U.S. Health Care System - Does The U.S. Have The "World's Best Health Care?"

Comments on New York Times editorial, “World’s Best Medical Care?”

The New York Times and other progressive news outlets often compare the performance of U.S. health care to other industrialized Western nations. In its latest August 12 editorial on the subject “The World’s Best Medical Care?” the Times notes;

•Michael Moore was right in Sicko! in labeling the U.S. as a “laggard not a leader in providing good health care.”

•Seven years ago, the World Health Organization (WHO) ranked the U.S. health care system 37th out of 191 nations (France and Italy were #1 and #2).

•In its latest report, WHO ranked the U.S. next to last compared to these countries with these populations: Australia (20 million), Canada (33 million), Germany (82 million), New Zealand (4 million), and the United Kingdom (61 million) – countries with 1.3% to 26.9% of the U.S. population.

Progressives overlook several major factors.

•Our culture, size, and diversity differs from other countries. We have a greater proportion of immigrants, a richer racial mix, more violence, more dynamic population growth, and greater regional variations in a vast continental nation. The U.S. receives 85% of the world’s immigrants; our population is now nearly 1/3 African American, Hispanic, and of other ethic origins. American culture tends to be less “pure” in its population mix, more conservative, less trustful of government, more litigious, less tolerant of rationing, and more desirous of having quick access to the latest technologies. These cultural factors don’t lend themselves to neat and swift health care reform.

•Medical care accounts for only about 15% of the health status and longevity of any given population, life style for 20% to 30%, and other factors - poverty, inferior education, income differences, and lack of social cohesion of the other 55%. This isn’t ideal or what most Americans want, but it’s reality, and it negatively impacts infant mortality and life expectancy statistics – the chief measuring rods of national health comparisons. In the U.S, there are vast differences in longevity among races (whites 81.5 years, other ethic groups 74 to 75 years), and in northern Midwestern states (81 to 82 years) and Southeastern states (74 to 75 years). This differences, and such things, such as “urban killing fields” within our cities, are beyond health system or physician control.

•Superimposing universal care on our current system would likely break State Budgets and the Federal Treasury. Somehow we must find a way to lower costs within the context of the current systems before proceeding to coverage for all. Many states –among them, Massachusetts, California, Illinois, and Pennsylvania – are finding universal coverage may cost more than their budgets will allow.

That said, most physicians would agree with the Times goals.

•Reduce the number of uninsured. This will be the #1 or #2 (it’s a toss-up between health care and immigration) domestic issue in the coming presidential campaign. Physicians can help through free clinics, charitable care, cash-only clinics with lower costs, and politically supporting the cause of reducing the number of uninsured.

•Improve coordination of care – In a public-private system with thousands of overlapping, sometimes competing entities, creating a unitary solution will take time, even with the best of intentions.

•Increase use of computerized records - As long as the costs outweigh benefits in physicians’ minds, this will be an elusive goal. Government financial incentives will be needed.

•Improve communications between doctors and patients – In the abstract, this is a great idea; but in today’s rushed and litigious environment, with the myriad of health care choices, and many patients seeing multiple specialists, it’s easier said than done.

Physicians might disagree with the Times that “this country lags well behind other countries in delivering timely and effective care.” That’s an opinion, and the Times is entitled to it, but it lacks roots in the realities of our culture.