The American healthcare system provides more incentives than countries with "socialized medicine" to doctors and hospitals
to provide better quality care.
The United States also lags behind other countries in the use of "pay for performance" incentives, which are larger, and have
been introduced earlier and on a wider scale, in Europe and some other countries.
Because Americans spend more on healthcare than people in other countries, more services are available to them.
The United States has fewer physicians, nurses, and hospital beds than a number of other western countries, and far fewer
MRIs than Japan.
In countries with single-payer systems, people are not free to choose their own doctors.
In most—possibly all—of these countries, people are free to choose their primary care physicians, if not their specialists.
The public welcomes consumer-driven care and wants to be empowered to take personal responsibility for its own healthcare.
So-called consumer-driven healthcare is really driven by employers and insurers. "Empowerment" and "personal responsibility"
are code words for increasing out-of-pocket costs, which is not something the public wants or welcomes.
If information on the quality of care provided by different doctors and hospitals is available, most people will use it.
The great majority of people who have seen information comparing the quality of different hospitals, physicians, and health
plans do not make decisions based on this information. Rather, they make decisions based on word of mouth, location, and
Patients are the best people to decide which care is appropriate and which is marginal or inappropriate.
Throughout the history of medical care, most patients have relied on the advice of their doctors to determine what care is
and is not appropriate. It is difficult for a patient who is afraid or in pain to make those decisions.
Malpractice insurance and defensive medicine are major reasons why American medical care is so expensive.
Research suggests that this may account for one or two percent of healthcare spending (which is, of course, a lot of money).
But no economists include these on their lists of major causes of high US healthcare costs.
The United States has the best healthcare system in the world.
Ten or 15 years ago, I heard this said at many healthcare conferences around the country. But, I have only heard it once in
the last few years, in a videotaped address by President Bush to the 2006 World Health Congress in Washington, DC. We have
many wonderful hospitals, doctors, and nurses. We have the latest in high-tech care. But it is difficult to find any important
criterion on which our system is demonstrably the best. It is by far the most expensive and, compared with many countries,
the least equitable and the least efficient, and one of the most unpopular.
The good news is that, as more good information about healthcare systems becomes available, we can distinguish myth from reality.
In addition, more people recognize that we can learn a great deal from the best practices in other countries without necessarily
adopting their healthcare systems.