Paying More and Dying Sooner

WASHINGTON — It turns out that Rudy Giuliani knows even less about health care than I thought. Not only are his figures about prostate cancer survival rates in the United States and Britain wildly misleading, but he’s also wrong on his general point: that a single-payer system, of the kind that Republicans call “socialized” medicine, inevitably would deliver inferior care.

Untrue, according to a major study conducted earlier this year by the Commonwealth Fund, a respected New York foundation with a track record in health care stretching back to 1918. Not that candidate Giuliani is likely to pay attention — he won’t even back down from his ridiculous assertion that he was nearly twice as likely to survive his bout with prostate cancer in the U.S. than he would have been in the UK, despite the fact that death rates from the disease in the two countries are basically the same.

For Giuliani, it appears, all that’s needed to establish truth is a simple assertion: “Because I said so.”

The Commonwealth Fund and Harris Interactive surveyed adults in Australia, Canada, Germany, the Netherlands, New Zealand, Britain — all of which have single-payer health care systems — and the United States. The methodology appears sound, the margin of error is less than 3 percent and the results are striking.

Respondents in the United States were less likely than those in any of the other countries to say their health care system “works well” — and much more likely to see a need for “fundamental” change or a total overhaul. With 47 million Americans lacking health insurance, I suppose that shouldn’t be much of a surprise.

What did surprise me was the wealth of data refuting the general criticism that single-payer health care systems are cold, impersonal and, well, uncaring. According to the survey, 80 percent of Americans have a regular doctor whom they usually see. That sounds pretty good, until you learn that 84 percent of Canadians, 88 percent of Australians, 89 percent of New Zealanders and Britons, 92 percent of Germans and 100 percent of Dutch respondents surveyed said they had regular doctors. Marcus Welby, M.D., seems to have emigrated.

OK, but what about the long waits for treatment under single-payer systems? The survey found that 49 percent of Americans said they could get a same-day or next-day doctor’s appointment when they were sick — as opposed to 75 percent of respondents in New Zealand, 65 percent in Germany, 58 percent in Great Britain, and so on. Only in Canada was it more difficult to get in to see the doctor within 48 hours.

It’s true that in the United States, the wait for elective surgery is likely to be shorter than in the other countries (except Germany, which has the shortest wait of all). But onerous delays of six months or more were significantly more common only in Australia, Canada and Britain.

When you look at overall costs and outcomes, meanwhile, there’s no contest.

The United States spends $6,697 per capita annually on health care, according to the survey — more than twice as much as any of the other countries surveyed. Americans were much more likely than any other national group to have spent at least $1,000 out of pocket on medical expenses over the past year. And, of course, 16 percent of Americans reported being uninsured, as opposed to essentially none in the other countries.

It makes sense, then, that far more Americans than respondents in the other countries reported that in the past year they had failed to fill a prescription or skipped doses, experienced a medical problem but decided not to go to the doctor, or skipped a prescribed test, treatment or follow-up.

And here’s the bottom line: The United States ranks dead last in life expectancy, at 77.9 years, among the countries surveyed. Britain is next-to-last at 78.7, while Australia is first at 80.6. The United States also has the worst infant mortality by far, at 6.89 per 1,000 live births; second-worst is New Zealand at 5.7. We’re paying more and dying more, or at least sooner.

American doctors do tend to give patients more information, and thus involve them more meaningfully in their own care. That’s a good thing, and I’d hate to give it up.

In fact, I didn’t set out to write a brief for a single-payer health care system. I lived for a while in London, and felt that the UK’s National Health Service had pluses and minuses. I agree with Giuliani that if I had a life-threatening illness, I’d rather be treated here.

But I have health insurance. Millions of Americans don’t.

Eugene Robinson’s e-mail address is eugenerobinson(at)washpost.com.

© 2007, Washington Post Writers Group