Care in need of a cure

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.