Q: We spend so much on healthcare in the United States. Unlike other countries that spend less and have better results, why don’t we have anything to show for it?
A: Criticisms of administrative waste in any system of healthcare funding and delivery are legitimate. But in terms of cancer survival, screening rates and the use of advanced treatment, we have significant returns on our investment.
Cancer Survival
Compared with women in the U.S., women with breast cancer in Europe are four times more likely to be diagnosed at an advanced stage-after the tumor has spread. Their survival rates are lower for the disease than women in the United States, which has the highest survival rates in the world for breast cancer.
According to the World Health Organization and the British medical journal Lancet, five-year survival rates for 13 of 16 types of cancer (including bladder, prostate, breast, uterine, lung, thyroid, and malignant melanoma) are consistently higher for patients in the United States than for Europeans. These figures report statistics for all Americans, not only those with private insurance.
British citizens suffering from lung cancer are half as likely to survive for five years compared with Americans diagnosed with the disease.
The American survival rate for leukemia is almost 50% while the European rate is significantly lower, just 35%. Esophageal carcinoma is often deadly, but compared with their European counterparts, American patients are more than twice as likely to survive the disease for five years.
Cancer Screening
Despite the fact that countries with a system of socialized healthcare supposedly promote and fund prevention, actual screening rates tell a different story.
Screening rates may contribute to the survival advantage for American patients, particularly for cancers that can be identified at early, treatable stages.Johns Hopkins University researchers report that U.S. cervical cancer screening rates are at 93% compared with the United Kingdom’s dismal 67%. The use of Pap smears for cervical cancer detection — and its ability to detect pre-cancerous lesions — has contributed to an extraordinary decline in the death rate of American women from cervical and uterine cancer, representing less than one percent of all cancer deaths among women.
84% of women aged 50 to 64 years in the United States obtain regular mammograms to screen for breast cancer. This exceeds the percentage of women screened in Australia, Canada, Great Britain and New Zealand.
Cutting Edge Cancer Treatment
In 2007, Swedish researchers reported in the Annals of Oncology that newer, more effective cancer drugs are less available in some European countries than other parts of the world. Cutting-edge cancer therapies were found to be most accessible in France, the U.S., Austria and Switzerland. American patients were ten times more likely to receive any of the newest medications for lung and colon cancer than Europeans.
Cancer research may also contribute to the higher survival rates of U.S. patients, particularly compared to those in the United Kingdom.
In the UK, health technology assessments are made by the National Institute for Health and Clinical Excellence (NICE). The same Annals of Oncology article explains how “research rationing” plays a role in the availability of cancer treatment:”
It was the explicit objective at the establishment of NICE to avoid any significant delays to bringing innovations to market in the UK. There is yet no evidence that this objective is met.”
What We Have — and Haven’t
The United States has a healthcare system of funding and delivery that is imperfect. Problems related to high cost, access, safety, quality standards and administrative waste should be evaluated.
But as the debate over whether and how to reform our current system continues, consideration of its strengths — including cancer research, screening, treatment, and innovation — should be given as much weight as condemnation of its weaknesses.
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