USA Healthcare Code Blue

[Guest guest]

Healthcare Code Blue

Not only do Americans spend more than anyone else on health care,

much of what we buy isn't the best stuff.

By Abramson, JOHN ABRAMSON, a clinical instructor at Harvard

Medical School, is the author of " Overdosed America. "

November 3, 2006

IF AMERICAN MEDICINE were a patient, he would weigh 350 pounds and be

gaining fast. Despite being repeatedly counseled about the dangers of

morbid obesity, he would be making at best half-hearted attempts to

mend his gluttonous ways. Meanwhile, his doctors, insurance company,

politicians and regulators would remain in a deep state of denial,

clutching the illusion that their patient, other than being a bit

overweight, was in tip-top health.

Truth be told, the U.S. medical system is headed for multiple organ

failure.

The spiraling cost of healthcare is well known: $7,100 per person

this year, projected to increase to $12,000 in 2015 and compounding

at more than double the rate of inflation. Already, medical care

gobbles up one-sixth of the GDP. Even so, we ask ourselves, how

better to spend our money than on the best healthcare in the world?

Not so fast. The facts show that these enormous expenditures may be

buying us the best amenities in medical care — but not the best

health.

For example, Canada spends only 60% as much per person on healthcare

as the United States. Yet, since 1980, the longevity of all Canadians

has improved more rapidly than that of only white Americans. (In

other words, these statistics aren't skewed by the unconscionable

racial and socioeconomic disparities in U.S. health and healthcare.)

Yes, the " queues " in Canada can involve delays in nonemergency care.

But these could be shortened with relatively small increases in

funding. An article in the U.S. journal Health Affairs investigating

the number of Canadians who come here to avoid these waits found the

number so small that it asked, " A tip with no iceberg? "

Britain spends only 40% as much as we do on healthcare. But according

to the Journal of the American Medical Assn., middle-class insured

Americans " are much less healthy than their English counterparts "

(who are insured because all Brits are insured).

In fact, although Americans spend twice as much per person on

healthcare as the other 21 wealthiest countries, data from the World

Health Organization show that we live the shortest amount of time in

good health — 2 1/2 years less than the average in the other

countries (69.3 versus 71.8 years).

Reviewing a Dartmouth Medical School study that found higher

mortality rates in areas that spent the most on Medicare, professor

Elliott Fisher concluded that " perhaps a third of medical spending is

now devoted to services that don't appear to improve health or the

quality of care — and may make things worse. " This means that the

U.S. is wasting more than $650 billion a year — half again more than

the entire Defense Department will spend this year, including the

cost of the war in Iraq — on unnecessary and often harmful care.

How can this be? One factor is specialists. Both U.S. and

international studies show that the more a healthcare system relies

on primary care, the better the outcomes and the lower the cost. But

American medicine is heavy on specialists and getting heavier. In

just the last eight years, the number of graduates of U.S. medical

schools choosing careers in family practice and adult primary care

has plummeted by more than half. Americans know they're paying more —

and fear they're getting less. A Kaiser Family Foundation poll this

month found that nine out of 10 consider the following issues

important in determining their vote Nov. 7: problems with quality of

their healthcare; the cost of health insurance and prescription drugs

(the U.S. is the only industrialized country that lets drug companies

charge whatever the market will bear); and the number of uninsured

(47 million and growing by 1 million a year).

One would think that politicians would be eagerly tapping into these

strong voter sentiments. So why are we hearing so little about

healthcare as the election nears? Is this because politicians on both

sides of the aisle are being influenced by the powerful medical

industries? Certainly this plays a role. But there is an even more

basic reason. Our government has become almost fundamentalist in its

reliance on market-based, pro-business solutions to social problems.

No politician wants to be tarred with the charge of

promoting " socialized medicine. "

The problem is, our healthcare system is exquisitely well designed to

maximize profits but exquisitely poorly designed to provide the best

healthcare most efficiently. And even our nonprofit medical

institutions shape the care they offer based on their own bottom

lines instead of the health needs of the communities they serve.

In Washington, we've got a Food and Drug Administration that's much

better at protecting the interests of the drug and medical-device

industries than those of patients.

And even in the midst of this pivotal congressional election

campaign, few politicians are addressing the crisis in affordable,

quality healthcare. Is this any way to run a democracy?

Back to our patient, American medicine. He'll probably end up getting

stomach-shrinking surgery at a cost of $27,000. Unless he's one of

the unlucky 40% who develop complications, in which case it could

cost $65,000 or more. We all deserve better.

http://www.latimes.com/news/printedition/asection/la-oe-

ambramson3nov03,0,3877408.story