How do they achieve what you call impossible?
It just so happens that more health care doesn't necessarily translate to measurably better outcomes (e.g. cancer screening helps reduce mortality for some cancers but not others).
It also just so happens that it's very rare to study whether a particular care regimen actually improves overall outcomes as opposed to just the thing it's ostensibly aimed at treating. Continuing our cancer example, cancer screening helps reduce mortality from _cancer_ for almost all if not all cancers, but for some the increased mortality from operations and other cancer therapies cancels out the improvement.
That's not to mention the fact that people in the US prefer to get care even if they know it'll likely make them worse than not getting care. I'll dig up the reference for this; I don't have it offhand.
But as examples:
http://www.ncbi.nlm.nih.gov/pubmed/2268793 (2.5x more coronary artery bypasses per capita in the US than in Canada in 1988; admittedly somewhat dated).
http://www.pillsforall.com/blog/cardiac-stents-are-used-twic...
I realize that's pretty weak support; I don't have anything better off the top of my head, unfortunately.
How do you defined "more health care?"
Yes, exactly.
> Could we save money and get the same outcomes?
That seems like an obvious corollary of the above... But yes, I think we could.
> And since we get worse outcomes then they do
Not necessarily worse; just not better. Measuring and comparing outcomes across different populations is hard enough that it's hard to say more than "our outcomes are not clearly better than theirs".
> could we spend less and still get better outcomes?
This question is based on a premise which doesn't seem to be true, so probably no.
> How do you defined "more health care?"
Number of procedures per capita per year for various procedures is a reasonable measurement (where procedures can be MRIs, surgeries of various sorts, etc, etc). Usually people focus on the expensive end of this, by the way; having more physical checkups won't necessarily blow up your healthcare costs the way that more invasive cancer surgeries will.
"Number of procedures per capita per year" is a horrible measure. It assumes that procedures done is a good proxy for overall health, which it isn't. Public health (clean food and water, trash pickup, promoting exercise and outside activities, cutting down on smoking, etc) is also important.
Here's a scenario. Country A and B are identical except that country A has pushed for potable water and B has not. As a result, 10% of the procedures in country B are from dysentery, cholera, and other water-borne diseases which are relatively cheap to treat (keep hydrated with a solution of salts and sugar). As a result, country B has more doctor visits per capita, and on average these costs are cheaper than in country A. Country B also has lower life-expectancy, more days sick per year, and other measurable outcomes.
By your definition, country B has the better health care system but I think most people would prefer the overall health of country A. Therefore your measurement is not so useful as an indicator of overall health outcomes.
My whole point is that it's not a good proxy for overall health. However it _is_ a good proxy for amount of money spent on the system. Which is how you can end up spending more but not getting better overall health.
Do read what I said again. You're arguing against a strawman.
Which
Reference for this, too, please.
I say it because many many many other places subsidize healthcare at least as much as America does. And people don't seem to count the taxes they pay as part of the monthly cost.
edit: edited my top comment, sources are there. Canadians, famous for cheap healthcare, pay $324 per month per person for healthcare. The government covers $227 of that, which means $227 per person per month comes from taxes.
We beat Japan on life expectancy, provided you restrict the comparison to people of Japanese descent. Japanese Americans live 84.5 years on average, Japanese only 82.6.
http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2...
http://www.google.com/publicdata?ds=wb-wdi&met=sp_dyn_le...
(Would love to see data doing similar comparisons to other G8 nations.)
That's despite people of Asian descent in the US having higher income and education than the average, both of which are positively correlated with life expectancy.
Even if it is true, I'm not sure what the significance would be. I would be surprised if you couldn't pick out many subgroups in the US which do better in the US than in their places of origin, without it supporting an argument about the quality of the overall system.
Even if it is true, I'm not sure what the significance would be. I would be surprised if you couldn't pick out many subgroups in the US which do better in the US than in their places of origin, without it supporting an argument about the quality of the overall system.
Very true. To actually make the argument you are trying to make, you'd actually need to do a carefully controlled study. But most such studies (which include ethnicity, rural living, diet, etc as predictors) actually show no significant relationship between marginal changes in health care and health outcomes.