Proposed Obama Speech before U.N. on Health Reform

Preface: The idea for this blog – a proposed but fictitious speech before the United Nations came from an article entitled “Wanted: A Defender of American Interests” in the September 27 Financial Times, by Christopher Caldwell.

"The percentage of the US population that is uneasy with Mr Obama has grown steadily. Conservatives are rightly outraged by Obama’s obsessive denigration of America and his reliance on mythical international consensus. Caldwell is getting to a much under-discussed aspect of the UN speech. Moderates are a bit nervous that he sounds sophomoric and naive. But Caldwell points to the gap, not between reality and Obama’s worldview, but between Obama’s view of America and Americans’ view of America."

This is my view of how Obama might defend America’s health system.

Good evening. Members of the United Nations. You have heard about the health reform debate now being taking place in the U.S. We know we have flaws – including high costs and lack of coverage for all. These flaws need correcting, and we are addressing them. We are not a perfect nation, but we should not let the perfect drive out the good.

Tonight I shall speak of what’s good, unique, and even exceptional about American health care. Despite contrary rhetoric, mine included , we are an exceptionalist nation, the shining City on the Hill - brimming with optimism, innovation, and a full of hope of what’s achievable based on building upon our current system.

As T.R. Reid, a Washington Post journalist, noted in his excellent book, The Healing of America: A Global Question for Better, Cheaper, and Fairer Health Care, America has the best hospitals and specialists in the world, although universal access to the best is sometimes unfair and costs too much.

We are a big-hearted and moral nation. Our nation spends as much of its GDP, outside of private pay, as other countries. We have no age cut-offs for dialysis, for hopeless cases, or for end of life care. We treat all patients who enter our emergency rooms – regardless of ability to pay or citizenship status. We do not allow people to die while waiting for expensive or life-saving technologies. We do not let them die in their beds or on the streets. Though we may, on occasion, be unfair, we are also overly generous, particularly to the elderly, which is the big reason behind our unfunded Medicare deficit.

Critics of our system are fond of citing a World Health Organization study indicating the U.S. ranked 37th among industrial countries. This study based largely on lack of universal coverage and high costs. What those same critics usually fail to mention is that WHO, one of the most respected of U.S. agencies, also conducted a study saying the U.S, ranked 1st, yes, you hear me correctly, number one, among 191 countries in “responsiveness,” defined as dignity, autonomy, prompt attention, quality of basic amenities, access to technologies and social support systems, and choice of providers. Our citizens are more appreciative of our system, and its responsiveness to their needs, than public health critics.

What critics fail to say is chances of survival for those with chronic disease – cancer, heart disease, lung disease, kidney failure, and AIDs – is better in the U.S. than almost anywhere in the world. Critics do not tell you the U.S. has 27 MRIs per million and 34 CT scans per million, compared to 6 MRIs per million in Canada and Britain, and 12 CT scans, and 8 in Britain and Canada. Our survival rates for cancer of the breast, colorectal cancer, and cancer of the prostate are better than elsewhere. More Americans are on statin drugs than in Canada, the U.K., Switzerland, Germany, and Italy, and we have the highest heart attack survival rate, 6%, in thw rold. Finally, we have a lowr out-of-pocket spending, 12.6% of total spending, than almost any other country.

To recapitulate and amplify, here are ten facts, gathered by the National Center for Policy Analysis.

Fact No. 1: Americans have better survival rates than Europeans for common cancers. Breast cancer mortality is 52 percent higher in Germany than in the United States, and 88 percent higher in the United Kingdom. Prostate cancer mortality is 604 percent higher in the U.K. and 457 percent higher in Norway. The mortality rate for colorectal cancer among British men and women is about 40 percent higher.

Fact No. 2: Americans have lower cancer mortality rates than Canadians. Breast cancer mortality is 9 percent higher, prostate cancer is 184 percent higher and colon cancer mortality among men is about 10 percent higher than in the United States.

Fact No. 3: Americans have better access to treatment for chronic diseases than patients in other developed countries. Some 56 percent of Americans who could benefit are taking statins, which reduce cholesterol and protect against heart disease. By comparison, of those patients who could benefit from these drugs, only 36 percent of the Dutch, 29 percent of the Swiss, 26 percent of Germans, 23 percent of Britons and 17 percent of Italians receive them.

Fact No. 4: Americans have better access to preventive cancer screening than Canadians. Take the proportion of the appropriate-age population groups who have received recommended tests for breast, cervical, prostate and colon cancer:

• Nine of 10 middle-aged American women (89 percent) have had a mammogram, compared to less than three-fourths of Canadians (72 percent).

• Nearly all American women (96 percent) have had a pap smear, compared to less than 90 percent of Canadians.

• More than half of American men (54 percent) have had a PSA test, compared to less than 1 in 6 Canadians (16 percent).

• Nearly one-third of Americans (30 percent) have had a colonoscopy, compared with less than 1 in 20 Canadians (5 percent).

Fact No. 5: Lower income Americans are in better health than comparable Canadians. Twice as many American seniors with below-median incomes self-report "excellent" health compared to Canadian seniors (11.7 percent versus 5.8 percent). Conversely, white Canadian young adults with below-median incomes are 20 percent more likely than lower income Americans to describe their health as "fair or poor."

Fact No. 6: Americans spend less time waiting for care than patients in Canada and the U.K. Canadian and British patients wait about twice as long - sometimes more than a year - to see a specialist, to have elective surgery like hip replacements or to get radiation treatment for cancer. All told, 827,429 people are waiting for some type of procedure in Canada. In England, nearly 1.8 million people are waiting for a hospital admission or outpatient treatment.

Fact No. 7: People in countries with more government control of health care are highly dissatisfied and believe reform is needed. More than 70 percent of German, Canadian, Australian, New Zealand and British adults say their health system needs either "fundamental change" or "complete rebuilding."

Fact No. 8: Americans are more satisfied with the care they receive than Canadians. When asked about their own health care instead of the "health care system," more than half of Americans (51.3 percent) are very satisfied with their health care services, compared to only 41.5 percent of Canadians; a lower proportion of Americans are dissatisfied (6.8 percent) than Canadians (8.5 percent)

Fact No. 9: Americans have much better access to important new technologies like medical imaging than patients in Canada or the U.K. Maligned as a waste by economists and policymakers naïve to actual medical practice, an overwhelming majority of leading American physicians identified computerized tomography (CT) and magnetic resonance imaging (MRI) as the most important medical innovations for improving patient care during the previous decade.

Fact No. 10: Americans are responsible for the vast majority of all health care innovations. The top five U.S. hospitals conduct more clinical trials than all the hospitals in any other single developed country. Since the mid-1970s, the Nobel Prize in medicine or physiology has gone to American residents more often than recipients from all other countries combined. In only five of the past 34 years did a scientist living in America not win or share in the prize. Most important recent medical innovations were developed in the United States.

In other words, despite serious challenges, such as escalating costs and rising numbers of the uninsured, the U.S. health care system compares favorably to those in other developed countries. In the United States, we are proud of our accomplishments. So are many of you – 400,000 of you come to this country for care you may have difficulty finding elsewhere, and your doctors flock here for advanced training in our leading medical centers. We welcome you. You have much to learn from us, and we from you.

Dr. Richard Reece’s latest book, Obama, Doctors, and Health Reform (IUniverse.com) is available at amazon.com, barnesandnoble.com, and booksamillion.com for $31.95 (hardcover), $21.95 (softcover), and $6.95 (electronic)