Healthcare Code Blue

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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

internationalstudies 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 healthcareas 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.