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Healthcare Code Blue

JOHN ABRAMSON, a clinical instructor at Harvard Medical School, is the author of "Overdosed America."

IF AMERICAN MEDICINE were a patient, he would weigh 350 pounds and be gaining fast. Despite being repeatedly counseled about the dangers of morbid obesity, he would be making at best half-hearted attempts to mend his gluttonous ways. Meanwhile, his doctors, insurance company, politicians and regulators would remain in a deep state of denial, clutching the illusion that their patient, other than being a bit overweight, was in tip-top health.

Truth be told, the U.S. medical system is headed for multiple organ failure.

The spiraling cost of healthcare is well known: $7,100 per person this year, projected to increase to $12,000 in 2015 and compounding at more than double the rate of inflation. Already, medical care gobbles up one-sixth of the GDP. Even so, we ask ourselves, how better to spend our money than on the best healthcare in the world?

Not so fast. The facts show that these enormous expenditures may be buying us the best amenities in medical care -- but not the best health.

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For example, Canada spends only 60% as much per person on healthcare as the United States. Yet, since 1980, the longevity of all Canadians has improved more rapidly than that of only white Americans. (In other words, these statistics aren’t skewed by the unconscionable racial and socioeconomic disparities in U.S. health and healthcare.) Yes, the “queues” in Canada can involve delays in nonemergency care. But these could be shortened with relatively small increases in funding. An article in the U.S. journal Health Affairs investigating the number of Canadians who come here to avoid these waits found the number so small that it asked, “A tip with no iceberg?”

Britain spends only 40% as much as we do on healthcare. But according to the Journal of the American Medical Assn., middle-class insured Americans “are much less healthy than their English counterparts” (who are insured because all Brits are insured).

In fact, although Americans spend twice as much per person on healthcare as the other 21 wealthiest countries, data from the World Health Organization show that we live the shortest amount of time in good health -- 2 1/2 years less than the average in the other countries (69.3 versus 71.8 years).

Reviewing a Dartmouth Medical School study that found higher mortality rates in areas that spent the most on Medicare, professor Elliott Fisher concluded that “perhaps a third of medical spending is now devoted to services that don’t appear to improve health or the quality of care -- and may make things worse.” This means that the U.S. is wasting more than $650 billion a year -- half again more than the entire Defense Department will spend this year, including the cost of the war in Iraq -- on unnecessary and often harmful care.

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How can this be? One factor is specialists. Both U.S. and international studies show that the more a healthcare system relies on primary care, the better the outcomes and the lower the cost. But American medicine is heavy on specialists and getting heavier. In just the last eight years, the number of graduates of U.S. medical schools choosing careers in family practice and adult primary care has plummeted by more than half. Americans know they’re paying more -- and fear they’re getting less. A Kaiser Family Foundation poll this month found that nine out of 10 consider the following issues important in determining their vote Nov. 7: problems with quality of their healthcare; the cost of health insurance and prescription drugs (the U.S. is the only industrialized country that lets drug companies charge whatever the market will bear); and the number of uninsured (47 million and growing by 1 million a year).

One would think that politicians would be eagerly tapping into these strong voter sentiments. So why are we hearing so little about healthcare as the election nears? Is this because politicians on both sides of the aisle are being influenced by the powerful medical industries? Certainly this plays a role. But there is an even more basic reason. Our government has become almost fundamentalist in its reliance on market-based, pro-business solutions to social problems. No politician wants to be tarred with the charge of promoting “socialized medicine.”

The problem is, our healthcare system is exquisitely well designed to maximize profits but exquisitely poorly designed to provide the best healthcare most efficiently. And even our nonprofit medical institutions shape the care they offer based on their own bottom lines instead of the health needs of the communities they serve.

In Washington, we’ve got a Food and Drug Administration that’s much better at protecting the interests of the drug and medical-device industries than those of patients.

And even in the midst of this pivotal congressional election campaign, few politicians are addressing the crisis in affordable, quality healthcare. Is this any way to run a democracy?

Back to our patient, American medicine. He’ll probably end up getting stomach-shrinking surgery at a cost of $27,000. Unless he’s one of the unlucky 40% who develop complications, in which case it could cost $65,000 or more. We all deserve better.


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