As the U.S. health care reform struggle (on both sides) becomes increasingly about political beliefs and power politics rather than about practical solutions, it is to be expected that comparative data will also be politicized. Statistics are, as always, particularly vulnerable to intentional as well as unintentional misrepresentation in the political arena. The September 15 report released by the Joint Economic Committee’s ranking Republican Senator, Sam Brownback, unfortunately fulfills that expectation.

The report seeks to divert attention from an annual snapshot of comparative health expenditures – in which the U.S. spends far more than other developed countries, with far more unmet need as well – to a consideration of the rate of change in these expenditures. According to this analysis, the U.S., at 5.9 percent growth per year, is less than the average of 6.6 percent growth per year among all countries in the Organisation for Economic Cooperation and Development (OECD).

The report makes a particular point that the U.K., at 7.2 percent, is higher than the U.S. in this statistical series. Based on this data, the report concludes that a) the U.S. is doing a better job than many government-run health systems in controlling health care costs, b) the U.S. would do a worse job of controlling health care costs if a “government-run” system were adopted, and c) “government-run” health systems control costs through rationing necessary care.

To reach its first conclusion, the report focuses on the U.S. number alone while conveniently missing the real story that the other data in this series conveys:

• Twelve countries (out of 30 in the OECD) had lower rates of growth than the U.S., including archetypal social-health-insurance based systems with nominally private health insurers(Germany, Switzerland, France) and highly regarded tax-funded systems with publicly owned hospitals and salaried doctors (Sweden, Denmark, Finland).
• Countries with higher rates of expenditure growth than the U.S. are poorer countries with far lower per-capita annual expenditures (Mexico, at $823 per capita, or Turkey, at $618 per capita) or post-Soviet countries with high import costs for pharmaceuticals combined with rapidly increasing wages for low-paid doctors and nurses (Hungary, at $1,388. per capita, and Poland, at $1,035. per capita), or the U.K., which just finished intentionally increasing its health care expenditures from 6 percent to 8.6 percent of gross domestic product (GDP) over the past five years in a concerted effort to reach the European Union average per capita expenditure of $2,992. By comparison, the equivalent U.S. expenditure figures are 16 percent of GDP and $7,290 per capita. (These are 2007 OECD figures).
• All of the above noted other countries – indeed all other OECD countries – have lower baseline expenditures for health care (from 5.7 percent to 11 percent of GDP). The U.S. figure of a 5.9 percent annual growth rate generates further increases on a 16 percent baseline. The U.S. pattern of expenditure growth signaled in this data series – compounded over 20 or 30 years into the future – is a formula for financial catastrophe, not a policy success to be trumpeted, especially in a fiscally incontinent country where the national debt is already increasing $1.8 trillion in 2009 alone.

The second conclusion of the report – that the U.S. would have less control over its health expenditures with a larger federal government role – seems hard to justify even on the one-statistic data series the report presents. Twelve European countries with far more public control over health care finances than the U.S. (typically from 70 percent to 85 percent of total health sector revenues, compared to 46 percent in the US) have lower rates of increase in the chart presented.

If anything, the data presented here suggest that greatly increasing federal control over health care expenditures may be the best way to reduce aggregate rates of growth in current U.S. health costs. This fiscal solution may be neither feasible nor desirable in the U.S. for a variety of policy reasons, but the central point here is that the data alone points in the opposite direction from what the report claims.

The third conclusion of the report – that government-run systems control costs “largely through government-imposed-rationing” – appears to directly contradict the report’s claimed second conclusion. If government-run health systems are unable to restrain increasing costs (as the report claims), then how can these same health systems successfully restrain their costs through effective government-imposed rationing?

In reality, of course, on this third point, nearly all other developed country health systems in varying degree do ration care by a number of established mechanisms (restricted physician training places, restricted permits for hospitals, constrained funding for service delivery, as well as waiting lists in most tax-funded health systems), although less so in social-health-insurance countries like Switzerland and Germany. Moreover, health economists on both sides of the Atlantic are busy developing techniques and justifications to further restrict future health care spending (QALYS, DALYS, comparative effectiveness, etc).

Thus in practice, on this third issue, the report is correct – most other developed countries have substantially more rationing than do adequately insured Americans (uninsured or poorly insured Americans also confront rationing). But these restrictions are one of the key issues raised by the relative success of government control over expenses, not its failure to do so as the report claims.

Ultimately, however, this single comparative data series does not demonstrate the success of any wealthy OECD country in adequately restricting the growth of aggregate national health expenditures. Long term, the numbers are bad for all wealthy countries in an era of burgeoning national budget deficits and a permanent shift of economic activity to Asia.

If the Joint Economic Committee wants to do something helpful about the dynamic pattern of health expenditure growth in the U.S., it would be well advised to drop casual analysis of comparative health system figures and instead concentrate on developing a solid strategy to expand the funding base for health care in this country by stimulating real private sector investment in real industries that have the real potential for long-term growth.

Richard B. Saltman is Professor of Health Policy and Management at the Emory University School of Public Health. He is cofounder of the European Observatory on Health Systems and Policies in Brussels and is currently head of the Atlanta hub. He has published 17 books and over 130 articles and book chapters on a wide variety of health policy topics, particularly on European health care systems. His new volume, Nordic Health Care Systems: Recent Reforms and Current Policy Challenges, co-edited with Jon Magnussen of Norway and Karsten Vrangbaek of Denmark, was just published by McGraw-Hill Education. RSALTMA@​emory.​edu; 404–727-8743.