Sunday, December 23, 2007
U.S. health care is expensive and dangerous
Dan Radmacher
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From the RoundTable blog
In the debate over the nation's health care, there is an oft-repeated claim that the United States has the best health care system money can buy.
Sadly, that simply isn't true. Despite spending nearly twice the percentage of our gross national product that other nations commit to health care, the quality of the U.S. system lags far behind.
Speakers at a recent seminar for editorial writers by the Knight Center for Specialized Journalism at the University of Maryland noted the following:
n According to one study, the likelihood of a patient receiving clinically appropriate care is only about 53 percent -- and that's regardless of whether the patient has private insurance, government-sponsored insurance or no insurance at all.
n A 2000 Institute of Medicine study found that medical mistakes kill about 100,000 Americans a year. A more recent Johns Hopkins study found that as many as 225,000 deaths each year result from medical errors, making America's health system the third-leading cause of death in the nation.
Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, said, "Health care in America is costly, dangerous and fraught with errors."
As much as 30 percent of care is unnecessary, she said. Antibiotics are prescribed for viral infections and MRIs are ordered when a simple X-ray would suffice.
On the other hand, there is too little appropriate care. Even people with private insurance don't get as much care as they should, when they should.
Uwe Reinhardt, a Princeton economist, pointed out that despite all the talk of rationed care in places like Great Britain, British citizens actually see doctors more regularly than American citizens.
Reinhardt, a German native with a wicked sense of humor and a well-honed sense of moral outrage, pointed to a case in California where a man racked up a multimillion-dollar medical bill that far exceeded his insurer's lifetime limit.
To get the bill covered by Medi-Cal, the man had to liquidate nearly all his assets. If you find yourself in this situation, you'll have to wait for your "middle-class wealth to be sucked out of you," Reinhardt said.
"No other country in the industrialized world would do that," he said. "Is this what America stands for? It is time to go to war. ... Victimizing people who cannot pay for necessary health care is unacceptable."
Both Reinhardt and Lavizzo-Mourey noted the lack of correlation between spending and quality.
A study of Medicare spending across the states found that the states with higher spending have lower-quality care. According to Reinhardt, this could be because states that spend more have a higher number of specialists. "States with more general practitioners use more effective care and have lower spending, while those with more specialists have higher cost and lower quality."
Some states are making systematic efforts to improve health care quality and reduce the number of medical errors. Pennsylvania's efforts may be the most wide-reaching.
A 2002 law mandated that all hospitals, outpatient facilities and birthing centers report both "serious events" -- medical errors that harmed patients --and "incidents" -- medical errors that nearly harmed patients before they were caught.
Lavizzo-Mourey said that studies have shown that reporting of errors only leads to safety improvements when hospitals know the reports will be made public.
A nationwide system for tracking and reporting medical errors could help Americans become more informed health care consumers -- and motivate hospitals to reduce their error rates.
As Chris Jennings, a health care adviser to Hillary Clinton, said, the issue is just not the cost of health care, but the value received for what we pay.
"America spends twice as much as any other nation to provide care that is no better, sometimes worse and sometimes dangerous," he said.
That is an accurate summary of the current situation, which is completely unacceptable.
A lot of talk will be devoted to the health care system in the 2008 election year. Americans need to demand a lot of action to follow.
Radmacher is the editorial page editor of The Roanoke Times.
