America’s Intensive Care Bonus
By a variety of measures, America’s health care system is both the most effective and most expensive in the world. But we can be thankful that we don’t have Medicare for All or its stalking horse, single-payer health care.
Our diversified system allows for far more ready access to almost all kinds of care than is offered by nationalized health care elsewhere in the world. If you think you have to wait too long to see a specialist here, try wait times – too often measured in years – in countries with nationalized health care systems like Canada, the United Kingdom, and Italy.
With the COVID-19 pandemic, our health care system has brought us another important advantage: The U.S. has far more intensive care units per capita than are available in other countries currently experiencing an onslaught of cases.
A National Institute of Health review of international intensive care by Meghan Prin and Hannah Wunsch, both medical doctors, found that the U.S. has 31.7 ICU beds per 100,000 people. Canada has 13.5, Japan has 7.9 and the U.K. has 7.4.
Of course, while we have a large number of ICUs per capita, they are spread across the country. COVID-19 hot spots like New York City are experiencing shortages but are still better off than the socialist average.
The NIH review finds that health spending is correlated “with increasing delivery of critical care.” This contrasts with countries whose socialized and chronically-underfunded health care systems ration intensive care.
The review continues, “Studies from Japan and the U.K determined that admissions to ICUs are severely limited for the very elderly and patients perceived to have little chance of survival.” In the U.K., many patients were “denied intensive care due to a lack of beds” and “discharged from the ICU prematurely.”
The U.K.’s National Health Service struggles every winter to provide adequate care during routine flu seasons.
Most of those who succumb to COVID-19 die of respiratory failure. Intensive care units in this country, with their specialized equipment and high staff-to-patient ratios, treat all comers with respiratory distress and who are at greatest risk, regardless of their age or pre-existing conditions.
Experience in Wuhan, China, and northern Italy indicates that patients in respiratory distress are more likely to survive with intensive treatment including a ventilator. But Italy is short of ventilators. In hard-hit Lombardy, doctors are connecting ventilators only to those with the best chances of survival—mostly younger patients.
Fortunately, the Society of Critical Care Medicine reports that U.S. ventilator capacity exceeds its number of ICU beds although local shortages in hard-hit areas may arise. Once again, ventilators are spread across the country, not necessarily where they’re needed at the moment.
We see handwringing that the U.S. has fewer general-purpose hospital beds than some of these countries. That is explained in large part by the proliferating number of outpatient surgery centers whose costs are lower than hospitals and where patients are less likely to catch infections.
The U.S. is also better equipped to handle COVID-19 because private insurers reimburse hospitals at higher rates than Medicare and Medicaid. If our hospitals were compensated at those low federal rates, Americans with COVID-19 would be more likely to suffer like the Italians now consigned to hospital hallways.
As described in last week’s column, scientists and administrators at the federal Centers for Disease Control failed to forecast the likely extent of the coronavirus impact here, delaying the administration’s response. The CDC over-estimated its ability to develop and distribute a successful diagnostic test.
Our current health care system is costly and undoubtedly improvements can be made. But we can take comfort in the fact that we are far better off going into the COVID-19 crisis than are countries with nationalized health care systems.
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“As described in last week’s column, scientists and administrators at the federal Centers for Disease Control failed to forecast the likely extent of the coronavirus impact here, delaying the administration’s response. The CDC over-estimated its ability to develop and distribute a successful diagnostic test.”
Above needs some editing. I am here to help.
AS NOT DESCRIBED IN last week’s column, OUR CURRENT ADMINISTRATION IN WASHINGTON failed to forecast the likely extent of the coronavirus impact here, delaying the CDC’S response. The PRESIDENT HIMSELF UNDER-estimated THE SIGNIFICANCE OF THIS VIRUS.
Wrong again: you’ve got the cart before the horse. Here’s the what the CDC director, Dr. Robert Redfield, told Congress on February 27th:
“The director of the Centers for Disease Control and Prevention on Thursday downplayed a fellow CDC official’s warning that spread of the COVID-19 coronavirus in the U.S. is inevitable, saying she misspoke.” See the entire story here:
https://nypost.com/2020/02/27/cdc-director-downplays-claim-that-coronavirus-spread-is-inevitable/
The president’s comments in late February and early March were based on these assurances. Who else would you expect him to believe? Given these assurances, Trump made a number of reassuring statements, wanting avoid creating a panic.
You’ve been getting your 20-20 hindsight from the main stream media whose intent is to discredit Trump at every turn. I’m no Trump fan, but using COVID-19 to discredit his administration is pure politics. Check your facts before repeating what you read in the MSM anti-Trump echo chamber.
Given that our country has surpassed other countries in numbers of COVID-19 cases and given the lack of adherence to isolation and distancing guidelines, as seen in Southern Utah, perhaps we may be expecting too much of this superior system you describe. Perhaps we are asking too much and giving too little by way of protecting ourselves. We will have to wait until it’s all said and done before giving too much credit to our American system as opposed to others it seems to me.
Lisa, as always a thoughtful reply but it misses the thrust of my column. We have far more ICUs per capita than do other countries because we don’t have a nationalized health care system. ICUs won’t prevent the spread of COVID-19 but do give us a head start in treating them. As you say, to the extent people don’t social distance as they’ve been urged to do, the virus will spread. But once again, that reflects personal behaviors, something no health care system can address.
Howard, I don’t think I missed the thrust of your column. I just think your faith in our system and the number of ICUs per capita won’t be supported until we see how that all works out and what the final stats from various countries compare. I just would not be giving too much credit to our system as this point but am glad we have so many. Having the most ICUs may not be that simple, though, as shown by this website (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3551445/) where this is stated: “However, we must be cognizant of the fact that the relative provision of (and therefore need for) intensive care may be driven by many factors. First are distinct differences in patient populations. Data comparing middle-aged Americans with a similar population in the United Kingdom demonstrated a higher burden of chronic illnesses among the American cohort –double the rate of diabetes and a third higher rate of hypertension [33]. Such comparisons are essential to understanding the relative healthcare needs of populations. Frequency of interventions and surgical procedures may also impact the need for intensive care. For example, patients who receive a liver transplant will require a stay in an ICU. This need for intensive care is, therefore, driven not solely by disease, but also by management choices [34]. An older study comparing admissions to intensive care in Alberta (Canada) and western Massachusetts (US) found that ICU days per million population were two to three times higher in western Massachusetts, primarily due to a higher ICU incidence (i.e. percent of hospitalized patients treated in the ICU). This discrepancy was driven by all of the factors described above [35].” Perhaps our American health is driving the need for ICUs more than our healthcare system not being a nationalized system. However, that said, our poor nation’s pool health could make a nationalized system challenged, too. We are our own worst enemies at times.
When assessing our system of health care it is a mistake to ignore the reality that 27.9% of the non-elderly in our nation are uninsured and many millions more are underinsured. Fortunately those of us over 65 have access to readily accessible health care thanks to Medicare, which I have accessed for nearly 20 years. Of course the Republicans have never supported the program. Even now, the president has recently pledged to get rid of Medicare if he is reelected. He along with other Republicans have repeatedly pledged to replace it with a better, as yet undefined, health care program. Also, just within the last couple of weeks there was a young man with the coronavirus who was turned away from a treatment facility in Los Angeles because he was uninsured. He died before he got to an emergency room.
We don’t have a healthcare problem in the USA, we have an INSURANCE problem.
The untouchable insurance companies with their huge investments in lobbying politicians have created a system with no meaningful competition. And no discussion on alternate solutions.
I should be able to my my health insurance via competitive bids, like I do my car insurance. Tell me exactly why I can’t do that. That is the third rail that nobody talks about.
If I decide to buy my healthcare insurance in Bangladesh and I can find a doctor in the USA who will accept it, then why is that not allowed?
The reason we continue with extraordinary costs for healthcare here in the USA is because the insurance racket is a huge monopoly with no competition. This is what is destroying the tax paying, hard working middle class in the USA. It’s not healthcare providers!
I am not aware of any developed nation in the world that uses capitalism primarily to pay for health care. One of the most efficient systems is in Germany that combines government and private market involvement. Insurance company prices are regulated by the government. I don’t think a transition to a Medicare for All system is feasible in the U.S. at this time. We could continue to combine the public and private financing by adding, as some have proposed, a public option that would compete with the private companies. That would bring more of a competitive pricing situation with the private insurance companies. I have granddaughters and their families that live in the UK and agree that there are certainly problems with their socialist system. I think they are starting to allow private insurance for those that can afford the cost. But, for all of the problems in general the public has reasonable access to health care without the risk of having to be burdened by unreasonable costs. There are situations in this country where families are driven into bankruptcy because of inordinate health care bills and those without insurance are to often denied access to health care.