of the Australian system I like.

There are aspects of the English system I like.

But I don't think that there's a system

we could just bring over here and install like a new fridge.

- So, maybe the better question is,

what would the best system for the US look like?

- And what would that look like?

- So, a good health care system or a good --

Yeah, let's just call it a health care system.

A good health care system has, to me, several attributes.

One is --

-How does it affect our health as a country?

- How long is it that people are living?

What is the infant mortality rate?

What is the rate of certain types of diseases,

and how well are they doing in prevention?

- And the second question I'd want to know the answer

to is, were the benefits of the treatment greater

than the cost of the treatment?

- A bad health care system could have overspending on care

that's of really questionable health benefit at the same time

that it has under-spending on health care

that's of vital importance to people.

So, when people say, "Do we spend too much on health care?"

We spend way too much on some things

and way too little on others,

so a good system would fix both problems.

- And the third dimension for a health care system is,

how well does it reflect our values as a society?

- And by values, I mean --

What are the rich willing to do for the poor?

What are the healthy willing to do for the sick?

The answer to that doesn't come from economics.

It's an answer that we all have within us.

But that answer profoundly effects how you answer questions

about what's good and bad about health care.

- And I would hope that, going forward,

as we think about the learnings from other countries,

we can take a hard look at what it is that we have

and whether they align with our core principles

that we otherwise hold so dear.

- So, my goal is, have a health system

that does the most it can to improve our health,

that protects people from financial ruin,

and that conforms to our values as a society.

- So, yeah, that would be the right thing to do in principle.

The next question should be, can we get there from here?

And I just don't see it.

- What we've seen over time is that the costs of health care

have gone up, but outcomes have also improved.

So, if we take some measure -- and the measure

that I like to use is life expectancy at age 40 --

and then I look on the other axis at the cost

of health care per person -- And what you find is,

if you look back to 1976 -- -All of these countries --

the US, Germany, Canada -- look similar in terms

of what share of GDP goes to health care.

- And people are living about 35 years after age 40.

Okay. - Fast forward 20 years,

and the US is spending a lot more of its GDP on health care,

and its life expectancy increases have not kept up

with the life expectancy increases in other countries.

- So, the US becomes increasingly an outlier

both in terms of outcomes --

that is, life expectancy -- and in terms of spending.

- Now, you can put the two on the same graph,

but that doesn't mean that they're related in any way.

I think we're simplifying the other health care system

to the point of getting it totally wrong.

But a lot of it depends on who you're talking to, right?

I think there's a view that some Americans have that,

in other systems, care is terrible.

There's very long waiting lines and waiting lists;

that the latest medical technologies

are routinely not available.

I think for a lot of other Americans,

there's this view that other countries

have just figured it out,

and what we should be doing in the United States

is copying what they've already figured out.

And I think both those views are not right at all.

- So, I think people mix up this term

called "socialized medicine"

with what I would call "universal health care."

- One is the insurance part -- that is, who runs the insurance.

And you can have socialized insurance --

where the government is running the insurance

or private insurance or private companies, or both --

and then, second, there's the providers of medical care,

who could be either government-run employees

or private employees.

- There are some methods that one could classify

as being socialized medicine,

meaning that the government is the single payer.

The government operates all the health care,

and people belong to a single government system.

- So, Britain has socialized medicine,

because the hospitals are government institutions,

and the physicians and nurses are government employees.

- And France has yet a different kind of a system,

also not government-owned.

And Switzerland, Netherlands, Germany --

these are places that have universal health insurance,

but they have active and important private health

insurance companies that administer it.

So, very different structures of these systems.

The thing that they share in common

is that they're universal.

- So, I think, coming full circle,

my great worry with health care reform in America

is that it has collapsed to the level of fighting

and arguing about these slogans,

and the slogans have nothing real behind them.

- These slogans have become so politically charged and tied

to a particular candidate or a particular viewpoint

that has become completely partisan

and will shut down constructive debate.

- And if you go back to what I was talking about --

how do you evaluate a good health care system --

you don't evaluate it

by the share of government in the system.

You evaluate it by whether patients

want the care that they get

and whether the care the patients get is worth it.

I think that other countries have great hospitals,

cover a lot of medical treatments,

have fantastic doctors.

And at the same time, they have not figured out

a bunch of things that we have not figured out.

So, if you are the kind of person

who's going without health insurance

in the United States -- -I hate to say it,

but I think they are better off

in many other countries than here in the US.

- But for a lot of diseases -- for a lot of people,

regardless of income -- this is probably the country

where you would like to get your health care.