Think America’s Health-Care System is the World’s Best? It’s Downright UN-American

It is hard to fathom how un-American the U.S. health-care system has become.

This has nothing to do with patriotism. It has everything to do with a system that forsakes ideals we hold dear: the sanctity of life, fairness, innovation and efficiency.

The Commonwealth Fund Commission on a High Performance Health System periodically does a U.S. health system scorecard comparing health outcomes to those of five other industrialized nations. It is brilliantly named “Mirror, Mirror on the Wall,” because our self-image is at odds with reality.

The United States was dead last in Commonwealth’s last three comparisons. That, too, is un-American. This country is used to being the top dog in nearly every endeavor: finance, military might, diplomacy, athletics, technology. President Bush has declared that he presides over a nation with “the best health-care system in the world.”

To a limited degree, Bush is correct. The United States is the best nation on earth to receive top-notch health care _ if you are rich enough to afford it or fortunate enough to have private insurance. Bush’s perspective appears to be partisan. According to a recent Harris Interactive-Harvard poll, 68 percent of Republicans consider the U.S. health system the world’s best, compared to 32 percent of Democrats and 40 percent of independents.

Consider the following findings in published studies in the last 12 months that compare the United States to other industrialized nations. In America:

1. You are more likely to die of a treatable condition.

In a “Health Affairs” article earlier this year, British researchers ranked leading industrialized nations on the rate of preventable deaths.

The U.S., which was 19th out of 19 nations, would have had 101,000 fewer preventable deaths annually if it performed as well as the top three countries in the 2002-03 study period. By gender, 23 percent of deaths in men and 32 percent of deaths in women were preventable with treatment. In another study, the U.S. life expectancy rank in 2004 was in 42nd place, down from 11th place two decades ago. We were 41st in infant mortality.

2. You pay outrageous prices for shoddy service.

In 2005, the United States spent $6,697 per capita for health care _ which is twice as much as five other industrialized nations. But its citizens were more likely to suffer from medical errors and be forced to go to the emergency room for care because of an inability to get a same-day appointment with a primary-care physician. Compared to five other nations with universal health care, the U.S. ranked fifth out of six on seeing a doctor promptly. The argument that universal health care produces more inaccessible service is a myth.

3. Our health care is primitive in its use of information technology.

It’s hard to believe that a nation that spawned Silicon Valley and Microsoft would be so far behind other countries on electronic medical records and medication prescriptions. Besides obvious inefficiencies, not employing technology makes it more difficult to coordinate care, measure outcomes, apply evidence-based clinical guidelines and investigate errors. 4Many people suffer because they cannot afford medical care. The United States is last in nearly every measure of equity because of the disparity in the quality of care received by those of means and those without. Americans are more likely than their counterparts to forgo treatment, skip recommended tests or leave prescriptions unfilled because of out-of-pocket costs. The common denominator in the consistently poor performance: The United States is the only industrialized nation without universal health care.

But there is much more to the story. Certainly, decreasing the number of uninsured would help these dismal numbers. But U.S. lifestyles and creature comforts also allow us to expend minimal energy. The resulting obesity and sedentary habits contribute mightily to our poor performance.

U.S. health care has become a caste system, stratified into the kind of social classes that the Founding Fathers so abhorred.

Those with private insurance rank on top for first-class service. In the middle are the underinsured, who have high deductibles in relation to their take-home pay. At the bottom are the uninsured. Even Medicare and Medicaid patients gradually are being squeezed out of the primary-care network because of inadequate provider reimbursement by the government.

And your class can literally be a life-or-death matter.

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MIRROR, MIRROR ON THE WALL:

“Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care” overview:

“Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This report _ an update to two earlier editions _ includes data from surveys of patients, as well as information from primary care physicians about their medical practices and views of their countries’ health systems. Compared with five other nations _ Australia, Canada, Germany, New Zealand, the United Kingdom _ the U.S. health-care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity and healthy lives. The United States is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill.”

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CAN YOU SEE A DOCTOR?

Only Canada fared worse in a study monitoring whether adults could get same-day access to a physician when sick.

32 percent of Americans with health insurance, who had same-day access to a physician when sick.

21 percent of uninsured Americans who did.

22 percentage of Canadians who did.

55 percentage of Germans who did.

Source: Commonwealth Fund

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THEY’RE WAITING … AND WAITING …

More than 1 in 4 uninsured Americans _ 26 percent _ must wait at least six days (or never manage) to see a doctor when they need medical attention. How that compares: 19 percent of insured Americans who wait at least six days or never see a doctor.

4 percent of New Zealanders

20 percent of Germans

30 percentage of Canadians

Source: Commonwealth Fund

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ABOUT THE WRITER

Steve Jacob is publisher of the Fort Worth Star-Telegram/Northeast and a master’s student in health policy and management at the University of North Texas Health Science Center in Fort Worth. Readers may write to him at: 400 W. 7th Street, Fort Worth, Texas 76102, or via e-mail at sjacob@star-telegram.com.

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