October 24, 2010
Is U.S. Health Care Truly 'Broken'?By Deane Waldman
There are reasonable people who question whether our health care system is, in fact, "broken," as opined by President Obama. (This is one of the few conclusions he makes with which I agree. Of course, ObamaCare is very clearly not the solution.)
Objective, evidence-based analysis of the U.S. health care system leads to the well-worn doctor joke: "I have good news and bad news." Every assertion below has "hard" scientific proof. What follows is fact, not unsubstantiated opinion.
First, the good news
Americans have better health care outcomes than most others: better survival rates for common cancers than Europeans, better preventative cancer screening than Canadians, better access to chronic disease treatments, greater and much faster access to new technologies, less waiting times for care than in either Great Britain or Canada, and higher patient satisfaction here than in most European "universal health care" countries.
By any measure you choose -- patents applied for, new drugs or procedures, Nobel prizes, and more -- the USA is the most medically innovative country on the planet.
American-trained providers are considered the best. The super-rich fly from all over the world to the USA for their medical care. They do not go to the Mayo Clinic in Rochester, Minnesota for the weather.
Now, the bad news
The "bad news" is financial difficulty, provider shortages, and outcomes.
The U.S. spends more per capita on health care ($4,631) than any other nation. Interestingly, eight countries have annual increases in national spending greater than ours. Until the recent U.S. real estate collapse, medical bills were the leading cause of personal bankruptcies.
Forty-five million American residents (13% of our population) have no health insurance. Interestingly, 24% are uninsured by choice: they qualify for government assistance programs but refuse to sign up. Also, 25% of the 45 million uninsured are illegal residents.
Health care is very inefficient with our dollars: almost 40% of the trillions we spend each year provides no care at all. It is consumed by the health care bureaucracy. Despite draconian cuts in reimbursements just passed by Congress, Medicare -- the program touted by Nancy Pelosi to be the model for our whole country -- will go broke by 2017.
In addition to its financial woes, health care has personnel issues. There are not enough doctors and nurses for our current health care needs. What will happen when (if) ObamaCare adds 30-45 million more people to the rolls of the insured?
In 1972, 95% of U.S. physicians reported they were professionally satisfied. In 2004, that number was 26%. Applications to U.S. medical schools have fallen off roughly 20% over the past fifteen years. Forty percent of doctors over age 50 are considering early retirement.
While the U.S. is first in per capita health care spending, we are either 33rd or 46th (depending on the source) in terms of infant mortality. Though this fact is often used to attack the U.S. health care system, it is unclear how much is due to epidemiologic issues such as illicit drugs or genetics and how much can be squarely laid at the health care system's doorstep.
Wait times for care in emergency rooms can exceed thirteen hours. The reported drug error rate is 1.13 for each and every patient admitted to a U.S. hospital. The number of avoidable, doctor-induced U.S. deaths is estimated as high as 98,000: that is equivalent to one jumbo jet liner crashing every day, killing all passengers, each crash caused by pilot error.
Finally, in terms of outcomes, people can be injured during health care. Our medical malpractice system fails to compensate the vast majority of injured patients. It is extremely costly (multi-billions a year at a minimum), produces defensive medicine, and does not improve medical quality.
While there are many good individual parts of U.S. health care, as a system, it is critically ill. It does not produce the outcomes we want and produces many outcomes we do not want. Health care is incredibly inefficient, drives providers away, and is drowning our country in red ink. According to many U.S. business leaders, our health care so-called system is dragging down U.S. global competitiveness.
U.S. health care is without doubt a "broken" system.
Deane Waldman, M.D., MBA is the author of Uproot U.S. Healthcare and an Adjunct Scholar for the Rio Grande Foundation in New Mexico.