Missing Fact on British Health Care
The New York Times had an interesting piece on the poor state of the dental care provided by the British public health care system in its Sunday paper. The article reports that people face long waits for even emergency dental care, and that many now turn to private dentists or go to foreign countries for treatment.
Readers naturally feel sorry for the plight of Britons with bad teeth and are thankful that here in the United States we have an efficient private health care system. The key fact missing in the story is that Britain spends less than 40 percent as much person for its health care as the United States. Whatever the relative merits of the British mechanism for providing health care and the U.S. system, it would be truly astonishing if the British system could best the U.S. in every category, spending just 40 cents to our dollar. (Britain does much better on life expectancy for its 40 cents.)
This article is part of a long series of articles in the New York Times which could go under the title of “the problem of publicly financed health care systems.” Previous articles in this series have noted problems in French, British, and most often the Canadian health care systems. Articles in this series almost never mention the fact that the health care system in question costs far less than the U.S. system or that it produces longer life expectancies. My guess is that most of the highly educated readers of the New York Times are ignorant of these basic facts about health care, even though Paul Krugman has done a heroic job of trying to fill the information gap in his columns.


22 Comments:
At 10:24 AM,
Anonymous said…
Different priorities in health care account for much of the difference in health care spending between the United States and Europe. Here in America we do not accept any limits whatsoever on end-of-life care, willingly spending huge amounts of money keeping dying people alive for a few days or weeks longer even when it's obvious that the chances of long-term survival and quality of life are both zero. It's no surprise that some huge percentage of the typical person's lifetime health care expenditures take place in the last 30 days of life. Europeans seem more accepting of the fact that no one lives forever, and understand that spending huge amounts delaying the inevitable for a few more days benefits no one, especially not the dying patients. Until we get a more realistic view of life and death, America's runaway health care spending will never be brought under control.
I also believe that Europeans are more focused on preventative care, while here in the United States no one seems to care and we instead spend huge amounts of money dealing with medical problems that could have been prevented, or treated when still minor, at far lesser cost.
Peter
Iron Rails & Iron Weights
Peter
At 1:01 PM,
Finnsense said…
You would be hard pressed to even find an NHS dentist in Britain. The fact is that, except for the poorest of the poor, no-one uses NHS dentists.
At 6:13 PM,
Anonymous said…
Dean, I love your blog, but your bias is showing with this post.
At 9:19 PM,
Anonymous said…
how does his bias show by pointing out that important information is not being supplied?
If the same article had not mentioned any problems with the British system, but kept saying "they save 60% with their system!" then it should be pointed out that information is missing, as well.
At 12:01 AM,
adam said…
Just wondering, is there a problem if Dean, on his own blog, shows his bias? Not that I think there's any bias in his most recent post - and the burden is on you to prove otherwise - but if it was, so what?
At 11:51 AM,
Madashell said…
Ok, so NHS dental coverage is inadequate. Big deal. What percentage of Americans have any comparable dental coverage at all? Except for the few who have access to good dental plans through their employers (a small percentage, I would imagine),or those for whom just writing a check for hundreds or thousands of dollars is no problem, how many Americans simply "go without" because they cannot afford to pay for private insurance or, heaven forbid, pay for the care directly? My 88 year old mother in law recently had to fork out hundreds of dollars recently to have a set of painful old dentures refitted--and no, Medicare does not cover dental care.
At 11:56 AM,
Erik L said…
Hi-
I take exception to using life expectency as some kind of measure of the quality of healthcare in a country. I don;t think we know all the factors that affect this aggregate number but I suspect the overwhelming majority of them do not have to do with a doctor diagnosing and treating a patient. Population distribution of genetic characteristics, factors that affect infant mortality, quality of plumbing, diet, vaccination rates; these are all things that can have a large effect on that number and they have little to do with how we pay for healthcare.
At 12:16 PM,
dale said…
Eric,
We know that inequality in it's various forms affects longevity.
Of course, the lack of health insurance, in and of itself, is one of the signs of low social ranking- that is one of the signs of inequality.
So, above and beyond the actual medical effects of having access to medical care we have the social effects of low status, exclusion from the community. These symbolic inequalities create poor health, shorter lives just as bad luck in genes and environmental pollution do.
At 12:51 PM,
Dean Baker said…
Erik,
there are of course many factors that can explain differences in life expectancy. It is also not always clear where the health system's responsibility begin and ends (vaccines can be seen as a responsibility of the health care system).
It strikes me that life expectancy is a good place to start an assessment of the quality of the health care system just as income per capita is a good place to begin an assessment of the effectiveness of a country's economic system. There are many reasons why we may say that a country with a lower per capita GDP actually has a better economy than a country with a higher GDP per capita, but until some other factor can be identified, I would be inclined to say that the country with the higher per capita GDP is doing better.
So, with health care, until we can get a clear explanation as what factors other than the quality of the U.S. health care system leads to bad outcomes, it seems fair to assume that the shorter life expectancy in the U.S. implies a less effective health care system.
At 2:51 PM,
Olaf said…
I'm not sure that Dean's criticism is on point. To begin with, even if this is about why private health care is better, wouldn't a private system allow that 40 percent figure to adjust to something more reasonable? One of the features of a public system is that the funding is, loosely speaking, fixed. But I'm not sure the article is even about the public/private choice. If funding is determined publicly, then its articles like this, articles that point to problems and say that "Britain has too few public dentists for too many people," that, according to my civics 101 class, prompt change (to say nothing of the fact that this is coming from a former colony!).
At 3:09 PM,
kmorford said…
The single largest factor affecting life expectancy is the infant mortality rate. This is because the quality of health care for adults will usually make a difference of only a few years in life expectancy, while the death of an infant makes a lifetime of difference. Publicly funded health care tends to do a much better job of ensuring that all infants receive the health care they need to survive. This in turn greatly increases life expectancy for the entire population. I like to judge a civilization (and a health care system) by how it treats its least powerful residents.
At 3:11 PM,
Erik L said…
Dean-
by your reasoning the people of the UK should not complain about lack of dentistry because it has little to no effect on life-expectancy in the country.
Let me tell you, when (god forbid) you go to the doctor and he tells you he thinks you may have a tumor and wants to send you for an MRI you will place incrdibly high value on getting your result quickly. In fact, I dare say that if you could bargain with the devil and give up the last few months of your life in your late nineties in exchange for having that incredible anxiety removed a few weeks early, you would likely take it.
The healthcare system has to allow people to value such things and represents the main problem with substituting government comittees for market forces.
At 4:50 PM,
mike said…
Erik: What relevance do market forces have to folks who have neither adequate income nor health insurance?
Do you think the nearly 50 million Americans, (including 10 or 15 million kids,) who have no health insurance are grateful that the market is doing such a wonderful job of allocating health care resources?
At 5:00 PM,
Dean Baker said…
This is really quite striking to me. I was making a point that the price of a health care system is a relevant factor in any discussion that is implicitly comparative (the NYT was writing for U.S. readers, not to prompt the British to improve their health care system.)
I didn't think that this claim about price being relevant would be so controversial.
At 10:18 PM,
Anonymous said…
Dean wrote:
So, with health care, until we can get a clear explanation as what factors other than the quality of the U.S. health care system leads to bad outcomes, it seems fair to assume that the shorter life expectancy in the U.S. implies a less effective health care system.
-----------
But we can identify other factors. Besides infant moratility, the US higher GDP/capita and cheaper food encourages obesity in the US beyond that of the UK. A better road system and gas that is almost 50% cheaper fuels this obesity trend as well...
At 10:18 PM,
Anonymous said…
Erik L wrote, The healthcare system has to allow people to value such things and represents the main problem with substituting government comittees for market forces.
Huh? What's market forces got to do with it, at least in the US?
Insurance, be it public or private, cannot cover everything.
At 8:35 AM,
Erik L said…
Dean-
No controversy. I agree with your point that it is unfair to compare what is delivered by the two systems when one spends far less than the other. The fair comparison would be between a government system and a whatever you call our system (corporate socialism?)spending equal amounts.
My point about market forces remains. When a government sets the policy you get what you have in britain- far less spending on healthcare.
Having, for example, many more MRIs in the US, benefits the uninsured as well. Those 50 million do not go without healthcare. The number of uninsured has always been a misleading statistic.
I think the system in this country sucks BTW.
At 2:42 PM,
Anonymous said…
a propos this discussion, there is an excellent article in the New Yorker by Malcolm Gladwell pointing out the basic fallacy in a "health care system" that doesn't cover one's teeth or eyes.
http://www.newyorker.com/fact/content/articles/050829fa_fact
At 4:17 AM,
Anonymous said…
They are robbing the suckers blind in the U.S. It is the American Way.
What are you? A communist or something?
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At 11:59 AM,
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