Ah-choo!

One of the big arguments deployed against the idea of a national health care plan is that Americans are satisfied with the present system which provides "the best health care in the world."

We're not and it doesn't.

As reported by WebMD.com, a recently-released survey of five industrialized nations conducted by the Commonwealth Fund revealed that residents of the US are the least satisfied with their basic health care. Among the five, Americans expressed the highest rates of dissatisfaction (one-third saying that their health care system should be completely rebuilt) and the lowest rates of satisfaction (only 16% said it required only minor tinkering).

The other four nations were Australia, New Zealand, the UK, and Canada. Yeah, that Canada: The one whose people are, to hear the wingnuts tell it, always running to the US for their health care.

The study shows that people in the U.S. face longer wait times to see doctors and have more trouble getting care on evenings or weekends than do people in other industrialized countries. ...

The U.S. is the only industrialized country that does not offer government-sponsored health coverage for all citizens. Proponents of market-driven health care often point to long wait times for services in other countries when warning of the dangers of a government-run system.

Sixty percent of patients in New Zealand told researchers that they were able to get a same-day appointment with a doctor when sick, nearly double the 33% of Americans who got such speedy care. Only Canada scored lower, with 27% saying they could get same-day attention. Americans were also the most likely to have difficulty getting care on nights, weekends, or holidays without going to an emergency room.

The one bright spot was that Americans were more likely to receive preventive care, such as Pap smears, and advice on prevention and self-care.

Those waiting times were not the only cause of dissatisfaction, though. Perhaps not surprisingly, cost was another.

Four in 10 U.S. adults told researchers that they had gone without needed care because of the cost, including skipping prescriptions, avoiding going to the doctor, or skipping a recommended test or treatment.

Meanwhile, 26% of Americans surveyed said that they had faced more than $1,000 in out-of-pocket health care costs in the last year, compared with 14% of Australians, and 4% of Britons.

Paying the most, but not, contrary to corporatist myth, getting the most.

Americans may pay more for health care than other countries, but they may not necessarily be getting the best medical care.

A new study shows the U.S. health care system ranks near the top on some but not all major health indicators and could take a lesson from the superior performance of other countries on several key areas, such as asthma and transplant surgery survival.

Researchers say the findings show there may be little evidence to back up the mantra often cited by policymakers, "Americans have the best medical care in the world."

"It is well known that the United States spends much more on health care per capita than other countries, and it is commonly assumed that we have the best health care system in the world," says researcher Peter S. Hussey of the John Hopkins Bloomberg School of Public Health in Baltimore, Md., in a news release. "However, the results of our study show that the United States performs better than other countries in only a few areas, while performing worse in others."

"This raises the question of what Americans receive for all of the money devoted to health care," says Hussey.

[N.B.: The article from which this and the following excerpts are taken appeared on WebMD on May 5. Their archives do not extend back that far. The link is to a copy of the article on AOL. That means that only AOL members will be able to link to it. Since some of you are AOLers, I've included the link. The full text of the original study appeared in the May/June issue of "Health Affairs" magazine, it's available to subscribers of the magazine. A free one-paragraph abstract is here.]

The study compares the same five countries as the Commonwealth Fund survey on a variety of 21 health care indicators indicating quality of care. Those included 5-year cancer survival rates, cancer screening rates, avoidable events (e.g., suicide, asthma deaths, and smoking prevalence), vaccination rates, and transplant survival rates, among others. No country consistently scored among either the best or the worst.

For example, the U.S. had the highest breast cancer survival rate, cervical cancer screening rate, and lowest smoking (tied with Canada). But the U.S. performed among the worst in other areas, such as asthma-related deaths and survival after kidney and liver transplants. In fact the U.S. was the only country in which asthma-related deaths were increasing rather than decreasing. ...

"Each country in our study has areas of care where it can learn from the other countries and areas where it could teach others," says Hussey. "That tells us that there are opportunities for improvement in the quality of health care in all five countries."

The bottom line remains what Hussey pointed out: We pay a good deal more for our health care and do not have better health care overall to show for it.

(If you want some good solid figures on just how much more we pay, Hussey has another article in the same issue of "Health Affairs" charting just that and exploring some reasons why we pay so much more even as compared to other nations with older populations. That article is available in full here. If nothing else, note the last section: "Pricing Low-Income Americans Out Of Health Care.")

Cost continues to be a major health care issue for Americans, and for good reason. In August, the Washington Post reported that 44 million Americans - 15.6% of the population - lack health insurance. But even that figure, standing alone, does not tell enough. There is a definite class bias in the availability of health insurance: Simply put, the less you earn, the more likely you are to be without it. Those making less than $25,000 a year are twice as likely to be without insurance as those making $50,000-$75,000 and three times as likely as those making over $75,000. (There is a race bias, too: For example, blacks are nearly twice as likely as non-Hispanic whites to lack insurance.)

Another study by the Commonwealth Fund discovered a double whammy:

Low- and moderate-wage workers—those earning less than $15 an hour (about $30,000 a year for a full-time worker) are more likely to lack health insurance coverage through their employers and are also more likely to lack other benefits such as paid sick days, leaving them even more vulnerable to economic and health problems. If these low-wage workers without sick leave do seek health care, they lose pay for taking time off from work for a doctor visit. But if they are too sick to work, they also lose pay. The situation contributes to lower rates of health care access and poorer health status for low-wage workers.

The abstract for the study, released October 6, notes that "few sources of affordable coverage exist outside the employer-based system" as a result of which there is "a deep divide in the US labor force," with lower-wage workers forced to forgo needed health care.

Unfortunately, despite all that it remains possible to stampede people into voting against improvements in coverage for those who need it.

California voters narrowly rejected a move to force medium and large employers to provide health care coverage for workers. The initiative called for businesses employing over 50 workers to either fund 80% of employee's health coverage or pay a fee to the state to provide insurance starting in 2007. ...

California passed a law in 2003 laying out the mandates. Voters were required to pass Tuesday's question, called Proposition 72, in order for it to take effect. Instead, they rejected it 50.9% to 49.1% after strong opposition from the restaurant and retail industries,

spinning the same hypnotic spiral comprised of claims of lost jobs, higher prices,wrecked businesses, destroyed industries, and depleted tax revenues that industries always do when faced with the specter of regulation. And no matter how many times they wind up handily surviving the very regulations they claimed would kill them, the next time a proposal is raised, the same tales get broadcast. What's notable this time is that while they succeeded in blocking the mandate, it was just barely.

When people are asked about various proposals for a revised health care payment system, national health care, or "single payer," consistently comes out at the top of the list. Employer mandates such as California tried to get are not by any means single payer, but the support the measure gained despite the fierce efforts of industry can be taken as an indication of the degree of dissatisfaction Americans have with the current system.

At some point we will realize that tinkering is simply not enough and that one-third that now looks to a complete overhaul will become a majority and then a majority so strong it can't be ignored. At which point we will join the rest of the industrialized, modern world in thinking of health care as a right to be guaranteed and no longer as a commodity available only to those who can afford it.