Any discussion of waiting times must begin with the observation that France, Germany, Switzerland and many other developed nations manage to combine universal access to care with rapid access to care. It’s an unfortunate quirk of international health-care policy that Canada and England, the two countries that do struggle with waiting times, happen to be the two nearby, English-speaking countries in the sample, and so our impressions of government-run health-care systems are disproportionately influenced by their experiences.
That said, it’s important to understand that America also struggles with waiting times. Someone who can’t afford to go to the doctor, or can’t afford to purchase an elective surgery, waits. In some cases, they wait forever. In some cases, they’re killed by the delay. But we don’t count them as having “waited” for care, and so they don’t show up in measures of American waits. But which would you prefer? A three-month delay for an elective surgery? Or no surgery at all?.
The Commonwealth Fund runs a massive survey of international health-care systems, and it’s helpful to juxtapose the questions testing cost problems and waiting problems. First, let’s look at cost. In addition to the normal suspects of Canada, France, Germany and the United Kingdom, I’ve also included the Netherlands and Switzerland, as those countries are closest to the health-care model that the Affordable Care Act implies we might evolve toward. As you can see, Americans are far more likely than residents of any other country in the sample to report skipping a doctor’s visit, medication or tests and treatments because they can’t afford them. And yet we tell ourselves that we don’t struggle with waiting times:
But now let’s look at waiting times directly. I’ve included three measures on this graph: waiting more than six days to see a doctor when you’re sick, waiting more than two months for an appointment with a specialist and waiting more than four months for an elective surgery. As you can see, Canada performs unusually poorly, and so does the United Kingdom. But we’re middle of the pack, at best. France, Germany, the Netherlands and Switzerland beat us on at least two of three measures:
And just for good measure, here’s what we’re paying, per-person, for this system:
The overall picture that emerges is devastating: More of our people never get care. More of our people wait for care. And compared to Switzerland, home of the second-most expensive health-care system in the world, we pay $3,000 more, per person, per year.
Which is why I find the conservative commentariat’s terror over slight — and potentially unrelated, and even meaningless — upticks in waiting times for some doctors in Massachusetts so baffling. The Wall Street Journal’s write-up of the data doesn’t even include the word “uninsured.” But you can’t think rigorously about waiting times without also thinking about the many, many Americans — more than 30 percent — who simply don’t get the care they need due to cost. If more people are waiting for care but fewer people are forgoing care, that’s a decrease, not an increase, in delayed care, but it shows up as an increase in our numbers.