The Myth of ‘Best In The World’

[question everything]

(Apologies if already posted. I just found it)

The Myth of ‘Best In The World’

A spate of new research shows the U.S. behind other countries in cancer survival and diabetes care.
Sharon Begley
NEWSWEEK
Mar 22, 2008

(snip)

Yes, many people of goodwill support extending coverage to the 47 million Americans who, according to the Census Bureau, had no insurance for all or part of 2006. An awful lot of the insured, though, worry that messing with the system to bring about universal coverage, even if it allows more newborns to survive, might also hurt the quality and availability of care that they themselves get ("If I have trouble getting my doctor to see me now, what will happen when 47 million more people want appointments?"). This is where you start getting the requisite genuflection to the United States' having "the best health care in the world." One problem: a spate of new research shows the United States well behind other developed countries on measures from cancer survival to diabetes care that cannot entirely be blamed on the rich-poor or insured-uninsured gulf. None of this implies a specific fix for the U.S. health-care system. It does, however, say that "the best in the world" is a myth that should not be an impediment to reform.

(snip)

One thing Americans love about their system is the availability (for the insured) of high-tech equipment and the latest procedures. But there is abundant evidence that these are not necessarily beneficial. I remember breast-cancer patients screaming bloody murder in the 1990s when they were denied access to bone-marrow transplants. Sadly, once the treatment was subjected to rigorous study, it was shown not to extend life. But it made women who worked the system to get it (some private insurers agreed to cover it) suffer even more than they already were. In a centralized system such as Medicare, science more than the market shapes what treatments are available. "Some of the things patients scream for," says Blendon, "aren't going to help them." Though they do run up the U.S. medical bill. At $6,697 per capita in 2007, it is the highest in the world (20 percent more than Luxembourg's, the next highest) and more than twice the average of the 30 wealthy countries in the Organization for Economic Cooperation and Development.

If only it bought better care. Only 55 percent of U.S. patients get treatments that scientific studies show to work, such as beta blockers for heart disease, found a 2003 study in The New England Journal of Medicine. One reason is that when insurance is tied to employment, you may have to switch doctors when you change jobs. In the past three years, says Karen Davis, president of the Commonwealth Fund, 32 percent of Americans have had to switch doctors. The result is poor continuity of care—no one to coordinate treatment or watch out for adverse drug interactions. Such failures may contribute to the estimated 44,000 to 98,000 annual deaths from medical mistakes just in hospitals, and to "amenable mortality"—deaths preventable by medical care. Those total about 101,000 a year, reports a new study in the journal Health Affairs. That per capita rate puts America dead last of the study's 19 industrialized countries.

Other data, too, belie the "best in the world" mantra. The five-year survival rate for cervical cancer? Worse than in Italy, Ireland, Germany and others, finds the OECD. The survival rate for breast cancer? You'd do better in Switzerland, Norway, Britain and others. Asthma mortality? Twice the rate of Germany's or Sweden's. Some of the U.S. numbers are dragged down by the uninsured; they are twice as likely to have advanced cancer when they first see a doctor than are people with insurance, notes oncologist Elmer Huerta of Washington Hospital Center, president of the American Cancer Society. But the numbers of uninsured are too low to fully explain the poor U.S. showing.

It isn't realistic to expect America to be the best in every measure of medical quality. And none of this tells us how to reform the U.S. system. But it does say the "best in the world" is misguided medical chauvinism that should not block attempts at reform.

URL: http://www.newsweek.com/id/128635

[Goodnevil]

1. What I want to know is

why it took us so long to figure this out?

[Warpy]

2. Our health care system is third world

and even the very wealthy don't get great hospital care because of staffing cuts.

None of the candidates has a health care plan that isn't a bandaid on a bad system, a system that is so far gone that no tweaks are going to make it work again.

Until health care delivery is the focus with cost containment a distant second, will this country get a decent system back.

As long as profit is being sucked out, forget about having health care in the US. As long as we are the only country in the western hemisphere without national health insurance (yes, you read that right), forget about having any improvement at all in the average state of health in this country. Certainly forget about improving any of those dismal statistics. As the profit motive causes continued deterioration, expect all those statistics to worsen.

Our system does not work.

[question everything]

3. I don't have problem with care givers being paid well

But when their reimbursements continue to deteriorate, while CEOs of insurance companies that are listed on the stock exchange get millions - this is where we need to look. After all, all they do is shuffling papers and "control" costs.

This is why some physicians stop accept insurance. They figure they can cut their overhead costs and still offer decent care at reasonable prices. Of course, these would be office visits, not major surgery or body imaging.

I cannot blame all of them: Clinton, Edwards and Obama for building on the employer-paid insurance. Clinton tried to really change the system in 1993 and the Democrats lost the House in 1994 because of that.

[Warpy]

5. Clinton originally wanted a single payer system

but was bullied by the insurance company thugs on her panel into staying with for profit insurance. They then turned around and stabbed her in the back with their "Harry and Lousy" commercials.

She learned absolutely nothing except to smile as she took their dirty money and kept letting them dictate their terms.

[Goodnevil]

6. I agree with you

My parents are ardent Bush supporters (there's a picture of them shaking hands with Bush on the helicopter pad in Crawford), very well off and have Federal government Blue Cross Blue Shield (my father is a retired Assistant U.S. Attorney).

Recently, my mother was diagnosed with lung cancer. Fortunately, it was caught early and it appears she's going to be fine.

After PETSCANS, etc., Blue Cross said "enough is enough" and charged them $4,000.00 for a precautionary PETSCAN to make sure there was no cancer left after her surgery because they judged it unnecessary.

The well off are getting screwed as well.

I have my own personal stories about health care with my wife and son, but that is for another post.

[Hydra]

4. I refuse to go to doctors

I've been misdiagnosed so many times that you'd think they were seeing someone else in my place.

After I heard the New England Journal study, I knew I wasn't alone and that it wasn't a fluke. Our system is almost useless...but like everything else in Bushworld, they want all of our money, and won't give us an alternative.