The best test of the WHO healthcare rankings

Micheal Moore, in his entertaining and heart wrenching dramedy Sicko, mentions the fact that the U.S.A. ranks 37th in the World Health Organization’s health care rankings. Megan McArdle (fka Jane Galt and fka Economist blogger) points to the criticisms of John Stossel ((who you might know from such shows as Good Morning America and 20/20)), but also, she comes up with a pretty good mechanism for ranking health care systems:

[O]ne would hope that the WHO rankings would reflect, to a first approximation, where you’d rather get sick. Does anyone really think that they’d rather be the average consumer of health care in Colombia, than in Columbus, Ohio?
But what about the worst off, you might say? What about them? The WHO table isn’t even a good ranking of where I’d prefer to be poor. I’d far rather be an uninsured day laborer in San Francisco, than in the Dominican Republic. For that matter, I’d rather be uninsured anywhere in the United States than an average citizen in Costa Rica.

This is about right. We should survey experts familiar with various health care systems to ask them where, if they were poor ((by developed world standards… this actually biases the survey against America)), they’d rather be sick. We could be more specific and ask where the experts would like to be treated for various conditions or illnesses.

5 thoughts on “The best test of the WHO healthcare rankings”

  1. I’d far rather be an uninsured day laborer in Berlin, than in the District of Columbia.

    Almost every line in the John Stossel piece you link to reads like something out of The Onion.
    -The rankings are faulty because they don’t account for our much higher murder rate, fatal traffic accident rate, or the generally poor diet and exercise practices of our citizens.
    -The rankings are faulty because the American government forces people to buy expensive insurance, whereas socialized countries only force their people to pay for expensive insurance, therefore we’re better.
    -The rankings are faulty because 1/3 of our poor households don’t use the government programs that, ahem, shouldn’t need to exist in a true free market society.
    -The rankings are faulty because lots of the uninsured make enough money but don’t have insurance, therefore they should be counted as insured (maybe the government hasn’t gotten around to forcing them to buy coverage yet).

    The US ranks at the top for quality of care and innovation, therefore that should be considered in our rankings. That’s kind of like saying “I got an A+ in Chemistry, therefore some of that grade should be counted toward my failing grade in English.”

  2. If you see health care as a market, then those onion-esque critiques sound less oniony. Maybe you think the murder rate should be lower, Americans should be skinnier and the government should buy stuff for people. That’s great, but those things aren’t measuring the quality of health care. They’re measuring the rate of violence, overeating and social democracy… none of which fit in the “heath care” category.

    Fine. Berlin. But Oman is ranked a head of Germany. Also, I don’t think you qualify as one of the “experts familiar with various health care systems.”

    And I fully expect you to fly to Berlin if you need major surgery. Surely the plane ticket would be a small fraction of the total cost.

  3. The really Oniony part is the first part of his argument where he more or less says “Aha! Those idiots forgot to account for our much higher violent death rate. Take that!”

    Fine, Muscat. Or Barcelona, Naples, or Liverpool.

    Why do I need to fly to Berlin for surgery? I actually have medical coverage at the moment, and US medicine is quite good, when you can pay for it. If I broke my leg or developed an infection in Berlin, though, I’d probably accept treatment there, if it were offered. I’m not talking about the best coverage available for me. That’s right here.

    You didn’t address his weak point that many of the uninsured make over $50k/year. I’m not sure exactly where he was going with this, because he kind of trails off at the end of that paragraph. I think he’s implying that most of those people choose not to have insurance, and therefore shouldn’t be counted. Yes, I’m sure that some of them really choose not to have insurance, preferring to pay cash for services. I wonder how many have been denied coverage, due to pre-existing conditions or poor genes. OK, maybe they should pay more, which would incentivize people to pick better parents. That’s great.

    Can you link to any stuff about insurance mandates? I thought insurance was expensive because of rampant fraud. Or doctors’ cartels.

  4. “Ask the experts” seems like it would guarantee skewed results anyway, since every expert will have their own bias, and the group selecting the experts will have their own bias.

    In what other ways can you quantify quality? Mortality rates for preventable or treatable diseases? Infant mortality rates? Medical tourism rates? (Your boy Stossel up there takes a swing at that one). Some composite of those?

    Somehow, I think a totally different set of people would be questioning the methodology if the US had come out on top of the WHO rankings.

  5. “In what other ways can you quantify quality? Mortality rates for preventable or treatable diseases? Infant mortality rates? Medical tourism rates?”

    I think the point is that its not easy to quantify these things. That said my gut instinct tells me something is wrong with the U.S. being ranked so low in the WHO standings.

    Its not clear that if we went to a European social democracy system that the great health care covered people get will still be as great. I’ll bet dimes to donuts, innovation will plummet. Health care would be more equal, but it would be equally so-so.

    I’m not sure why insurance is expensive. I think a big chunk of it is that it comes bundled with your job and malpractice lawsuits are widespread. The first causes information problems where the people paying for the care are far removed from those consuming it. The second is a problem in combination with the first because doctors will over-service patients (e.g. order more tests than necessary, prescribe more expensive drugs than necessary, etc). Insurance companies will, of course, attempt to stop this, but no one but the patient is in a better position to know better and because they’re not paying, they don’t care.

    Also, we have social norms to try to do everything for dying patients. I think this is true in America more than other countries. We really, really don’t like dying and the last moments of peoples lives are the most expensive… We’re far away from the supposed Inuit norms of sending their old folks out on the ice to get eaten by polar bears.

    That said. I’ve been directly or indirectly paying hundreds of dollars a year for medical insurance, but I’ve yet to use any major medical services. I think I got a shot once to clear up some bad poison oak rashes. Its not obvious that it makes sense for me to have paid all that money, but I did because I was obliged to (through work or school). Young healthy people buying health insurance is sorta like buying extended warranties. Most always it doesn’t makes sense and on average they come out way behind. Of course there’s the occasional catastrophe like my mom’s back or your little tumble down that hill. But for those cases, why isn’t there a market for catastrophic coverage which, I’d suppose, would be much cheaper?

    What this means, though, is that lots of people are making rational decisions not to buy insurance like most people make the rational decision not to buy extended warranties. I don’t see anything wrong with letting people do that, but… BUT, I should be expected to pay for it when they do fall down that hill. If they’re willing to take that gamble (and its a pretty good gamble) then they should bare the costs if things go bad.

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