Healthcare In The U.S.

It seems to me…

As soon as healthcare reform passed, the assault began.  Insurance companies, pharmaceutical companies, HMOs and other healthcare profiteers began spending billions in advertising and more billions in lobbying to convince us that the U.S. has the BEST healthcare system in the world and that reform will ruin our system.  Repeated studies have shown nothing could be further from the truth.  We have claimed a reputation for quality healthcare by deceit.  Our healthcare is not the best in the world; we are 37th on the list behind most EU countries with government-run single-payer universal healthcare.

This does not mean I am advocating a government-run single-payer universal healthcare; I am not.  But I do believe in being realistic about the quality of healthcare we are receiving.  Conservative extremists have proposed privatizing healthcare, including Medicare and Medicaid, in the mistaken belief that competition will bring down costs.  They (e.g., Rep. Paul Ryan, R-Wis) would limit maximum government contribution assuming insurance companies would drive down costs in a competitive environment.  While this has been shown to work in some markets, such as for technology products like televisions or computers, it has not affected prices for services or many other products.  Gas stations are on every corner.  Cable or satellite television company prices continue to rise despite competition.  Beverages (Coke, Pepsi), food products (breakfast cereals) – competition has not had any affect on prices.  Contrary to wishful thinking, competition probably will not have any appreciable affect on healthcare either.

As stated, we frequently hear – mostly from politicians – that the U.S. has the best healthcare system in the world.  But if this is so, why does every study indicate otherwise.  It seems as though the only category in which the U.S. has a strong lead is in cost; all studies agree our healthcare is the most expensive in the world.  The only logical conclusion is that the U.S. needs to reexamine its system of medical practice and care.  Here are some of the facts…

An editorial in the New York Times, World’s Best Medical Care?, http://www.nytimes.com/2007/08/12/opinion/12sun1.html summarizes “…the disturbing truth is that this country lags well behind other advanced nations in delivering timely and effective care.”

An article by Christopher J.L. Murray, M.D., D.Phil., and Julio Frenk, M.D., Ph.D., M.P.H. in the New England Journal of Medicine, Ranking 37th — Measuring the Performance of the U.S. Health Care System, http://healthpolicyandreform.nejm.org/?p=2610 ranked the U.S. healthcare system 37th in the world.

The following table is from the article US Ranks Last in Health Care vs. AUS, CAN, GER, NETH, NZ, UK, http://www.ritholtz.com/blog/2010/06/us-ranks-last-in-healthcare/

Their summary was that “The U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States underperforms relative to other countries on most dimensions of performance.  Among the seven nations studied — Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States — the U.S. ranks last overall, as it did in the 2007, 2006, and 2004.

Seven years ago, the World Health Organization made the first major effort to rank the health systems of 191 nations.  France and Italy took the top two spots; the United States was a dismal 37th.  More recently, the Commonwealth Fund compared the United States with other advanced nations through surveys of patients and doctors and analysis of other data and in its latest report, issued last May, ranked the United States last or next-to-last compared with five other nations — Australia, Canada, Germany, New Zealand and the United Kingdom — on most measures of performance, including quality of care and access to it (other comparative studies reached similar conclusions).

They looked specifically at the following areas of healthcare: insurance coverage, access, fairness, healthy, and quality.

Insurance Coverage.  All other major industrialized nations provide universal health coverage, and most of them have comprehensive benefit packages with no cost-sharing by the patients.  The United States has some 45 million people without health insurance and many more millions who have poor coverage.  Although some claim these people can always get treatment in an emergency room, many studies have shown that people without insurance postpone treatment until a minor illness becomes worse harming their own health and imposing greater costs on the healthcare system.

Access.  Citizens of other countries often face long waits before they get to see a specialist or undergo elective surgery.  Americans typically get prompter attention (although Germany does better).  The primary problems are the costs facing low-income people without insurance or with poor coverage.  But even Americans with above-average incomes find it more difficult than those in other countries to get care on nights or weekends without going to an emergency room and many report having to wait six days or more for an appointment with their own doctors.

Fairness.  The United States ranks last on almost all measures of equity because we have the greatest disparity between the quality of care given to wealthy and poorer citizens.  Americans with below-average incomes are much less likely than those in other industrialized nations to see a doctor when sick, to fill prescriptions, or to get needed tests and follow-up care.

Health. America has a high infant mortality rate and ranks last among 23 nations.  We rank near the bottom in healthy life expectancy at age 60, and 15th among 19 countries in deaths from a wide range of illnesses that would not have been fatal if treated with timely and effective care.  The good news is that we have done a better job than other industrialized nations in reducing smoking.  The bad news is we have the highest obesity rate in the world.

Quality.  In a comparison with five other countries, the Commonwealth Fund ranked the United States first in providing the “right care” for a given condition as defined by standard clinical guidelines and gave it especially high marks for preventive care: e.g., Pap smears and mammograms to detect early-stage cancers, blood tests and cholesterol checks for hypertensive patients.  But our overall quality rating put us in last place in coordinating the care of chronically ill patients, in protecting the safety of patients, and in meeting their needs and preferences.  American doctors and hospitals kill patients through surgical and medical mistakes more often than their counterparts in other industrialized nations.

In all fairness, it also is very true that not all is bad.  A recent “Investor’s Business Daily” article provided very interesting statistics from a survey by the United Nations International Health Organization regarding the state of healthcare in the U.S. relative to England and Canada.

  U.S. England Canada
Percentage of men and women who survived a cancer five years after diagnosis 65% 46% 42%
Percentage of patients diagnosed with diabetes who received treatment within six months 93% 15% 43%
Percentage of seniors needing hip replacement who received it within six months 90% 15% 43%
Percentage referred to medical specialists who see one within one month 77% 40% 43%
Number of MRI scanners (a prime diagnostic tool) per million people 71 14 18
Percentage of seniors (65+), with low income, who say they are in “excellent health” 12% 2% 6%

 

The U.S. is at the top of the list in at least two areas: cost and obesity (though we also have a relatively high rate of diabetes).  I think we as a nation have quite a ways to go before we are able to legitimately extol the benefits of our healthcare system.

That’s what I think, what about you?

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About lewbornmann

Lewis J. Bornmann has his doctorate in Computer Science. He became a volunteer for the American Red Cross following his retirement from teaching Computer Science, Mathematics, and Information Systems, at Mesa State College in Grand Junction, CO. He previously was on the staff at the University of Wisconsin-Madison campus, Stanford University, and several other universities. Dr. Bornmann has provided emergency assistance in areas devastated by hurricanes, floods, and wildfires. He has responded to emergencies on local Disaster Action Teams (DAT), assisted with Services to Armed Forces (SAF), and taught Disaster Services classes and Health & Safety classes. He and his wife, Barb, are certified operators of the American Red Cross Emergency Communications Response Vehicle (ECRV), a self-contained unit capable of providing satellite-based communications and technology-related assistance at disaster sites. He served on the governing board of a large international professional organization (ACM), was chair of a committee overseeing several hundred worldwide volunteer chapters, helped organize large international conferences, served on numerous technical committees, and presented technical papers at numerous symposiums and conferences. He has numerous Who’s Who citations for his technical and professional contributions and many years of management experience with major corporations including General Electric, Boeing, and as an independent contractor. He was a principal contributor on numerous large technology-related development projects, including having written the Systems Concepts for NASA’s largest supercomputing system at the Ames Research Center in Silicon Valley. With over 40 years of experience in scientific and commercial computer systems management and development, he worked on a wide variety of computer-related systems from small single embedded microprocessor based applications to some of the largest distributed heterogeneous supercomputing systems ever planned.
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3 Responses to Healthcare In The U.S.

  1. Pingback: Legislative Insanity | Lew Bornmann's Blog

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