U.S. Pays Most for Healthcare of Any Industrialized Nation … But Ranks Worst for Healthcare

[Marenco]

U.S. Pays Most for Healthcare of Any Industrialized Nation … But Ranks Worst for Healthcare

The Commonwealth Fund reported last year:

The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. underperforms relative to other countries on most dimensions of performance. Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity. In this edition of Mirror, Mirror, the United Kingdom ranks first, followed closely by Switzerland

While UK residents averaged $3,405 per year on healthcare costs (the second-lowest, trailing only New Zealand), Americans paid $8,508 per year. And yet Commonwealth ranked the UK as number 1 for healthcare, and the U.S. dead last … 11th out of 11 industrialized nations.

Of course, Commonwealth’s main complaints with U.S. healthcare are access, efficiency and equity:

http://www.commonwealthfund.org/~/media/images/publications/fund-report/2014/june/davis_mirror_2014_es1_for_web.jpg?h=511&w=740&la=en

In other words, America’s extreme inequality – and lack of socialized medicine – means that healthcare is only good for those who have enough cash to pay for it.

http://www.washingtonsblog.com/2015/03/u-s-pays-healthcare-industrialized-nation-ranks-worst-healthcare.html

[muh_roads]

Strange seeing UK #1. Don't a lot of them sport shitty teeth?

[DamianTV]

I think there is a big difference between the two types of healthcare the two countries provide.

UK provides Socialized Health Care. Not that it is perfect, but in its nature, it is very different than the type of healtcare provided to the US.

US demanded Corporatized Health Care. Now that it is required by Law, it has become the worst form of health care possible.

The big difference between Socialized and Corpratized is in application. Socialized by its nature (while still not perfect) would seek to minimize the costs while maximizing effictiveness of treatment provided. Corpratized is the exact opposite. Maximum costs while providing the minimal form of treatment, which extends to even providing intentionally bad treatment so patients have to return for even further care. In Socialized health care (again, not perfect or that I am trying to advocate for such a system) actually treating the medical condition with minimal costs is the goal because to do so otherwise becomes a burden on the system. Unfortuantely, one of the many negative effects of Socialized Health Care is that Health related Behavioral Laws will be put into effect. Smoking will be the first thing to be outlawed, and will eventually extend to Salt, Red Meat, and other non food or consumption related issues like Skateboarding, Skydiving, Unprotected Sex, etc. Corpratized Health Care will result in a conflict between Insurance Providers and Health Care Providers, both of which will seek to maximize their profits. The Insurance will try to be similar to the Socialized version and get laws passed that regulate Human Behavior, eating foods deemed unhealthy (things like Aspartame wont be due to their high profit margins) and behavioral regulations. One of the faults with the Insurance is that they will seek to charge as much money as possible based on the behaviors of the insured. OMG watches too much TV, charge them more money! Smoker, charge more money! Eat bacon, charge more money! Too poor to afford to buy organic food, charge even more money! Other problem with Corpratized lies on the Care Providers side. As with any business, they will also seek to maximize profits while minimizing costs. It will be more profitable to amputate a leg than to treat a stubbed toe. The result is that Health Care turns into Fast Food. Get em in, give em as crappy of service as is possible, get em out, and make sure they come back again and again and again. Neither system works out for the Patient.

As usual, I think the Free Market Solution is the best, and get Govt the fuck out of it. Medical Practicioners will charge what patients can afford, and if they charge too much, they dont come back, or if they provide poor quality service, they also dont come back. Competition drives the quality, and getting Govt over-involved leads to the Elimination of Competition by application of Law, and prevents the naturally occuring progress in Quality to be undermined. Without that Competition, there is less incentive to advance medicine, and the burden of being healthy is placed completely on the individual, regardless if they have a path to positive personal health or not. We suffer for their profits in a country where Mandatory Insurance is the Law and actual Health Care is never ever the intended goal.

[Intoxiklown]

My wife is a healthcare provider, and if anyone thinks she cuts corners to make money, you've lost your fucking mind. Healthcare costs are up because of government involvement, and people who simply won't pay their bills. Period. Every patient covered by Medicare / medicaid or Obamacare means the provider is taking a loss right off the bat, as these plans don't offer full reimbursement. Throw in the MILLIONS of people who use ERs with no intent to pay, and you've really added more cost.

I don't fault medical people for charging a lot. Someone who goes to school for 10 to 12 years to specialize in something that provides life makes it hard to haggle with. I hurt my back last August, and had to have a neurosurgeon perform emergency surgery on me. Do you want to guess how expensive it is to have a brain surgeon operate on your back? I spent three days in a state of pain that 99% of the people on these forums don't have the ass to take, and was in danger of being paralyzed from the waist down. I am now pain free, and have 100% of use and mobility. He was worth every damn penny.

Some people hate on doctors over the most insane things.

[2young2vote]

Strange seeing UK #1.

I've read from many accounts that the UK has a very low quality standard for healthcare.

Unfortunately we have a private industry infested with government regulations and we all know what that means.

[angelatc]

Yep - they're marching right ahead with their demands for single payer. There is no stopping this.

[Carson]

It's amazing how much an employer spends on an employees health care. Since it's sort of out of sight and mind of the individual it seems they've been able to jack it up to the stratosphere.

The healthcare industry is held in check about as well as our global crazed military.

(Actually, "global crazed military" isn't very fair. It isn't so much them calling the shots now so much as they are just doing their duty.) ?

[Zippyjuan]

We do have some of the best health care in the world- if you can afford it. Unless you are rich or your employer has a healthcare program, you are on your own to see what you can afford. Nearly all of the European countries in the chart in the OP have national healthcare programs. It is fiscally impossible to offer every citizen of any country the highest healthcare in the world.

Perhaps ironically, our diversified number of health insurance plans (competition) to pick from is a major reason behind the costs of our system. Paperwork (overhead) is like 40% of healthcare costs in this country vs say 15% in Germany or Canada. Why? Paperwork. Thousands if not millions of different policies have different requirements of what to include and who to send it to for re-imbursment or even approval of treatments. This greatly adds to cost. With a single payer network the paperwork is all the same and can be streamlined.

[NorthCarolinaLiberty]

We do have some of the best health care in the world- if you can afford it.

And if you can't afford it, then you just have your president make someone else pay for it. Like me, a person who takes care of himself but now has to foot the bill for others.

You have a lot of nerve voting for Obama and making your gratuitous posts on this board.

[DamianTV]

I wonder what our Economy would look like if Employers were not involved in providing Health Insurance AT ALL?

One thing to note is this may not yeild good results across the board. While real Unemployment would probably go down, the number of people that can not afford access to Health Care (not Health Insurance, Obamacare be damned) may go up, which, depending on ones perspective isnt necessarily good. Making an adjustment to one thing leads to a consequence in the opposite form somewhere else in the whole system. This one I again attribute to Govt Intervention as being a big source of the problem, where the Govt Solution is worse than the problem itself. OMG! Zit! Quick! Amputate their face! Govt has demanded Health Insurance be purchased by everyone, which supports Crony Capitalism, not Free Market Capitalism.

[CaptUSA]

We do have some of the best health care in the world- if you can afford it. Unless you are rich or your employer has a healthcare program, you are on your own to see what you can afford. Nearly all of the European countries in the chart in the OP have national healthcare programs. It is fiscally impossible to offer every citizen of any country the highest healthcare in the world.

Perhaps ironically, our diversified number of health insurance plans (competition) to pick from is a major reason behind the costs of our system. Paperwork (overhead) is like 40% of healthcare costs in this country vs say 15% in Germany or Canada. Why? Paperwork. Thousands if not millions of different policies have different requirements of what to include and who to send it to for re-imbursment or even approval of treatments. This greatly adds to cost. With a single payer network the paperwork is all the same and can be streamlined.

Nearly negged this, Zippy.

Health care is something you pay for. Of course the more you spend on it, the better care you will get. Same thing goes for your house. Shall we have a single payer for housing, too?! The cost of paperwork is NOT from the myriad of insurance companies, it's from the myriad of laws with which these insurance companies must comply. It's from the myriad of lawsuits that can be filed if someone doesn't perform a procedure like the witness for the claimant would have.

It has NOTHING to do with the different policies! Hell, you should be able to pick any policy that you feel comfortable with. It's friggin' freedom! You like graphs so much... How about charting this one? The amount of government money funneled into the health care sector compared to the overall cost of health care. Hell, do the same for education!

Single payer makes things better... SMMFH.

[Brian4Liberty]

Paperwork (overhead) is like 40% of healthcare costs in this country vs say 15% in Germany or Canada. Why? Paperwork.

It's interesting that only time that "paperwork" becomes an issue is when it's related to government or business that is heavily regulated by the government. Government is the root of all evi...excess paperwork.

[RPfan1992]

I've read from many accounts that the UK has a very low quality standard for healthcare.

Unfortunately we have a private industry infested with government regulations and we all know what that means.

I'm guessing they measure good quality healthcare in a different way. I've read many stories of people dying due to incompetence or long waiting times in the UK.

[angelatc]

Liberal think tank cherry picks data to produce "data" to support liberal talking points.

http://www.weeklystandard.com/articles/last-credibility


Typical of the Commonwealth Fund is a recent study claiming that the U.S. health care system ranks last when compared with seven industrialized countries. It’s just the latest in a string of policy studies from organizations that want to see a European-style, government-run health care system brought to these shores. Democratic politicians and their allies then use those studies to bolster the case for dramatic reforms.“Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally” was widely reported. National Public Radio warned: “U.S. Spends the Most on Health Care, Yet Gets Least.” The Week asked if American health care was “Worst in the World?” The Los Angeles Times decided to entice readers with, “U.S. is No. 1 in a key area of healthcare. Guess which one.” Answer: spending.
In all this coverage, did anyone in the mainstream media raise serious questions about the study’s assumptions or methodology? Or delve into the organization behind it?


But how about cancer survival rates? Or access to the latest technology or the newest medicines? Or where the cutting-edge research and development is occurring? Commonwealth Fund studies don’t ask such questions.The Commonwealth Fund isn’t the only group regularly pumping out suspect studies. Others include Families USA and the Center on Budget and Policy Priorities. They, too, always seem to find that more government control improves quality while lowering costs, and are praised in the media for it, while getting a pass on their assumptions and methodology.
For example, Families USA promotes the notion that Medicaid funds create a state-level “multiplier effect,” providing more than a dollar’s worth of economic bang for each dollar spent. That’s an important finding since the president’s reforms will see millions​—maybe tens of millions of people—join Medicaid, at a time when state budgets are already stretched.

Lots more at the link. But until the GOP can start playing offense, this battle is lost. You can't make a sale if you can't control the conversation.

[56ktarget]

This was true before Obamacare... Stop trying to spin and confuse the health care issue. Ever wonder how the countries with best healthcare systems in the world all have "socialized medicine?"

[NorthCarolinaLiberty]

This was true before Obamacare... Stop trying to spin and confuse the health care issue.

I did not pay one thin dime of health care before Obama. Now I have to pay a lot. I get the EXACT same thing I got before, which is no health care at all. Zero.

Tell me where the confusion lies.

[Slave Mentality]

This was true before Obamacare... Stop trying to spin and confuse the health care issue. Ever wonder how the countries with best healthcare systems in the world all have "socialized medicine?"

Statists are gonna state. Extra chocolate ration for you.

[idiom]

Hey Y'all.

New Zealand, ranked up there with the lowest cost per capita care, has true safety net public hospitals, and lean efficient shiny private hospitals that operate happily side by side. The public hospitals also tend to be attached to public universities, so are full of student nurses and doctors from around the world, along with very sharp teaching staff.

I just spent three days in a public hospital with a nasty arse virus, but previously spent two weeks getting an emergency bowel resection following peritonitis, with half the time spent in the ICU with a tonne of specialists. Total cost was only around $8k which I paid cash for. For the public care I only had to wave my passport at the emergency room and it came out of my taxes.

When I need a procedure which I get warning for, I get two quotes from private hospitals and a time estimate from the public service.

Like a colonoscopy might be $900, $1100, or a 4 week wait.

I have epic chronic ilness so I have to self-insure or use my tax supported system when funds are limited.



Imagine instead of Obama care, there was one federally owned hospital in each congressional district. Sort of like the VA system, that is what a saftey net should look like.

Not giving money to an insurance company. That's nuts.




This is really ranty, I full of meds.

[idiom]

Strange seeing UK #1. Don't a lot of them sport shitty teeth?

The UK having that many #1 rankings while simultaneously having a #10 for healthy population and having such a low cost make one think the survey might be a tad skewed.

I mean the NHS has a "Death Season" for crying out loud.

[nobody's_hero]

Ditto intoxiklown's post. I'd wager most of the cost you see providers charging, at least in hospitals, is to offset the huge number of non-paying customers who use the facilities. These folks have been encouraged by misguided laws like EMTALA which sought to force hospitals to treat emergent situations and then compounded the problem with lawyers and liability.

Everyone that comes into our ER does NOT have an emergent situation, by any means. But I guaran-damn-tee you that most everyone who comes into the ER with, say, a belly-ache, is gonna get: CT scan, IV start, chemistry panels, complete blood counts, cardiac enzyme labs, etcetera etc. In socialized medicine there would be more cost controls and scrupulous use of testing but that's because the facilities will be protected from lawsuit (think about it: socialized = state and how often do you see someone sue the state and win?). Private organizations are, however, supposedly 'evil manipulative entities' and will always be fending off lawsuits.

EMTALA, if followed as written, would mean anyone who comes into the ER who doesn't have a true emergency would be quickly evaluated by the MD and simply be told to go see a doctor in the morning. However, you'd be surprised how many people come to the ER who have been having symptoms for one to two weeks and suddenly thinks a $600 ER visit in the middle of the night makes more sense than a $50-100 visit to the doctor which they could have done yesterday or wait 'til morning.

Private and socialized healthcare systems are two totally different beasts. DamienTV pointed that out fairly well. However I disagree with his assertion that private healthcare systems try to provide the shittiest, cheapest service and keep people coming back for more. Reputation would count for something in a competitive free market. It doesn't mean much today because thanks to our laws, no matter where you go they're required by law to treat you.

What you see today is the result of private companies trying to exist in a world where government regulations and fear of lawsuits have distorted any logical profit models that private industry relies on. For example, if you owned a grocery store, and every week the same exact jackass comes in the store, collects a basket of food, and walks by the checkout counter without paying (and maybe even smiles and boldly states that he won't pay!), eventually you'd put that person's picture on the wall and let all your employees know that he is not to be allowed into the store. Try doing that in healthcare, and you're just some 'heartless manipulative bastard' with no regard for the needy. And the government thinks that hospitals are supposed to be able to turn a profit with people doing this over and over and over. Well, they can try, but it involves recouping the cost via the more reliable patrons, and that's why the rest of us lousy schmucks get charged $500 for a piece of plastic medical equipment that was made-in-China for 50¢.

[jbauer]

I did not pay one thin dime of health care before Obama. Now I have to pay a lot. I get the EXACT same thing I got before, which is no health care at all. Zero.

Tell me where the confusion lies.

The only way that would hold true would be that you never got sick and didn't have health insurance. Otherwise they were getting it from you long before Obamacare came walking into town.

[nobody's_hero]

Furthermore, the data the OP presents neglects to include taxes as part of the cost of operating their healthcare systems in the list of compared countries, which I assume goes towards funding their hospitals and providers whether you use them or not. Private industry doesn't typically tax you for x-years for operating costs and then charge you a fee at the door when you come do business with them. It's apples to oranges.

[RabbitMan]

I love that the only complaint I see from people about the UKs quality of healthcare is "I read some stories" and "don't they have bad teeth?"

I've heard from many sources, you know like from folks who are visiting from there, that they had zero complaints about their healthcare system and I think it is fair to just let them have their win. There is nothing wrong with having a good socialized healthcare system, outside of the violations of private property and all that libertarian jazz. Plus they have private hospitals and insurance like Idiom spoke of in case you don't want to wait. Like someone else mentioned, it gives them impetus to regulate behavior and taxes will be higher, but aside from that I don't see the downside.

[AuH20]

Ditto intoxiklown's post. I'd wager most of the cost you see providers charging, at least in hospitals, is to offset the huge number of non-paying customers who use the facilities. These folks have been encouraged by misguided laws like EMTALA which sought to force hospitals to treat emergent situations and then compounded the problem with lawyers and liability.

Everyone that comes into our ER does NOT have an emergent situation, by any means. But I guaran-damn-tee you that most everyone who comes into the ER with, say, a belly-ache, is gonna get: CT scan, IV start, chemistry panels, complete blood counts, cardiac enzyme labs, etcetera etc. In socialized medicine there would be more cost controls and scrupulous use of testing but that's because the facilities will be protected from lawsuit (think about it: socialized = state and how often do you see someone sue the state and win?). Private organizations are, however, supposedly 'evil manipulative entities' and will always be fending off lawsuits.

EMTALA, if followed as written, would mean anyone who comes into the ER who doesn't have a true emergency would be quickly evaluated by the MD and simply be told to go see a doctor in the morning. However, you'd be surprised how many people come to the ER who have been having symptoms for one to two weeks and suddenly thinks a $600 ER visit in the middle of the night makes more sense than a $50-100 visit to the doctor which they could have done yesterday or wait 'til morning.

Private and socialized healthcare systems are two totally different beasts. DamienTV pointed that out fairly well. However I disagree with his assertion that private healthcare systems try to provide the shittiest, cheapest service and keep people coming back for more. Reputation would count for something in a competitive free market. It doesn't mean much today because thanks to our laws, no matter where you go they're required by law to treat you.

What you see today is the result of private companies trying to exist in a world where government regulations and fear of lawsuits have distorted any logical profit models that private industry relies on. For example, if you owned a grocery store, and every week the same exact jackass comes in the store, collects a basket of food, and walks by the checkout counter without paying (and maybe even smiles and boldly states that he won't pay!), eventually you'd put that person's picture on the wall and let all your employees know that he is not to be allowed into the store. Try doing that in healthcare, and you're just some 'heartless manipulative bastard' with no regard for the needy. And the government thinks that hospitals are supposed to be able to turn a profit with people doing this over and over and over. Well, they can try, but it involves recouping the cost via the more reliable patrons, and that's why the rest of us lousy schmucks get charged $500 for a piece of plastic medical equipment that was made-in-China for 50¢.

EMTALA has been so abused. It's ridiculous.

[ZENemy]

its not healthCARE, its health INSURANCE, it has nothing to do with health and everything to do with money. healthCARE starts in the kitchen and ends with exercise.

Nobody calls their car insurance CARCARE.

[2young2vote]

I love that the only complaint I see from people about the UKs quality of healthcare is "I read some stories" and "don't they have bad teeth?"

I've heard from many sources, you know like from folks who are visiting from there, that they had zero complaints about their healthcare system and I think it is fair to just let them have their win. There is nothing wrong with having a good socialized healthcare system, outside of the violations of private property and all that libertarian jazz. Plus they have private hospitals and insurance like Idiom spoke of in case you don't want to wait. Like someone else mentioned, it gives them impetus to regulate behavior and taxes will be higher, but aside from that I don't see the downside.

The government run hospitals we already have here in the USA are terrible. These would be the VA hospitals, by the way. They are dirty and poorly run. The doctors have no idea what they are doing and the a majority of the nurses are incredibly rude and unsympathetic. No, nobody you knew had a good experience at a UK run hospital - they were judging the quality relative to their out-of-pocket cost which was very little to nothing, and so expected as much. If the experiences that my family has had at VA hospitals is indicitave of what public healthcare is going to be in the USA, then we are screwed. It was so bad for my step-dad, in fact, that he stopped going to the VA hospital and started going to private hospitals. They are better in every imaginable way.

[RPfan1992]

The government run hospitals we already have here in the USA are terrible. These would be the VA hospitals, by the way. They are dirty and poorly run. The doctors have no idea what they are doing and the a majority of the nurses are incredibly rude and unsympathetic. No, nobody you knew had a good experience at a UK run hospital - they were judging the quality relative to their out-of-pocket cost which was very little to nothing, and so expected as much. If the experiences that my family has had at VA hospitals is indicitave of what public healthcare is going to be in the USA, then we are screwed. It was so bad for my step-dad, in fact, that he stopped going to the VA hospital and started going to private hospitals. They are better in every imaginable way.

It's not just anecdotes either. Wales has very bad ambulance response times for example. http://www.walesonline.co.uk/news/wales-news/ambulance-response-times-branded-national-7325276

This study found out that Thousands of people die of thirst each year in NHS hospitals.
http://www.telegraph.co.uk/news/health/news/10778537/Thousands-die-of-thirst-and-poor-care-in-NHS.html

Watch this video it explains why NHS hospitals are terrible.

https://www.youtube.com/watch?v=2CBqX3I75hQ

[kpitcher]

EMTALA, if followed as written, would mean anyone who comes into the ER who doesn't have a true emergency would be quickly evaluated by the MD and simply be told to go see a doctor in the morning. However, you'd be surprised how many people come to the ER who have been having symptoms for one to two weeks and suddenly thinks a $600 ER visit in the middle of the night makes more sense than a $50-100 visit to the doctor which they could have done yesterday or wait 'til morning.



I've noticed a lack of general practice doctors in my area. My family Dr I've known for decades retired and I haven't had to see one in years, thankfully. I needed to list a new primary with my insurance so calling all around in a 50 mile range, there was a 6 month waiting for first appointment. If I got sick I'd guess I'd have to do the emergency clinic adjacent to the ER and wait hours.

[DamianTV]

I've noticed a lack of general practice doctors in my area. My family Dr I've known for decades retired and I haven't had to see one in years, thankfully. I needed to list a new primary with my insurance so calling all around in a 50 mile range, there was a 6 month waiting for first appointment. If I got sick I'd guess I'd have to do the emergency clinic adjacent to the ER and wait hours.

How much more would that cost?

[Brian4Liberty]

its not healthCARE, its health INSURANCE, it has nothing to do with health and everything to do with money. healthCARE starts in the kitchen and ends with exercise.

Nobody calls their car insurance CARCARE.

And just think... If auto insurance included routine maintenance, an oil change would cost $600, but your co-pay would only be $40, and idiots would think it's a good thing.

[Adam Ante]

It is such a pity that Americans knowledge of other nations healthcare systems only extend to Canada and the UK. And those systems are what everyone associates with "universal healthcare."

Look at that survey. The nations in it. Germany delivers universal healthcare through private non-profit insurance, mainly though employment. Switzerland and the Netherlands use for-profit insurance. This is called a Bismarck-style system. Norway and Sweden use NHS-style government systems, known as Beveridge type. Canada has what is called a National Insurance system. Australia, France and New Zealand, I think, have hybrid models. All of them except Canada have a healthy private sector supplementing the public system. Yes, hostility to the private sector is a feature of the Canadian system, not UHC systems in general.

Whats more, some of the government-run systems, like Norway, makes heavy use of internal markets, and private providers bid on surgery-batches and treatments along with public providers.

They are very, very different from each other, and the systems of countries like Switzerland and the Netherlands have more in common with the US than with other European systems. What they all have in common though, is that they provide good results for far less money than the US system. In fact, the 8500 $ per person the US spends, is split about 50/50 between government and private spending. The 4200 $ per citizen the US government spends to provide healthcare to 28 % of the population is more than all those countries except Norway, spends to provide UHC to everyone. And Norway has a massive cost level for everything, as a percentage of GDP the spending is just average. Half the US. The $ 3400 the UK spends per person actually includes both private and public spending, and its less than just the US government spending.

What makes the US unique here is trying to run all the different systems at once. Employer-provided insurance is Bismarck style healthcare like Switzerland. Medicare is national insurance like Canada. Veterans is Beveridge-style like Scandinavia. Everyone has their own system of gatekeeping, paperwork (in fact the insurance sector has a vast number of paperwork systems), liaising, credit-checking and billing. Other nations decided on one system, stuck with it and let the private sector do what it likes.

Imagine you worked for a huge corporation, and were designing a system for providing a vital in-house service. Would you suggest one system for sales, a completely different one for IT, a third one for management, something else for production, nothing at all for delivery, and a huge job bloat for gatekeeping, internal billing, etc to administer it all? With totally different IT systems, paperwork etc.

Its like that. There is nothing wrong with any of the US systems that can't be sorted, but trying to overlap them all generates an enormous amount of duplicate work.

[JohnM]

Thanks for that post, Adam Ante.

You obviously know something about the subject, unlike me.

I read the original post and immediately had a lot of questions, such as

1) What would Ron Paul say about this. After all, he is a very experienced physician, as well as being an experience congressman. His insights on that article would be interesting.

2) Are the categories used by the Commonwealth Fund the most appropriate categories for assessing health care systems?

3) What are the pre-suppositions that the Commonwealth Fund works with? Does it have ideological biases?

4) Do any countries have a real free market in health care with little or no government involvement - and if not, which countries get closest?

Speaking personally, my own experience in recent decades has been almost entirely with the UK's NHS. I have been to see my local physician twice in the past month about laryngitis. The first time I telephoned and asked for an appointment, and was offered one in 20 minutes. The doctor looked at my throat, declared that it was probably a virus, and told me to come back in three weeks. Three weeks later I telephoned and asked for an appointment, and was offered one in 45 minutes. The doctor again looked at my throat, prescribed a course of antibiotics, and told me to come back in three weeks if I had not recovered. I was given the antibiotics about a minute later. There was no charge for them. The taxpayer picks up the bill.