Thursday, May 04, 2006

Can doctors treat the illogical? Will insurance pay for it?


Don’t you try that socialized medicine stuff here in America, pal. I like my health care dysfunctional--One of the reasons often given for not having universal health care is we in the U.S. enjoy the best medical care in the world. By God, we don’t wait in line for months for hip replacement surgery like those fools up in Canada. We can go see any doctor we want, whenever we want, for whatever we want, not like those foolish Brits. It’s an interesting argument, partially fueled by the propensity for Americans to assume that everything we do or touch or create is superior to everything anyone else has. It happens, of course, not to be true, and it is particularly untrue of health care. A new study out shows the problem with that line of argument. It turns out that the middle-aged British, even with their troubled national health care system (generally conceded to be something of a mess), are healthier than we are.

If you, like me, are fully insured, and live in a city with first-rate (even world-class) hospitals and medical schools (New York, Boston, Philadelphia, Baltimore as examples), you really do have access to some of the best medical care in the world. That doesn’t mean you will get it, just that it is a possibility. I have a dear friend who died at Stanford University Hospital because her doctor at the vaunted Palo Alto Clinic misread her mammogram, and screw-ups here at Johns Hopkins are by now legendary. Recent studies have shown that if you are hospitalized, your chances of getting the appropriate care are about 50-50, even at teaching hospitals. If you live far from major medical centers or, like almost half of Americans, are uninsured, you do not get the best medicare in the world. Period.

What we most certainly do have is the most expensive health care system in the world. We spend twice the money on health care ($5,200 per capita) than the Brits do yet we have higher rates of diabetes, heart disease, strokes, lung disease and cancer. Even the Fat American doesn’t provide an explanation. Accounting for that variable still produced the same result. Smoking rates are the same and the British drink more. This holds despite income or educational level. A well-educated, prosperous middle-aged Englishman is healthier than his counterpart in the U.S. The study, published in JAMA surprised health care experts but I’m not sure why. It is well known that the U.S. trails in life expectancy and in infant mortality and the reason is clear. In the year 2000, the World Health Organization reported: "Basically, you die earlier and spend more time disabled if you’re an American rather than a member of most other advanced countries."

In fact, we spend more money in our health care system than the rest of the world combined, and we rank 27th or 28th in most indicators for longevity. And, every one of those countries ahead of us has single-payer, government-run health care in one form or another. Every one.

Our health care system is totally and completely dysfunctional, immoral, inefficient and scandalous. There are some things in life for which the answer to all problems is not capitalism (or “free market”) and health care is one of them. Every other developed country in the world (and most undeveloped ones) have universal, government-run health care systems and despite the problems, they work better than our system does.

The other argument is that, well, I sure don't want government bureaucrats telling me what treatments I can or cannot have. You'd rather have an insurace clerk do it?

2 comments:

chsw10605 said...

Part of the problem is a measurement problem. The Brit system is notorious for not using medications for those individuals with treatable conditions, like enlarged prostates, and for abandoning others with terminal conditions. That said, they are not quite at the point where the Dutch are, actively pushing people into their graves, but they may not be far behind.

Also, the Brit system is actually two systems. There is a functioning non-government medical system in the UK. It is entirely separate from the government system and has a different set of regulations. (Never underestimate the ability of regulations to add costs more thoroughly than they solve problems.)

chsw10605

Bill Thomasson said...

Joel wrote: "In fact, we spend more money in our health care system than the rest of the world combined, and we rank 27th or 28th in most indicators for longevity. And, every one of those countries ahead of us has single-payer, government-run health care in one form or another. Every one."

Are you saying the US ranks higher in longevity than Japan? Belgium? Germany? I don't think that's true. And while all of those countries have systems that guarantee helth-care coverage for everyone, none of them does so through a government-run single-payer system. There's more than one way to skin a cat. (Is this news? It shouldn't be?)

I'd love to see a comparison of the health of middle-aged Britons and Canadians. Both countries have government-run single-payer health systems, but they are organized very differently -- especially in regard to delivery of primary care. And the study's authors hypothesized that it was British primary care that made the difference. If they are right (and I suspect they are), the health of Canadians should be closer to that of Americans than that of Britons.

And chsw wrote: "That said, they are not quite at the point where the Dutch are, actively pushing people into their graves, but they may not be far behind."

The US, too, is already there. Or Texas, at least. As specifically permitted by Texas law, a hospital recently stopped treating a patient because, in its sole judgement, the treatment was "futile."