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Care in need of a cure

Americans are beginning to realize that money alone won't buy them long, healthful lives. The proof is stacking up.

June 18, 2007|Susan Brink | Times Staff Writer

IN the midst of criticism of America's healthcare system over the last decade, Americans held fast to the belief that if you have to be sick, this country is the best place to be. Faced with casual comparisons with Canada or Europe, many were ready with counterarguments: Americans don't have to wait months for bypass surgery, like they do in Canada. Doctors here aren't constrained by government interference. Unlike in England, American patients receive costly treatments such as hemodialysis even if they are old and infirm.

But now, the knee-jerk attitude that the U.S. is the best place on earth to be sick, fueled by the reputations of great institutions like the Mayo Clinic and by America's leadership in drug and technology development, is beginning to be challenged by rigorous international comparisons. There is increasing evidence that, despite justified pride in individual institutions and medical breakthroughs, the world's biggest medical spender isn't buying its citizens the longest, healthiest lives in the world.

It's not just moviemakers and comics saying so. The dire message that the U.S. healthcare system is, by some measures, an also-ran on the worldwide stage is being delivered by doctors, researchers -- even insurance industry giants.

On screen, slamming U.S. medical care is coming of age with Michael Moore's documentary "Sicko." Through the eyes of people who have faced healthcare catastrophes, he tells graphic stories of the problems with America's system. The movie has received Oprah hype, the ear of some in the California state legislature and the support of several national healthcare advocacy groups weeks before its June 29 release.

Considerably more sobering are the warnings from an official at the National Institutes of Health, who declared in the May 16 issue of the Journal of the American Medical Assn. that the U.S. healthcare system is "a dysfunctional mess." So unusual is it for a government official to speak out against the U.S. system that Dr. Ezekiel Emanuel, chairman of the department of ethics at the NIH, emphasizes a point made in print during a conversation. "I'm speaking for myself, not for the NIH or the Bush administration," he says.

As early as 2000, the World Health Organization made the first attempt at ranking all the world's healthcare systems. The U.S. came in 37th out of 190 nations in the provision of healthcare. (France, according to the June 2000 report, was first.) The report was criticized for using inconsistent comparison measures and for failing to note that some countries deny expensive care to very sick patients. Americans could still reasonably cling to their long-held pride.

But in 2006, the Organization for Economic Cooperation and Development, an international organization that aims to lift living standards by promoting economic development, compared health spending and health statistics in its 30 member nations. Its report was more detailed than the WHO rankings, and had more controlled and consistent measures. The data, taken more seriously than the WHO rankings, left Americans with little to brag about.

And Emanuel's recent commentary was published the day after another report released by the Commonwealth Fund, which supports independent research into healthcare issues, found the United States at the bottom among six industrialized nations on measures of safe and coordinated care.

If all of that doesn't seem damning enough, insurance provider UnitedHealthcare Group took out a full-page ad in the Wall Street Journal on March 19 declaring: "The health care system isn't healthy.... A system that was designed to make you feel better often just makes things worse." One of the very industry giants that critics point to as a cause of the problem was defensively pointing back.

Amid stacks of reports, all with wonky measures of access, equity, efficiency and medical outcomes, two statistics stand out. The U.S. spends more on medical care than any other nation, and gets far less for it than many countries. According to the 2006 analysis by the Organization for Economic Cooperation and Development, the U.S. spends an annual $6,102 per person -- more than any other country and more than twice the average of $2,571. Yet Americans have the 22nd highest life expectancy among those nations at 77.2 years compared with the analysis' average of 77.8 years. People in Japan, the world leader in longevity, live an average of 81.8 years.

The report also found that the United States had about 2.5 times the average years of potential life lost due to diabetes: 101 years per 1,000 people compared with the average of 39 years per 1,000 people. Americans had fewer practicing physicians, or 2.4 per 1,000 people, than the average of 3 per 1,000 people. Infant mortality rates have been falling in the U.S., but are still higher, at 6.9 deaths per 1,000 live births, compared with less than 3.5 deaths per 1,000 live births in Japan, Iceland, Sweden, Norway and Finland.

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