Dr. Forbush Thinks

Look at the world through the eyes of Dr. Forbush. He leads you through politics, religion and science asking questions and attempting to answer them....

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Location: California, United States

Tuesday, September 08, 2009

Crazy Health Care

It drives me crazy every time I hear someone utter the factually incorrect statement that the US has the greatest healthcare in the world. I heard it again today on a radio talk show and the comment wasn’t even challenged. Of course this didn’t surprise me, because this assertion is never challenged.

Now, to be fair, there are certain ways that the USA could be ranked number one in health care. If by “best” we mean “most expensive,” then we might be in the running. However, if we would measure quality of health care as a function of healthy outcomes then the USA is not even close.

If we start by making the assumption that the goal of having a good health care system is to prolong life we might start by looking at the list of countries ranked by the number of deaths in a country per 1000 people living in the country. By looking at this list we see that the US is ranked about the center of the list ranked from highest to lowest -- 94th with a rate of about 8.1 deaths per 1000 out of over 200 countries. ( 2009 List by the CIA World Factbook) This does not tell us everything, but it does tell us that countries like Mexico have rates much lower than ours. Why?

There could be other problems just looking at this number, because some countries have younger populations than other countries. A younger country should have a lower death rate than an older country by the mere fact that everyone eventually dies. So, lets assume that the goal of health care is to allow people to live as long as possible. The measure of success then would be the life span of the average citizen in the country. If we rank countries from the longest life span to the shortest, we find the US ends up at 50th out of over 200 countries with an expected life span of 78.11 years, while Japan finishes near the top of the list with 82.12, Australia has 81.63 and Canada 81.23. With these numbers how can anyone still argue that the US has the best health care in the World?

What exactly is a person thinking when they claim that the US has the “best” health care in the World? How do they measure best? It is true that within the borders of the USA there exists some very good health care. And, it is true that if someone has unlimited resources they would be able to have access to some of this very good health care. The problem is that many people in the US do not have access to this care. And, hence these people pull the average life expectancy of the US down.

So, if someone asserts that the US has the best health care in the World they must be asserting that their own health care is part of the elite few that have access to this advanced health care. They are also asserting that they really don’t care what happens to the population that does not have access to this elite care. Of course this is sad and selfish, but in the USA we do not have laws against being selfish and most people are numb to the suffering of others.

But, even the assertion that a person has access to the elite health care that exists in the USA is suspect. This is because many people are covered by insurance that they have only rarely used. This is because many people in the US never go to a doctor for a yearly physical. Insurance companies don’t see any benefit in having people see a doctor on a yearly basis, because it costs them money and they are in the business of collecting revenue and figuring out ways to avoid paying any money out. Insurance companies are in the business of making a profit, and any layout goes against the bottom line. It isn’t in the interest of the insurance company to care about the health of its customers. In fact, it is in their interest to see that their customers die in the cheapest way possible.

A person normally doesn’t learn the effectiveness of their insurance until the insurance is needed. And, when the insurance is needed its too late to change coverage. And, when the insurance is needed the trauma of the situation clouds ones vision of the financial picture. Many people with what they believed to be “good” insurance find themselves bankrupted and embarrassed by finding out how poor their coverage was when they needed it. This embarrassment prevents them from sharing this with their family and friends.

The silent killer in the US health care system is the fact that health care costs have been rising over the last 20 years. People may have had favorable experiences with their insurance companies over the years, but their current situation may have changed over the years. Many procedures and drugs are no longer covered under some plans. Employers are buying cheaper coverage that covers less with higher deductibles and co-payment options. This means that more money comes out of your pocket before the insurance company pays anything.

Eighteen years ago the US was already a very expensive health care system. I know this from personal experience. My daughter was born in Germany in a private hospital. I was working for a US company and therefore my US insurance would cover the hospital and delivery costs in Germany. I just needed to get the bill and send it to the insurance company. As my wife went through prenatal care and through the birth of my daughter I submitted the bills to my health insurance company. The total at the end of the process was completely covered by my health insurance. And, the company could not believe that I had submitted all of the bills in total because the cost of my wife spending an additional three days in the hospital “should cost much more” as the insurance company wrote to tell me. The German bill noted each procedure and expense in meticulous detail -- even to the extent of pointing out that I was being charged an inflated cost because we were covered by private insurance.

The question we should be asking is -- Why was there such a disparity in cost between the US system costs and services and the German system? I would assert that it must be greed in the US system. I would also assert that greed itself is not illegal, but it preys on people when they are in very vulnerable situations. Greed in health care pushes suppliers to encourage patients to over spend. The emotional situation urges the loved ones of the ill to “do whatever is possible.” There is no natural limitation to this spending except the bottom of each person’s money supply.

I know that this greed is real from another personal experience. I was involved in a project to develop one of the first MRI (magnetic resonance imaging) machines. At that time we called it NMR (nuclear magnetic resonance), because the technique actually causes the atomic nuclei to resonate. When we talked with doctors they told us many quite interesting things that gave me insight into the health care industry.

The first thing they told us was that the word nuclear needed to be dropped, because nuclear was a scary word and people would not want to subject themselves to a machine that used nuclear anything. Of course, MRI is one of the safest forms of imaging, applying a magnetic field and electric field and measuring the magnitude of the resonance signal of particular nuclei in order to map the density of water in the body for example. This is much less dangerous than using X-rays that can cause mutations when they hit the DNA in a cell.

The next thing they told us was that the MRI pictures were three dimensional and multi colored. The colors did not look like the colors in the body, so it would be much better if we could make them look more like X-ray pictures. Obviously the doctors could not recognize the advantage of the new technology and they would prefer that the new technology was only slightly better than the older technology so that the doctors would be more likely to adopt the new technology. Obviously this is something to keep in mind whenever one takes a trip to the doctor.

And the most frightening revelation of all was that the doctors told us that they were happy that the new technology was cheaper to operate than the previous technology. But, it was new technology, therefore they could charge more for it. The most important implication was that the profit margin would be larger with the new technology.

The summary of this is that the doctors were willing to make the technology less effective, they were willing to lie to the patients by changing the name of the machine and they wanted a higher profit margin. I have to tell you that I have had a very skeptical view of all doctors because of this experience. I think that we should all be more skeptical.

When I was in Germany I noticed that the doctors were much more friendly and willing to share what they didn’t understand as well as what they did understand. I felt more connected with the process. I felt like my questions were listened too and thought about. In the US this is much less frequently the case.

Anyway, I am still very confused at the assertion that the US has the best health care in the World. If anyone knows of any evidence that supports this I would love to read it. Please tell me what you know I am all ears.


Don't forget what Stephen Colbert said, "Reality has a well-known liberal bias."

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