John Stossel


Predictably, the study begins: "Despite having the most costly health system in the world, the United States consistently underperforms."

I was immediately suspicious, considering the loaded study by the World Health Organization seven years ago. (I wrote about it last week.)

My suspicion was justified. It turns out the new study is almost as biased as the WHO's. The authors write, "The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes."

I see. America "underperforms" because we don't have enough government intervention.

But while the U.S. lost points for not having national health insurance, the authors added, "[I]f insured, patients in the U.S. have rapid access to specialized health care services."

That's an understatement. Insured Americans have almost immediate access to cutting-edge procedures performed by some of the best-trained doctors. It's why our outcomes for such diseases as prostate and breast cancer are markedly better than in Canada's and Britain's socialized systems. The Commonwealth Fund doesn't mention that.

The United States is the center of medical innovation for the world. When internists ranked the world's top 10 medical innovations, eight were developed thanks to American innovations. The Commonwealth Fund ignores all that and focuses almost exclusively on the problems of our uninsured population.

As I've noted previously, the problem of the 45 million uninsured is exaggerated. The statistics represent a snapshot, and many uninsured people are reinsured in less than a year. The same people are not uninsured year in and year out.

The Commonwealth Fund study divides "quality" into right (effective) care, safe care, coordinated care and patient-centered care. The U.S. placed fifth or sixth in the last three.

But where did the U.S. place in "right care"?


"Right care" is the most important criterion because it includes things like how often women have mammograms and whether diabetics get proper treatment.

The Commonwealth Fund ranked the U.S. last in "equity": "Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick, not getting a recommended test, treatment or follow-up care ... because of costs."

But how much of that is due to the government's increasing the cost of care and insurance through mandates, a tax code that encourages reliance on expensive insurance and bureaucratic red tape?

The Commonwealth Fund's study has other problems. It was based on telephone interviews with patients and doctors. So it grades nations on people's perceptions without controlling for their expectations. Yet patients who live in a country with long waits for medical care and bureaucratic inefficiency may have low expectations.

More ridiculous is the arbitrary way the Commonwealth Fund assigns weight to each of its measures. The proportion of patients who say they got infected at a hospital counts about the same in the "quality" measure as the proportion of doctors who use automated computer systems to remind them to tell patients their test results. Those things aren't equal in my book.

The study's authors also consider having high administrative costs and spending the largest share of GDP on health care worse than having the highest share of patients who wait four months or more for surgery. This seems designed to make the U.S. look bad.

Finally, the study penalizes nations for having large numbers of patients who spent more than $1,000 on medical care out of pocket, as if third-party payment is somehow superior.

Michael Cannon, the Cato Institute's director of health policy studies, summed up what's wrong with the study: "The report does nothing more than reveal which nation does the worst job of satisfying the subjective preferences of the people who conducted this study."

Fans of the Canadian system should note that Canada ranked fifth out of six and did worse than the U.S. in many ways.

Are you listening, Michael Moore?

John Stossel
