Best health care in the world? Not us, not the US

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“Ranking 37th — Measuring the Performance of the U.S. Health Care System” is an article posted online by the New England Journal of Medicine. Excerpt:

Despite the claim by many in the U.S. health policy community that international comparison is not useful because of the uniqueness of the United States, the rankings have figured prominently in many arenas. It is hard to ignore that in 2006, the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy. These facts have fueled a question now being discussed in academic circles, as well as by government and the public: Why do we spend so much to get so little?

What an important question for US journalists to tackle more deeply more often.

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Joseph Arpaia, MD

January 6, 2010 at 7:42 pm

People are suggestible. When advertisers spend billions of dollars sending the message that you are sick and need expensive medications or procedures this makes people sick.
Its worse then disease mongering, its causing disease. If someone comes in to work and everyone in the office tells him that he looks like he has a headache and offers him ibuprofen, there is a high likelihood that he will take ibuprofen even if he didn’t have a headache to start with.
Everyday I see people who are worried sick about their health because of the constant advertising suggesting that we are fragile creatures who are going to die soon unless we “ask the doctor” about the latest medication.
People need to get the message that they are tough. We are not fragile creatures. When our culture starts encouraging self-reliance rather than faith in pills and procedures then we will get more results from health care.


January 6, 2010 at 10:34 pm

Interesting post. I think it interesting that politicians keep saying we have the best healthcare system in the world when the US really does not. I think one of the drivers for healthcare reform should be national pride about having a great healthcare system.

floormaster squeeze

January 7, 2010 at 8:48 am

We do not have the best healthcare system in the world for a lot of reasons but the fact we have such horrible “macro” health statistics is precisely because we over emphasize that health care creates health. It does in a way but there a far more important things that determine your health (things that people REALLY do not want to talk about). We do not educate our citizens that broadly (yes, some are well educated but large groups are not); we have a lot of poverty; even in the midst of 10% national unemployment the stresses of job loss and the lives of people without income security are hardly ever mentioned in news, politics and the arts. There are lots of things that influence health and that is the trouble; we choose to promote things that also create wealth for providers (health care) and ignore social investments in things that could save a lot more lives (like education, jobs, safety, environment, social integration, etc.).
This is precisely why the perspective of this website is so important. If health care is a cost that every employer has to add to production in the economy it is no wonder we struggle to compete in internationally traded goods. Sure, health care does provide income and wealth for some but at what cost? The irony is that the stress and poverty created by our bloated health care system creates more illness and disease with all the money, jobs and family peace lost. Yes, health care rooted in evidence and need provides much more good than it costs its just we are billions past that point and the waste creates real harm.
The real health care reform is to realize that health care itself is only a part of what makes us well.

Scott R. Anderson

January 7, 2010 at 11:49 am

Combining the concepts of overall “Health” and our “Health Care System” is misleading at best.
As an international traveler I can confirm that our “Health Care System” as measured by the quality of our facilities, availability of services, and provider training is second to none. Has anyone ever been to one of the countries that is “better” than us based upon mortality rates. We win hands down….
Of course “Health” as defined by infant mortality,life expectancy etc. is an example where we lose.
Combining the concepts of “Health” and “Health Care System” to achieve a single answer is alot like saying that public school teachers are solely responsible for “outcomes” of students in their schools, when in fact the environment and parents play a much bigger role.
As I always dislike discussions without solutions to the bigger issue, here is mine:
We must reinvent the “Health Care System” reimbursement model to focus on “quality of life” and be more proactive in disease management in conjunction with a single payment model for medical conditions, vs. discreet services reimbursement as now utilized with CPT codes in this country. With this change in reimbursement we will see overall “preventive” services increase, with a equal amount of decrease in “reactive” care for chronic medical conditions.

Margaret Hanson

February 11, 2010 at 3:58 pm

I couldn’t agree more with this post and Dr. Arpaia’s comment. I am in the healthcare field and became disillusioned after learning about the millions of people suffering needlessly with conditions related to stress/tension, who are routinely misdiagnosed and treated ineffectively, by a supposed top notch healthcare system. I know this firsthand because I was one of them. I had 10 years of upper back pain. Consulted with numerous doctors and tried many treatments both traditional and alternative. In desperation, I agreed to shoulder surgery, which turned out to be unnecessary. I had to stumble across information, that had been available for years, that introduced me to the mindbody connection and began my full recovery. I found Healing Back Pain, by Dr. John Sarno, and what I learned will help me for the rest of my life. I am currently working with a compassionate group of physicians and therapists to educate other health professionals along with the public, about the relationship between emotions and health and the incredible healing power within each one of us. Thank you Mr. Schwitzer for you excellent post.