The myth of American medical superiority
Sen. Mitch McConnell of Kentucky was on a roll.
“Nothing makes me more angry … than the suggestion that America does not already have the finest health care in the world,” the Senate minority leader said Monday at a forum in Kansas City.
He got no argument from Sen. John McCain of Arizona, the former Republican presidential nominee, who appeared with Mr. McConnell.
“The quality of health care in America is the best in the world,” Mr. McCain said.
It has become an increasingly familiar refrain, and no wonder. It appeals to patriotic audiences and implies that reform — tinkering with what purportedly is the best system — would be dangerous and unnecessary.
So it seems almost subversive to ask this simple question: Is it true? Is U.S. health care the world’s best?
The short answer: No.
It does well on some quality measures, not so well on many others.
Study after study has found quality problems in U.S. health care.
Here’s what experts from the Institute of Medicine, part of the National Academies of Science, wrote in a 2001 report: “The American health care delivery system is in need of fundamental change…. Health care today harms too frequently and routinely fails to deliver its promised benefits.”
Individual American physicians often are outstanding. But the system in which they practice is fragmented and uncoordinated, filled with misdirected economic incentives and surprisingly lacking in basic care management tools.
The result: Even people with good insurance get recommended treatments only about half the time. Meanwhile, medical errors kill more Americans each year than breast cancer, AIDS or motor vehicle accidents.
No health system is perfect. Other countries have problems, too. But many researchers have compared U.S. health care to that in other developed countries and reached similar conclusions.
A new analysis by experts from the non-partisan Urban Institute concludes: “It is safe to say that U.S. health care is not pre-eminent on quality.”
Where does it stand out? “(I)n the very high costs of its health care and the share of its population that are uninsured.”
In a ground-breaking report published nine years ago, the World Health Organization compared the health systems of 191 nations. It ranked the United States at number 37.
That report isn’t based strictly on quality measurements. Instead, it compares actual performance against what health experts say could be accomplished with the resources spent on care.
The poor performance of our health care system is reflected in quality indicators that have become distressingly familiar in the reform debate.
• Average life expectancy is lower here than in most other developed nations. Infant mortality is significantly higher.
• We have the highest rate of preventable deaths among 19 industrialized nations in a recent study. That rate has declined in recent years, but not as much as it has elsewhere.
• A survey of doctors in five countries found American physicians are more likely to say cost controls threaten the quality of care they provide, and to complain about limitations on medications that they can prescribe.
• American patients — especially those with chronic illnesses — are far more likely than those in other countries to report skipping medicine or missing doctor visits because of cost.
Good news: We do very well on cancer care. The United States has a higher five-year survival rate for many cancers than most other countries.
The implication, at least in the minds of many reform opponents, is that means we have the latest, most technologically advanced treatments. But experts say the better survival rate is almost entirely because of more aggressive cancer screening here.
U.S. women are more likely to have annual mammograms than women in most other countries. Men are more likely to be screened for prostate cancer.
Screening helps catch cancer earlier, when it’s easier to treat. It also helps catch some cancers that never would become life threatening and require treatment. That increases the survival rate.
Those achievements must be balanced against the fact that about 50 million Americans are uninsured and have limited access to care. Millions more are underinsured and face the threat of bankruptcy should they become seriously ill.
Among other developed nations, only Mexico and Turkey have such large proportions of uninsured residents. None has a similar rate of medical bankruptcy.
Quality of care issues dramatically affect the uninsured. Remember those high rates of preventable deaths? The Institute of Medicine reports that thousands of uninsured people die every year from preventable illness.
Uninsured diabetics are more likely to have uncontrolled blood sugar than those with insurance. Uninsured people with hypertension are more likely to have uncontrolled high blood pressure. Stroke, a common consequence, is the third-leading cause of death.
Lack of health insurance even skews quality measures in which the United States performs well, like cancer. People without insurance, or those who are underinsured, are less likely to get those potentially life-saving early screenings. Thus, they are likely to be diagnosed with cancer at a more advanced stage than people with coverage.
Here are some interesting statistics:
• Survival rates for U.S. cancer patients under age 45 are similar to those in Europe, but cancer patients 65 and older do much better than those in Europe.
• Average U.S. life expectancy at birth is low, but average life expectancy at age 65 is better here than in Europe.
• And while childhood vaccination rates are lower in the United States than in Europe, the rate of elderly Americans who receive annual flu shots is substantially higher.
Why do health outcomes for Americans get better when they hit 65? Because that’s when they qualify for Medicare. Many get health insurance for the first time.
Congressional Republicans like to repeat scare stories about Canadian health care. Researchers have reached a very different conclusion.
Of 10 large peer-reviewed studies comparing quality of care for cancer, heart disease, chronic illness and surgical procedures, five favored Canadian care, two favored the United States, and three reported mixed results.
Mitch McConnell and John McCain may believe America has the world’s finest health care, but the facts tell another story.
The biggest threat to Americans is not needless tinkering with the U.S. health system. It’s sabotaging efforts to improve it.
Also note that the Urban Institute has also said that our deficit spending is out of control. http://www.urban.org/url.cfm?ID=901277
You are still LYING about the uninsured “Americans” statistic. Do your homework people! Stop spreading this misinformation!!! Are you guys so dam incompetent that you can’t seem to understand what an “American” is?
Fetus mortality is a disgrace. Over 1 million babies didn’t make it to term last year. Something must be done in the reproductive services sector to reduce that number. It’s almost like doctors are purposely grinding the babies up instead of providing the care they deserve.
Start thinking about the consequences of your actions. Medicare is not sustainable. Social Security is not sustainable. This government take over is not sustainable. The pot smoking, heroin addict baby boomers are becoming seniors. I don’t see why my generation and my kids’ generation needs to be raped to support these degenerates and their past health mistakes.
Give the people the option to buy their own insurance from any company in the country. Ditch the trial lawyers and get rid of malpractice suits for profit. Let the free market work.
“…the fact that about 50 million Americans are uninsured…”
Again and again with this falsehood: http://tinyurl.com/d34ryy
Anyone that believes American health care is the best simply isn’t living in the real world. Leave it to the phony flag wavers to believe such self-serving propaganda. This isn’t about health care, it’s about taxes that wealthy people don’t want to pay and since they don’t pay anywhere close to the percentage of income middle income tax payers do, it’s even more hypocritic. What they really strive for is to not pay taxes at all.
Thank you, thank you, thank you for saying so well what many of us have been saying for years now. BUT the reason we can’t get any traction is how long it takes to refute a simple lie with a complex truth. McCain/McConnell speak in bumper stickers, while we are forced to argue the truth, which in the case of this editorial took many paragraphs.
The crying shame of it is that the PRESS lets these demagogues get away with it. I seldom see the press asking where do they get their data, and then checking the sources for bias. No wonder the state of journalism is so wretched. When TV news starts asking pertinent questions instead of just letting these clowns ramble on and say anything without challenge, then we’ll see journalism. Broadcasters should be forced to set aside resources for fact checking and required to report the results when airing the views of public officials, candidates, and pundits. We’ll never have an informed citizenry when TV and radio exacerbate the problem by treating the public as if everyone had attention deficit disorder.
A glimpse into the Editorial Board room at the Post-Dispatch would find selected and dedicated leftists milling about, supporing editorial policy in straight jackets, attended by stenographers and men in white coats with butterfly nets.
Struggling to maintain control of their megalomania, their priorities continue to be skewed by spreading the fear of bankruptcy as they slough off the need for cures of cancer, heart disease, cirrhosis of the liver and AIDS. Millions are dying while our local daily news organ crusades to keep bureaucrats occupied and creditors whole through government intervention and dictate.
The left is blindly ignoring the shortage of primary care physicians and the teaching of new ones because medical specialties provide a better return on educational investment, So, just who is going to do all this early detection and treatment in your pipe dreams to raise our health standards? Perhaps an investigative journalist ensconced in a mall kiosk intervening in the unhealthy life styles of shoppers?
And, by the way, how does this country rank in bankruptcies from lack of health insurance compared to those from wild irrational spending without the necessary resources to keep up with the Joneses?
It wasn’t long ago you lamented that American doctors do too many procedures for fear of a lawsuit. Now you are saying we aren’t getting enough recommended treatments?
Doctors complain about limitations on medications that they can prescribe? What a joke! I can’t tell you the number of people I know that take 10 - 15 pills a day! They should take more?
I’m not going to argue your numbers, but I will say the fact that Americans, as a whole do not take care of themselves should factor into it. If the country with the best health care in the world took over the health care of 300 million Americans, even they would begin to see numerous problems. They would soon throw us out saying not to come back until we start taking better care of ourselves.
And last, you say some are sabotaging efforts to improve it. Be honest, the only improvements will be to those currently uninsured. For most of us, there are NO efforts to improve it.
“• Average life expectancy is lower here than in most other developed nations.”
This is starting to look like the 47 million uninsured number—> phony. If you go to the actual report and look at the numbers, they include all causes of death, including murder, auto fatalities, suicide, accidental deaths, and so on. These causes have nothing to do with our health care system and could easily skew the data. For example, Americans drive more and we have a higher inner city murder rate than many other developed countries. Until the data is normalized for these kind of anomolies, I am not buying the report.
So if the Urban Institute is non-partisan, why is it that they have the same sponsors as NPR?
* Annie E. Casey Foundation
* Ford Foundation
* Robert Wood Johnson Foundation
* Henry J. Kaiser Family Foundation
* Charles Stewart Mott Foundation
It’s a who’s who of liberal sponsorship.
I’m not saying they don’t do good research. But let’s not claim them as an unbiased source.
Jom,
You assessment of the tax code of the U.S. is about as accurate as the Post’s assessment of the American Medical System.
The top 1 percent of taxpayers paid 40.4 percent of the total income taxes collected by the federal government. This is the highest percentage in modern history. By contrast, the top 1 percent paid 24.8 percent of the income tax burden in 1987, the year following the 1986 tax reform act.
The share of the taxes paid by the top 1 percent now exceeds the share paid by the bottom 95 percent of taxpayers combined. In 2007, the bottom 95 percent paid 39.4 percent of the income tax burden. This is down from the 58 percent of the total income tax burden they paid twenty years ago.
To put this in perspective, the top 1 percent is comprised of just 1.4 million taxpayers and they pay a larger share of the income tax burden now than the bottom 134 million taxpayers combined.
While our system is not perfect, when foreigners get sick, you don’t see them flying to the 36 countries the Post says are better than the U.S.
So they are saying that Washington U.’s Center for Advanced Medicine and places like Mass General, John Hopkins and the University of Pennsylvania are just poorly run institutions that provide below average medical care.
Right?
Our country has a large heterogeneous population, with many of the poorest “life-styles” in the world, like the highest drug use in the world. We are obese, lazy, smoke and drink. Just go to any Walmart or Costco and see the parade of 300+ pound people, and our society accepts the huge people with no incentive for proper behavior (like cheaper health insurance rates for physically fit people-see Safeway).
Our inner cities are filled with individuals that have high risk behavior, where the rates of STD’s is among the the highest in the world.
I love it when the US is compared to Switzerland or Japan, it is our cultural decay and bad life styles that show up in the statistics.
Ask yourself, how many Americans go to countries like India for Med school vs. Indians coming to the US?
How many great Pharma and Medical Tech companies are in Cuba, which ranked higher than the US?
It is our diversity in poor life styles that create the poor medical outcomes.