I really appreciate Revere's writings on public health issues. As such, I thought it would be very appropriate to use a post he wrote about the state of health care in the U.S. to get the conversation about universal health care started. I will be adding posts from others on this topic, both pro and con, in the future, along (of course) with my own thoughts. This post was originally posted to Effect Measure, June 19th 2007. . .
From Effect Measure;
The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.
It's a myth that's hard to bust. The one that says the United States, the country that spends more on health care than any other, has the best medical care in the world to go with it. It hasn't been true for a long time. It doesn't. But it is part of the core belief of most Americans. I wonder who benefits most from that falsehood? But to the facts:
As early as 2000, the World Health Organization made the first attempt at ranking all the world's healthcare systems. The U.S. came in 37th out of 190 nations in the provision of healthcare. (France, according to the June 2000 report, was first.) The report was criticized for using inconsistent comparison measures and for failing to note that some countries deny expensive care to very sick patients. Americans could still reasonably cling to their long-held pride.
But in 2006, the Organization for Economic Cooperation and Development, an international organization that aims to lift living standards by promoting economic development, compared health spending and health statistics in its 30 member nations. Its report was more detailed than the WHO rankings, and had more controlled and consistent measures. The data, taken more seriously than the WHO rankings, left Americans with little to brag about.
And [NIH's Dr. Ezekial Emanuel's] recent commentary [in the Journal of the American Medical Association] was published the day after another report released by the Commonwealth Fund, which supports independent research into healthcare issues, found the United States at the bottom among six industrialized nations on measures of safe and coordinated care.
If all of that doesn't seem damning enough, insurance provider UnitedHealthcare Group took out a full-page ad in the Wall Street Journal on March 19 declaring: "The health care system isn't healthy.... A system that was designed to make you feel better often just makes things worse." One of the very industry giants that critics point to as a cause of the problem was defensively pointing back.
Amid stacks of reports, all with wonky measures of access, equity, efficiency and medical outcomes, two statistics stand out. The U.S. spends more on medical care than any other nation, and gets far less for it than many countries. According to the 2006 analysis by the Organization for Economic Cooperation and Development, the U.S. spends an annual $6,102 per person -- more than any other country and more than twice the average of $2,571. Yet Americans have the 22nd highest life expectancy among those nations at 77.2 years compared with the analysis' average of 77.8 years. People in Japan, the world leader in longevity, live an average of 81.8 years.
The report also found that the United States had about 2.5 times the average years of potential life lost due to diabetes: 101 years per 1,000 people compared with the average of 39 years per 1,000 people. Americans had fewer practicing physicians, or 2.4 per 1,000 people, than the average of 3 per 1,000 people. Infant mortality rates have been falling in the U.S., but are still higher, at 6.9 deaths per 1,000 live births, compared with less than 3.5 deaths per 1,000 live births in Japan, Iceland, Sweden, Norway and Finland. (LA Times)
When Andrew Speaker used subterfuge to fly back to the US for treatment of his XDR-TB an Denver's National Jewish Hospital it was not only to get home to his family but because he believed the care in the US was better than anywhere else. In fact, Italy has the second best health care system by the international comparison rankings and some of the best TB experts in the world. You probably didn't know that. Number 1? France. I'll bet you didn't know that either. You can quibble about the ranking method (if you can claim some expertise), but the only thing everyone agrees the US comes out on top for is cost. Cadillac prices for a high mileage junk car.
When I was in medical school the prestige specialties were internal medicine and psychiatry. That's what the brainy students chose. Not any more. Why? Because you don't get to do "procedures" in those specialties. Doctors get paid for "procedures." Handsomely paid, I might add. Managing chronic disease? Sorry. No procedures.
For starters, the American system doesn't measure up worldwide in controlling chronic diseases, such as diabetes or hypertension. Payment systems reward doctors for doing procedures, not for managing those chronic conditions, so a world-class center -- like Boston's Joslin Diabetes Center, which is supported by philanthropy -- stands in stark contrast to results seen by regular doctors treating the disease in average patients.
Kidney disease patients on dialysis have a higher risk of death in the United States. By an act of Congress in 1972, all end-stage renal disease is covered by Medicare, even for patients younger than 65. But because of Medicare funding cuts, patients on dialysis receive less time on dialysis than patients in Europe and Japan. That helps explain why Americans on kidney dialysis have a mortality rate of 23% compared with 15% in Europe and 9% in Japan, according to a May 2002 report in JAMA.
The US, alone among the industrialized nations, has no universal health care. Let me correct this. The average US citizen doesn't. Members of Congress already have their health plan. Even the CongressThings so adamantly opposed to "socialized medicine" are not giving up their government health plans. They'd rather hold the average American hostage to their ideological pecadillos.
Meanwhile, those of us who can afford to, pay. And pay. And pay. But we don't get our money's worth.
And those who can't afford it? You supply the answer.