What Health-Care Crisis?
Barnes, Fred
ill and Hillary Clinton have contributed heavily to a national myth. Mrs. B Clinton, as boss of the administration task force plotting to overhaul America's health-care system, refers routinely to...
...in 1991, 50,000...
...Private hospitals, anxious to fill empty beds, have their own come-on...
...When the time comes (T-cell count below 500), the patient is started on AZT, which costs about $5,000 a year...
...Then there's Great Britain, home of the National Health Service...
...The American death rate is 1.7...
...For a country with a heterogeneous population and large pockets of pathology, this is remarkable...
...This put the U.S...
...We have a large number of people who indulge in high-risk behavior," says Leroy L. Schwartz, M.D., of Health Policy International, a non-profit research group in Princeton, New Jersey...
...He was put on a waiting list...
...In outpatient care, a clinic physician sees an average of 49 patients per day [and] 13 percent see more than 100," Ikegami said...
...In 1986, the number was 90,000...
...Japanese doctors also prescribe and sell drugs...
...The number of patients waiting six months or less grew by 10 percent...
...Yet, in most polls, 60 to 70 percent feel the health-care system is failing and needs significant, if not radical, reform...
...There's practically nothing to emulate...
...The infant mortality rate (IMR) is also "reflective of health and socioeconomic status and not just health care," wrote four Urban Institute scholars in the summer 1992 issue of Health Care Financing Review...
...The Canadian health-care system has many nice attributes, but speedy treatment isn't one of them...
...Real Tests While primary and preventive care are important, the best measure of a health-care system is how well it treats the seriously ill...
...Only Sweden has a lower death rate from breast cancer...
...About 25 percent of spinal cord injuries result from assaults...
...If millions of seriously ill Americans were being denied medical care, that would be a crisis...
...On the contrary, foreign health officials, Germans especially, now look at the incentives in the American medical system as a way to remedy problems in their health care systems...
...This dilutes the services provided...
...Not only that...
...There's a reason the uninsured get less health care, beyond the fact most work in low-paying jobs without health insurance...
...Parade, the popular Sunday supplement, emblazoned its February 28 cover with this headline: "THE GROWING CRISIS IN HEALTH CARE...
...But that wasn't sufficient for Robert Bourassa, the premier of Quebec...
...But it is high-quality health care...
...Hillary's task force meets in private, keeps the names of its members secret, obsesses over leaks, spurns the advice of outsiders (doctors, Republicans...
...Insurance firms encourage beneficiaries to have an operation or other treatment in a private hospital...
...But we can't...
...Japan...
...You know that, don't you...
...There are 100 assaults reported by U.S...
...Turning away patients isn't an option...
...The way hospitals and doctors are financed is sometimes bizarre...
...Behavioral problems become health problems: AIDS, drug abuse, assaults and violence, sexually transmitted diseases, etc...
...It's 2 in Canada, 2.7 in Germany, 3 in the Netherlands, 3.1 in Great Britain, and 3.2 in Sweden...
...and three years longer for women, has had fewer than 300 AIDS cases...
...of the 1950s...
...Germany also has strict fees for doctors, with predictable results...
...Japan has universal access and emphasizes primary care at clinics, financed mostly through quasi-public insurance companies...
...The problem is price controls...
...There isn't enough primary care—regular doctor's visits—for, many Americans...
...A study by the Fraser Institute in 1992 found that 250,000 people are awaiting medical care at any given time...
...Infant mortality rates of babies born to unmarried mothers are about two times higher than the rates of babies born to married mothers," the scholars write...
...For radiation therapy, the U.S...
...He bemoaned that many Americans get care at emergency rooms and occasionally wait six or eight hours...
...Its motto is: "Our specialty is devoted to treating everyone in need, no questions asked...
...Rival Systems Canadian politicians get special health care privileges, moving to the head of waiting lists or getting treatment at the elite National Defence Medical Centre...
...Once social factors have played out, the U.S...
...In Russia, with twice as many doctors per capita as the U.S., a wait of six to eight hours represented unusually fast service...
...A friend of mine volunteered to help an indigent, bedridden AIDS patient...
...What if you've got an enlarged prostate...
...At Christmas, they offer discount prices for operations...
...A hernia or intestinal obstruction...
...the United States is not the best or even among the best...
...It is not...
...Its shortcomings can be remedied by tinkering, or at least by less-than-comprehensive changes...
...Great Britain...
...To make sure we really have universal access, I checked on how victims of the most recent epidemic, AIDS, are treated...
...On infant mortality, the U.S...
...B Clinton, as boss of the administration task force plotting to overhaul America's health-care system, refers routinely to "the health-care crisis...
...This was an extreme case, but waiting is common in the Canadian system, in which the government pays all costs, including set fees for private doctors...
...The problem is the people...
...came out ahead in every category, way ahead in several...
...To the American's shock, the Russians erupted in laughter...
...Ian R. Munro, M.D., a Canadian doctor who emigrated to the U.S., wrote in Reader's Digest last September of a young boy in Canada who needed open-heart surgery to free the blood flow to his lungs...
...According to a new poll by Frederick/Schneiders, 39 percent are 18-29 years of age and another 25 percent are 30-39...
...Doctors in emergency rooms are specialists...
...for surgery, all at his own expense...
...And he goes one step further...
...An overhaul of the sort Hillary Clinton envisions is not only unnecessary, it's certain to reduce, not expand, the amount of health care Americans receive (price controls always lead to less of the controlled commodity...
...Life expectancy for American males at 65 is 14.7 years, only a tad less than Canada (15), Sweden (14.9), and Switzerland (14.9), more homogeneous countries with fewer social problems...
...What's• wrong with these measures...
...Like Canada's queues, this is an extraordinarily inefficient way to dispense care...
...Providers seek to maximize their revenue by seeing more patients," wrote Naoki Ikegami, professor of health at Keio University in Tokyo...
...The federal and city governments—the taxpayers footed the bill...
...They had 37 percent fewer sessions with doctors and 69 percent fewer days in the hospital...
...In fact, they have a professional organization, the American College of Emergency Physicians...
...No matter what the disease—epilepsy, hypertension, stroke, bronchitis—the U.S...
...Let's examine four key aspects of the health care debate: access, false measures of quality health care, true measures, and how America's system compares with those of other industrialized democracies (Canada, Germany...
...Exacerbated social problems . . . adversely affect U.S...
...If enacted, it will make the problem worse...
...Ninety-nine percent are eligible for Medicare...
...What if a penniless AIDS patient shows up at, say, the Whitman-Walker Clinic in Washington, D.C...
...The death rate per 100,000 persons is 2.7 in the U.S., compared to 2.8 in the Netherlands, 3.1 in Canada, 4.9 in Germany, 7.6 in Sweden, and 8 in Great Britain...
...He lived with a boyfriend, but the boyfriend was not required to pay for any of the care...
...The U.S...
...it a health problem...
...Sweden, Great Britain, and Germany may have higher incidences of prostate illness, but not high enough to account for the wide disparity in death rates...
...Federal law (section 9121 of the Consolidated Omnibus Budget Reconciliation Act of 1985) requires medical screening of everyone requesting care at a hospital emergency room...
...Nope...
...The existence of a few health care problems, chiefly the lack of proper primary care for several million Americans, allows them to declare a crisis and go on wartime footing...
...The infant mortality rate is the number of deaths of children under one year of age, divided by the number of births in a given year, multiplied by 1,000...
...behind Canada, France, Germany, Italy, Japan, and Great Britain, among others...
...In April 1992, it was down to 1,600...
...That patient, even if indigent, gets treatment...
...The uninsured tend to be young, thus healthy...
...Another study found that the 16.6 percent of the non-elderly population who are uninsured-36.3 million people—accounted for 11 percent of the nation's personal health-care expenditures in 1988...
...They won't...
...Officials take great pride in having reduced the number of patients waiting more than two years for medical attention...
...In 1990, life expectancy in America was 72 years for males, 78.8 for women...
...In contrast, American hospitals make heroic efforts in neonatal intensive care, saving some infants, losing others, and driving up the IMR...
...Sounds great, but there's a catch...
...has the lowest death rate: stomach cancer, cervical cancer, uterine cancer...
...The entire medical system bears the brunt of social and behavioral problems that are far worse in the U.S...
...Being uninsured means "one is more likely to use emergency-room care and less likely to use office, clinic, or regular inpatient care," said Richard Darman, President Bush's budget director, in congressional testimony in 1991...
...In MRI's, the U.S...
...In other words, pricecontrols are as inefficient in Germany as in Japan...
...homicides result in per capita homicide rates 10 times those of Great Britain and 4 times those of Canada...
...has little but painful lessons to learn 1 from the health-care experience of other countries...
...We think we can take care of everything by calling...
...Not surprisingly, they sell plenty...
...Finland, Spain, Ireland, East Germany, and Italy finished higher...
...I could go on, and I will...
...I'm grateful to Dr...
...To prevent infections or complications, the patient is treated with prophylaxis...
...Annual doctor's visits per capita are 11.5 (5.3 here), a figure exceeded only by Japan (12.9...
...The drugs are paid for mostly by federal funds...
...In 1991, an American official addressed Russian health experts in Moscow...
...Life expectancy is determined by much more than the quality of a nation's health care...
...A lot of Americans don't have health insurance," he told a group of schoolkids February 20 during a nationally televised children's town meeting at the White House...
...Can these be attributed solely to varying 'incidences of ulcers and obstructions...
...health outcomes," noted three Department of Health and Human Services officials in the fall 1992 issue of Health Care Financing Review...
...Your chances of survival are better if you're treated here...
...And he'll keep buying health insurance...
...The one exception is specialists at Japan's teaching hospitals...
...This is not to suggest that this is desirable...
...Hospitals face perverse incentives, too...
...And this was achieved, a survey by the National Association of Health Authorities and Trusts found, chiefly because of a 13 percent hike in NHS spending in 1991, not increased efficiency...
...Sure, the company pays, but it knows that once a patient has experienced care in a private hospital, he'll never go back to the socialized medicine of NHS...
...There's also doctor care, painkillers, laboratory work...
...Later, the patient gets expensive, experimental drugs: DDI, DDC, D-4T...
...The point is not that America's high IMR is excusable, but that it's grown to abnormal levels in large part because of factors unrelated to the quality of health care...
...False Tests Judging by the two most common measures of health, life expectancy at birth and the infant mortality rate, health care in...
...tl...
...The 20,000 annual U.S...
...The patient had no insurance...
...The government pays a fixed rate per day, regardless of the patient's illness or length of stay...
...had 3.97, Germany 3.13, Canada 0.54...
...than in other industrialized democracies...
...Most opinion polls show roughly three-quarters of Americans are satisfied with the availability and quality of the health care they receive...
...A lot of Americans don't have health care...
...It's a myth...
...Just this: they're a reflection of health, not the health-care system...
...Everyone gets health care in this country—the poor, the uninsured, everyone...
...also has the second lowest death rate from heart attack...
...Health care may (or may not) be too costly, But it's the best health care system in the world—not arguably the best, but the best...
...Social factors probably have a bigger impact...
...He got a surgery date only after news reports embarrassed health officials...
...Patients return repeatedly to get the same care that in the U.S...
...The overall death rate from cancer is slightly higher in America than in Sweden or Germany, but lower than in Canada, the Netherlands, and Great Britain...
...There's solid evidence...
...Japan, where life expectancy is four years longer for men than in the U.S...
...This is a common phenomenon in Washington...
...What this adds up to is "universal access" to health care in America, as one head of a hospital board told me...
...After waiting two months, he died four hours before surgery...
...Through June 1992, there were 230,179 reported AIDS cases here, two-thirds of whom have died...
...Another measure that's important is the proliferation of new technology...
...He was amazed at the level of care...
...He compared the availability of six technologies—open-heart surgery, cardiac catheterization, organ transplantation, radiation therapy, extracorporeal shock wave lithotripsy, and magnetic resonance imaging—in the U.S., Canada, and Germany in 1987...
...The overall drop in waiting lists was only three percent...
...No, our health-care system isn't perfect...
...Schwartz for all these figures...
...The good news in Great Britain is that private insurance is allowed and 6.6 million Brits have it...
...For the elderly, a survey found, the average number of doctor's visits for a six-month period was 17.3 (3.6 here) and the length of visits was 12 minutes (30 in, the U.S...
...Canada has other problems: health costs are rising faster than in the U.S., hospital beds and surgical rooms are dwindling, and doctors are fleeing (8,263 were practicing in the U.S...
...Major medical technology has had a profound impact on modern medicine and promises even greater impact in the future," wrote Dale A. Rublee, an expert in cross-national health policy comparisons for the AMA's Center for Health Policy Research, in Health Affairs...
...Patients receive assembly-line treatment...
...had 3.26, Canada 1.23, Germany 0.74...
...The more resources a country's health-care system places on saving high-risk newborns, the more likely its registration will report a higher IMR," according to the Urban Institute scholars...
...For open-heart surgery, the U.S...
...in 1990...
...The U.S...
...There was never a sense we'd be left in the lurch...
...And so on...
...They aren't recorded as "live born" and aren't counted in infant mortality statistics...
...Thirty percent of the country's health expenditures are for drugs (7 percent in the U.S...
...But for specific cancers, the U.S...
...When Louis Sullivan, M.D., President Bush's secretary of health and human services, visited Japan, he was surprised to find medical care matched that of the U.S.—the U.S...
...The Japanese model isn't any better...
...An ulcer of the stomach or intestine...
...ranks at the top in life expectancy...
...Then we really will have a health-care crisis...
...n truth, the U.S...
...emergency rooms for every homicide...
...death rate from prostate trouble is one-seventh the rate in Sweden, one-fourth that in Great Britain, one-third that in Germany...
...It is not uncommon for patients to wait months or even years for treatments such as cataract operations, hip replacements, tonsillectomies, gallbladder surgery, hysterectomies, heart operations, and major oral surgery," according to Edmund F. Haislmaier, the Heritage Foundation's health-care expert...
...He came to the National Cancer Institute in Bethesda, Maryland, for diagnosis, then returned to the U.S...
...Every year the pool of pathology in this country is getting bigger and bigger...
...It's .no secret how much health care the uninsured get...
...The American Hospital Association estimated in 1991 that hospitals provide $10 billion in uncompensated care annually...
...The press also trumpets the crisis theme...
...Emergency rooms are often swamped...
...The incidence of AIDS is even more telling...
...And there are measurement problems...
...runs into trouble...
...The uninsured get health care, only less of it than the insured...
...The U.S...
...To avoid queues, patients pay bribes of $1,000 to $3,000 to be admitted to a private room and treated by a senior specialist...
...It was an endless supply of extremely sophisticated drugs, an elaborate IV system [to feed the patient], and eventually a five-day-a-week home help nurse," my friend said...
...The result is that the American people, despite their personal experience, now believe there actually is a health-care crisis...
...By the way, the elderly (65 and up), who requiremore medical care, are covered...
...is given in a single visit...
...At age 80, when most people are highly dependent on the health-care system, Americans have the longest life expectancy (7.1 years for men, 9.0 for women) in the world...
...But that's not happening...
...Canada and Germany were selected because their overall health-care resources are fairly comparable to the United States," Rublee wrote...
...Her husband uses the same phrase ("Our government will never again be fully solvent until we tackle the health-care crisis," Clinton declared in his State of the Union address on February 17...
...The program that emerges is sure to dwarf the problem...
...If treatment is needed, it must be provided...
...In Japan, wrote Ikegami, "no real incentives exist to maintain quality...
...compares well...
...Small wonder that, as Rublee put it, "American physicians, with a universe of modern technology at their fingertips, are the envy of the world's physicians...
...A poverty rate twice Canada's and Germany's, a rash of drug-exposed babies, a high incidence of unmarried teenage pregnancy—all lead to low-birth-weight infants and affect the IMR...
...had 3.69 per one million people, Germany 0.94, Canada 0.46...
...Access Will someone please tell Bill Clinton that having no health insurance is not the same as having no health care...
...Social factors affect life expectancy, and this is where the U.S...
...The problem is not the health-care system," says Dr...
...There is no health-care crisis...
...Sometimes we had so much medicine, we had to throw it away...
...Some people never learn...
...So hospitals pad their billings by keeping patients for unnecessarily long recuperations, which compensates for the losses they incur taking care of critically ill patients...
...Hillary Clinton and health policy wonks should stop apologizing for our system...
...fared still worse, ranking nineteenth in 1989 with a rate of 9.7...
...Many countries make no effort to save verylow-birth-weight infants...
...The American Medical Association says "lifetime medical care" for a single AIDS patient costs $102,000...
...Schwartz...
...You don't have to take my word that there's no crisis now and that health care here is the world's best...
...These are the folks doctors are supposed to be leery of dealing with...
...Liberals love this...
Vol. 26 • May 1993 • No. 5
