Some people in the US seem to think Obama is Hitler, because he wants to reform their healthcare. If only Hitler had stuck to being a healthcare reformer, instead of annexing the Sudetenland…
The majority of US citizens think US health care is the best in the world. Therefore it is understandable that they would be concerned about any changes in the status quo. Why fix it, if it ain’t broke. However, they may be wrong.
Only 55 percent of U.S. patients get treatments that scientific studies show to work, such as beta blockers for heart disease, found a 2003 study in The New England Journal of Medicine. One reason is that when insurance is tied to employment, you may have to switch doctors when you change jobs. In the past three years, says Karen Davis, president of the Commonwealth Fund, 32 percent of Americans have had to switch doctors. The result is poor continuity of care—no one to coordinate treatment or watch out for adverse drug interactions. Such failures may contribute to the estimated 44,000 to 98,000 annual deaths from medical mistakes just in hospitals, and to “amenable mortality”—deaths preventable by medical care. Those total about 101,000 a year, reports a new study in the journal Health Affairs. That per capita rate puts America dead last of the study’s 19 industrialized countries.
Other data, too, belie the “best in the world” mantra. The five-year survival rate for cervical cancer? Worse than in Italy, Ireland, Germany and others, finds the OECD. The survival rate for breast cancer? You’d do better in Switzerland, Norway, Britain and others. Asthma mortality? Twice the rate of Germany’s or Sweden’s. Some of the U.S. numbers are dragged down by the uninsured; they are twice as likely to have advanced cancer when they first see a doctor than are people with insurance, notes oncologist Elmer Huerta of Washington Hospital Center, president of the American Cancer Society. But the numbers of uninsured are too low to fully explain the poor U.S. showing.
It isn’t realistic to expect America to be the best in every measure of medical quality. And none of this tells us how to reform the U.S. system. But it does say the “best in the world” is misguided medical chauvinism that should not block attempts at reform.
One famous example of medical chauvinism was a statement about prostate cancer by Rudy Giuliani, here explained by Gerd Gigarenzer.
In a 2007 radio advertisement, former NYC mayor Rudy Giuliani said, “I had prostate cancer, five, six years ago. My chances of surviving prostate cancer — and thank God I was cured of it — in the United States: 82 percent. My chances of surviving prostate cancer in England: only 44 percent under socialized medicine.” Giuliani was lucky to be living in New York, and not in York — true?
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Giuliani is a case in point. One basic concept that everyone should understand is the 5-year survival rate. Giuliani used survival rates from the year 2000, where 49 Britons per 100,000 were diagnosed of prostate cancer, of which 28 died within 5 years — about 44 percent. Is it true that his chances of surviving cancer are about twice as high in what Giuliani believes is the best health care system in the world? Not at all. Survival rates are not the same as mortality rates. The U.S. has in fact about the same prostate cancer mortality rate as the U.K. But far more Americans participate in PSA screening (although its effect on mortality reduction has not been proven). As a consequence, more Americans are diagnosed of prostate cancer, which skyrockets the 5-year survival rate to more than 80%, although no life is saved. Screening detects many “silent” prostate cancers that the patient would have never noticed during his lifetime. Americans live longer with the diagnosis, but they do not live longer. Yet many Americans end up incontinent or impotent for the rest of their lives, due to unnecessary aggressive surgery or radiation therapy, believing that their life has been saved.
Another example is a US medical blog, which when presented with data showing the US not to be the best in world reached for an anecdote about poor performance in the UK’s NHS. Such instances occur in all health systems. Right now US newspapers are running stories about 200,000 deaths a year from preventable medical error, adding up to 2 million deaths over the past ten years since the publication of “To err is Human“. That’s a lot of anecdotes.
Secrecy built into the system has long kept both the scope of the crisis and the specific problem areas out of public view. Some of those lives could have been saved with innovations as simple as color-coding medical tubes to avoid confusion.
A Hearst data analysis lifted a corner of that veil of secrecy to show that in five states served by Hearst newspapers — New York, California, Texas, Washington and Connecticut — only 20 percent of some 1,434 hospitals surveyed are participating in two national safety campaigns begun in recent years.
Also, a detailed safety analysis prepared for Hearst Newspapers examined discharge records from 1,832 medical facilities in four of those states. It found major deficiencies in patient data states collect from hospitals, yet still found that a minimum of 16 percent of hospitals had at least one death from common procedures gone awry — and some had more than a dozen.
Now, as the Obama administration wrangles with Congress over access to health care, frustrated patient-safety leaders say another priority must finally be addressed — making hospitals safer.
No-one I know who works in the NHS claims it is perfect, but some humility and honesty about their healthcare system would serve Americans well.