That the American health care system needs reform is conventional wisdom. We are told anecdotally that having an appendectomy in France is performed efficiently and no bills ever appear. Ask someone in the United States with appendicitis and you probably will hear that it was performed efficiently here as well. However, as no bill is generated in France, it obviously is a better system. Michael Moore “proved” that in his film Sicko. But health care systems always have at least two kinds of individuals using them. One, like a patient with appendicitis, is pretty healthy and occasionally interacts with the system. The other, like a patient with chronic congestive heart failure, is chronically ill and needs complex coordinated care.

If the United States is headed for reform of its health care system similar to those experienced by other industrialized nations, it is worth knowing exactly how chronically ill patients feel about those health care systems. The Commonwealth Fund, an organization that is committed to health care reform, conducts a number of policy initiatives and studies to that end. It telephoned between 700 and 1200 individuals with at least two chronic conditions in eight industrialized countries. Regardless of your political orientation or your feelings about government-run health care, the chart below, published by the Commonwealth Fund, should give you pause. Given that there are substantial out of pocket expenses in the United States whereas there really is no bill in Canada or Germany, for example, it is pretty clear that there is a great deal of happiness out there in free-healthcare-land. The Commonwealth Fund chose to focus on the percentage of people in each country looking for a total rebuilding of the system as an argument that we really do need a total rebuild and that the U.S. system is in the worst shape. But clearly the desire for fundamental change is pretty widespread.