The Best Health Care System in the World - Sometimes

An August 12 Editorial in the New York Times reviews the findings from a recent Commonwealth Fund report on the relative performance of the U.S. health care system when compared with other countries.

• Follow this link to the NY Times editorial (subscription may be required)
• Follow this link to the Commonwealth Fund home page for the study mentioned
• Follow this link for the Commonwealth Fund's Commission on a High Performance Health System

Let's start with the good news. According to the report and the editorial, our Nation ranks very high in following certain guidelines for preventive care. The Times states that three-fourths of Americans "rate their medical care as excellent or good, so it could be hard to motivate these people for the wholesale change thought by the disaffected." The Commonwealth Fund polls, the editorial states, rate U.S. opinions as very negative stating that a third of the "adults surveyed called for rebuilding the entire [health care] system, compared with only 13 percent who feel that way in Britain and 14 percent in Canada."

In the "Dark Ages"

The editorial emphasizes what we already know: "despite our vaunted prowess in computers, software and the Internet, much of our health care system is still operating in the dark ages of paper records and handwritten scrawls. American primary care doctors lag years behind doctors in other advanced nations in adopting electronic medical records or prescribing medications electronically. This makes it harder to coordinate care, spot errors and adhere to standard clinical guidelines." Admittedly, these claims must be considered in light of the correlation between payer complexity and automation and the reports of dissatisfaction and information technology snafus in the U.K. and elswhere, but it does seem unconscionable for a sector controlling this much of the GDP to have allowed such neglect in our infrastructure.

Other issues

The editorial adds to a long list of factors that we as citizens ought to weigh when we consider the state of our health care in the present and for our Nation's children and grandchildren. These include:

• Access. Try to find care on a weekend. The editorial and report point out we as a nation are les likely to have a long-te3rm doctor, less able to see a doctor on the day when sick, and less apt to get our questions answered.
• Disparities. Try to find care on a weekend if you have no insurance
• Insurance coverage. It is difficult to say anything new here.
• Life and death. We score high in some critical areas
• Healthy lives. We have a shameful infant mortality rate, but we seem to neglect our own care as well as that of our infants; we rank very low in healthy life expectancy at age 60.
• Quality. The report mentions our inability to coordinate the care of our chronically ill, emphasizing again that our "system" of care arguably forces silos of care to compete - to the disadvantage of our own care. This writer believes such coordination can only be realized if we address the information technology infrastructure in the right way.
  

Everyone reads what they believe in such reports. Some may focus on the higher out-of-pocket expenses Americans pay for health care. This claim should be placed in context with the higher out-0f-pocket expenses the middle and upper classes incur for plasma TVs, automobiles, and consumer debt.

No answers or even firm opinions are offered here, but one should ask the broader question - what is the total cost for our social safety net if we include employer tax deductions and other hidden "taxes" we as citizens pay. Perhaps the challenge is to make the true cost of this sincere but faulty system more transparent. The challenge, perhaps, is to lay out the facts in a way that makes the real decisions more apparent. It may be that we are reaching a point where we cannot make any decisions other than painful ones (much as the Romans, no doubt, did not "decide" to let the Goths invade their failing empire.)

For this reason, the issue is not a partisan one but more one of first creating a spirit of true "transparency" in our health care system - something Secretary Leavitt strongly supports. With a more transparent system based on useful data, we can debate our different views on equity, self-reliance, and role of both government and the individual.

The system is broken. Some make the analogy with a trauma patient on life support who will not recover from a their injuries. Some would argue we should work even harder at saving this life as it is currently organized. Others would argue it is time to let this soul go and to start thinking about how to harvest organs. A crude choice, perhaps, but in the end the editorial is not just about ideas, it is about the savage reality of life and death.