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Occupy Healthcare

Posted by Mark Ryan, MD November 4, 2011 at 8:00 PM

Why do we need to occupy healthcare?  Why are we here, on this website, calling for change?  We are so often told that America has the best healthcare system in the world.  If that were so, then there would be no need to change anything.  We could continue running things as we currently are, and all would be well…

Except that we do not have the best healthcare system in the world.  And we do need to change our current dysfunctional system.

When I make this statement, naysayers usually point out that America is the destination of choice for people all over the world who come here for care of their complicated medical problems.  Advanced cancer, for example—the US is apparently the place to be if you need high tech, high-intensity care.  Another argument is that patients come here to jump the line to get hip surgery or heart surgery that would require a much longer wait in their original country…although it is not often that this claim is supported with evidence that the procedure in question could not have waited.

So: I have staked a position, one that is contrary to the common wisdom.  I have made the claim that American healthcare is not the best in the world.  It is now necessary to defend this position:

•    American healthcare is not #1 in the world.  In this World Health Organization (WHO) analysis, the US ranks 37th.  We place just behind Costa Rica.  Other nations that outrank us: Dominica, Chile, Saudi Arabia, Cyprus, Greece, Colombia, and Morocco.  Just below us: Slovenia, Cuba, Brunei, New Zealand.  Essentially every developed nation in the Western Hemisphere performs better than we do.

•    It’s worse than it looks: as this analysis shows, we are 39th in infant mortality, 43rd for adult female mortality, and 42nd for adult male mortality and some of the US’s quality measures have not increased as much as other nations’.

•    We rank last among seven developed Western-style democracies in US healthcare performance (graphic here).  We ranked 7th out of seven in efficiency, equity and “long, healthy, productive lives” 6th in access, and tied for 6th in access.  This last category (access) is ironic, given that many of the arguments against reforming the US healthcare system focus on the potential loss of patients’ access to their physician; it appears this access is not as robust as we might believe.

•    Our healthcare spending per capita is 50% greater than the next highest nation’s, and our healthcare spending in the US is increasing faster than most other nations’, and the % of national GDP spent on healthcare in the US is the highest in the world (reference here).

•    According to this just-released report from the Commonwealth Fund, the US scored 64 out of 100 points and lagged behind other developed nations.  You can see the short version of the report here.

Americans pay much more per person, to support a health care system that does not function very well at all, that provides inadequate and unequal care for far too many people (pdf), and that leaves nearly 50 million Americans without health insurance. (pdf)  These are all indicators of a system with significant, fundamental dysfunction.

How can we tolerate this?  How long do we continue paying for a system that is not meeting our needs, and that is costing us more and more?  How long can we continue draining resources on a system that is unequal and that does not meet its intended goals?

Every system is perfectly designed to produce the results that it is producing.  If we continue doing the same things, we will continue getting the same results…only at ever-greater cost.  Even with the passage of the Patient Protection and Affordable Care Act (PPACA), the fundamental structure of our system will not change, and we will still need to find ways to make our healthcare system more effective, equitable and efficient.

We cannot continue the status quo.  We must occupy healthcare, and we must fight for reform that will make a true difference for our nation and improve our fellow citizens’ health.

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