Category Archives: Health Care

See Sicko

Posted on by

I believe Sicko opens today nationwide, so be sure to see it over this long weekend.

Ari Melber responds to a criticism of the film from Dean Barnett. You remember Barnett; he’s the twit who thinks fertilized eggs are people, but soldiers aren’t, and of course women are merely major appliances. Barnett makes the knee-jerk assumption that Moore made the film to elect Democrats.

Melber points out that Moore probably is harder on Hillary Clinton than he is on George Bush in this film. I’ll let Melber continue (emphasis added) —

These are not the kind of stories that prime people to think of partisan affiliations or presidential campaigns. If anything, the genuine human struggles in “Sicko” raise questions about our society that run much deeper than what passes for political discourse today.

Why does such a rich nation let people suffer and die without health care? If we truly value the Americans who risked their lives on Sept. 11, why do some struggle without treatment for injuries they sustained while trying to keep us safe? And in the toughest challenge for American exceptionalists, why do so many other countries do a better job of providing care to all of their citizens? (Specifically, 36 countries, according to the World Health Organization.)

These questions probably won’t send people running from the theater to endorse a particular health care policy. Yet “Sicko” could drive the public to demand a realistic national debate on how to achieve quality care for all Americans, and to reject the recurring political attacks on the people working toward this admirable goal.

The recent personal attacks on Moore – and other health care reformers, such as former Sen. John Edwards (D-N.C.) – are in line with the vacuous scare tactics that have stifled health care policy long before the Clinton administration attempted reform. The detractors typically don’t offer solutions or engage reformers’ ideas. They don’t join the vital debate over how our public policy should value every human life. They just defend the status quo and launch personal attacks.

This brings us back to Mr. Barnett’s Politico column. It offers a conservative’s supposed concern that the intricate politics of “Sicko” will backfire on Democrats (why would he care?). Then it recycles the canard that Edwards should not help the poor because he is wealthy. (By that logic, Americans with good health care shouldn’t help anyone else, and cities with solid homeland security shouldn’t collaborate to defend more vulnerable areas.)

But after 800 words, Mr. Barnett fails to say anything about health care policy, or whether the Sept. 11 rescue workers deserve assistance or whether the U.S. should even try to improve our world health rankings. The column, like so many attacks on health care reformers, ignores the issues and gloomily accepts America’s dismal health care condition – and then labels Moore as the pessimist. “Smart politicians would avoid him like the plague,” concludes Mr. Barnett.

Here it’s painfully obvious that Mr. Barnett didn’t see the movie or didn’t get it. The issue is not how “smart politicians” position themselves – the public could not care less. The issue is what our nation can do about a health care crisis that leads to the needless suffering and death of our fellow citizens. They are the ones who have to avoid a real “plague,” since they can’t count on decent treatment when they get sick.

I’ve read a number of reviews that complain Sicko is one-sided and that Moore doesn’t always explain where he gets his facts. To this I say, first, that the more you know about what’s going on in American health care, the more you realize the “other” side is indefensible. Second, Moore said very little that I hadn’t already learned in my own research. I can’t swear the film is without factual error, but overall the way it portrays U.S. healthcare is accurate. Moore may be guilty of oversimplifying — the Canadian and British health care systems do have some problems that aren’t discussed in the film. But Moore is also an entertainer. This is a theatrical film, not a presentation for policy wonks.

But most of the bad reviews I’ve read amount to sputtering defenses of the status quo and personal attacks on Michael Moore. What the critics never ever do is honestly address the problem of people who can’t get insurance, or our crumbling emergency rooms, or our dismal health data. They just make excuses.

Clarence Page writes:

Numerous congressional proposals have offered wider, less-expensive and more-reliable coverage than Americans receive from our current patchwork, employer-based system.

But no matter how workable, practical or desirable the proposals may be, the insurance industry reliably shoots them down. Armed with billions of dollars for political campaign contributions, spin doctors and attack ads, the industry has largely steered the nation’s health care debate for decades.

Mr. Moore evens things up a bit. He uses the same pop culture that brings you Paris Hilton and American Idol to offer something truly valuable: a vision of a better American health care system than the one we have.

The fact is that whatever truncated national discussion we’ve had about health care going back as far as I remember has been entirely one sided. It’s the health care industry saying we have the Best Health Care in the World, and if you don’t agree you must be a Communist. End of discussion.

He offers something else that most Americans never see: how easily anyone – including visitors – can access good public health care in Canada and Europe and how satisfied those country’s citizens are with their systems. Critics predictably charge Mr. Moore with sugar-coating his view of the other countries, particularly Cuba, where Fidel Castro’s government still affords superior care to favored Communist Party elites. Nevertheless, having witnessed health care in each of the countries Mr. Moore visits, I think he got it about right.

In Canada and Europe, customer satisfaction is high, despite the drawbacks. Defenders of our health care status quo come up with one horror story after another of long lines, waiting lists, rising costs or rationed care. But they don’t like to talk about the long lines, waiting lists, rising costs or rationed care that Americans face in our existing system. Mr. Moore’s movie does.

Nobody’s system is perfect. But despite the smear job that conservatives over here give to British health care, for example, stalwart conservatives over there aren’t mounting much of an effort to change it.

If the film does nothing else but get people to realize it doesn’t have to be this way, it has done its job.

Update: See Crooks & Liars about a hit piece on Sicko in the Los Angeles Times.

More Sicko

Posted on by

Cenk Uygur of The Young Turks appeared on CNN’s Paula Zahn show last night to talk about health care and the film Sicko. You can watch the video here. Be sure to check out the spokesperson for the Right, Amy something.

My comments:

The young lady representing the Right kept going on about how she didn’t have health insurance because she was self-employed and wanted some kind of tax credit so she could afford it. However, I’m reasonably certain self-employed people already can deduct 100 percent of their health insurance premiums from their federal income taxes (Form 1040, line 29). So I’m not sure what other tax incentives she might need.

Which takes me to the next point — she was complaining about those awful “regulations” that make insurance so expensive. When the COBRA policy from my last job ran out I was able to purchase a private Blue Shield HMO policy, even though I am 55, overweight, and have high cholesterol. This is thanks to New York state regulations. I’m paying almost $700 a month for it, but by damn I’m insured. In many states I probably could not have purchased private insurance at any price.

This is, I think, critical: Empire Blue Cross/Blue Shield could not deny my application because I applied the same month my COBRA insurance expired. I didn’t have to get a physical or anything; just provide proof of my prior insurance. This was New York law, they told me. Had I waited more than a month, they could have turned me down. In many states I wouldn’t have had even the grace period; I could have been denied coverage just because. These are the kind of “regulations” the Right says are so onerous.

Also in New York, if you start a new job, your new employer’s health insurance provider has to insure you even if you have pre-existing conditions. There may be some loopholes somewhere, but I have never heard of an employed co-worker being denied coverage in all the years I’ve lived around here. That’s another of those damn “regulations” the Right wants to do away with.

Ms. Amy the Tool (who is a pretty girl, but a twit) exemplifies another problem with “The System.” She’s young and healthy and thinks it doesn’t make sense for her to purchase health insurance when she sees a doctor maybe once or twice a year. Never mind that she’s gambling she won’t be in an accident or come down with something serious. Insurance is about risk sharing, and if healthy people aren’t in the system it drives up costs for everyone else.

Finally, the segment implied that Sicko focuses on the problems of uninsured people, but it’s more about insured people who have been ripped off by their insurance providers.

I hope I’m not being too hard on Cenk, who did good.

Also: Nice commentary on Sicko by Maggie Mahar.

Update: I forgot to answer one other thing — Ms. Amy Something mentioned all those Canadians who are dropping dead while on waiting lists for elective surgery. I don’t remember the number she gave. I want to repeat something I wrote last month:

Nearly a year ago the Institute of Medicine issued three reports (key findings here) saying the nation’s emergency rooms are inadequate and getting worse. Among other things, it found:

  • Demand for emergency care has been growing fast—emergency department (ED) visits grew by 26 percent between 1993 and 2003.
  • But over the same period, the number of EDs declined by 425, and the number of hospital beds declined by 198,000.
  • ED crowding is a hospital-wide problem—patients back up in the ED because they can not get admitted to inpatient beds.
  • As a result, patients are often “boarded”—held in the ED until an inpatient bed becomes available—for 48 hours or more.
  • Also, ambulances are frequently diverted from overcrowded EDs to other hospitals that may be farther away and may not have the optimal services.
  • In 2003, ambulances were diverted 501,000 times—an average of once every minute.

    • After these reports came out, David Brown wrote in the Washington Post:

    The number of deaths caused by a delay in treatment or lack of expertise is especially uncertain, though it may not be small. San Diego established a trauma system in 1984 after autopsies of accident victims who died after reaching the ER suggested that 22 percent of the deaths were preventable, said Eastman, one of the Institute of Medicine committee members.

    Our system doesn’t kill people by putting them on waiting lists for elective surgery. Out system has other ways to kill people. If it doesn’t kill them in the ER, it kills them by denying them necessary surgeries. Experimental, you know. And it kills them when it denies them basic medical care.

    A report came out in 2002 that 18,314 people die in the US each year because they lack preventive care services, timely diagnoses or appropriate care. They lack these things because they are uninsured.

    Those people would have been better off in Canada, wouldn’t you say?

    So I’m Blue in the Face

    Posted on by

    Andy doesn’t get it:

    Moreover, a wholesale shifting of healthcare from the private to the public sector simply means replacing rationing by wealth with rationing by number, and a drastic decrease in individual freedom on both sides of the medical equation. You’d replace insurance company bureaucrats who deny care with government bureaucrats who deny care. Removing the financial incentive from doctors simply means they will provide sloppier treatment. They’re not saints. They’re human beings. And slashing the profit motive from the drug companies will simply mean fewer new drugs for fewer illnesses. This is the trade-off the left will deny till they’re blue in the face. But it’s a real trade-off.

    But for the most part these trade-offs are not happening elsewhere. So why would they happen here if they are not happening in, say, France?

    In one part of Sicko a doctor — I can’t remember if he’s British or French — explained that his income goes up if his patients get healthier. Meaning, if his records show he is providing patients with good preventive care, as opposed to just writing prescriptions, he gets bonuses. Here, doctors get paid for not treating people.

    Patients in those nasty foreign countries like Canada actually have shorter waiting lines in emergency rooms than they do here. They get better general care, which is why they live longer and have lower infant mortality rates. Patients are not being denied care because of some technicality in their private insurance contracts. People are not being driven into bankruptcy by medical bills. Other nations’ plans are not perfect, but nearly all of ’em are a whopping huge improvement on what we’ve got.

    As far as the “fewer drugs for fewer illnesses” line — what’s actually happening is that highly subsidized American Big Pharma cranks out tons of boutique drugs for boutique illness (toe rot; restless leg syndrome) or “new” drugs advertised as breakthrough but which usually are just minor tweaks to the old drugs, or perhaps not as good as the old drugs. “Life-saving” often means “terminal patients get one more month.” That sort of thing. I’ve written about his before; see “Demand Supply” and “Unhealthy Care.”

    Andy continues,

    The European health systems have, of course, been free-riding on private U.S. drug research for decades. Name a great new drug developed in Europe these past ten years. Their own pharmaceutical industries have been decimated by the socialism Moore loves (and many of Europe’s drug companies have relocated to the US as a result). But I fear the left is winning this battle; and the massive advantages of private healthcare are only appreciated when you lose them.

    European drug companies move here because they make money like bandits here. But let’s play Andy’s game. Name a great new drug developed in Europe these past ten years. Then name a great new drug — and I mean really great, and really new, not just advertised as great and new — developed in the United States these past ten years. Most of the “new” drugs I know of coming out of America are either variations on old stuff, drugs that had to be withdrawn from the market after patients developed nasty side effects, or drugs that really don’t deliver all that much — one fabulous “new” drug I discussed here increased overall survival rate in cancer patients by 4.7 months, for example. That’s nice, but that’s the “trade off” Andy doesn’t want to give up for single payer health care. I’m not convinced.

    Update:     Kevin Drum writes,

    This business about America providing all the world’s pharmaceuticals is a common trope on the right, but it’s absurd. There are more biotech startups in Europe than in the U.S. Pfizer is targeting Japan as one of its biggest near term growth opportunities (and Japan is also a major source of new biotech development). And plenty of pharmaceutical research is done outside the U.S.: The #3 pharmaceutical company in the world, GlaxoSmithKline, is British. The #4 company, Sanofi-Aventis, is French. The #5 company, Novartis, is Swiss. #6, Hoffman-La Roche, is also Swiss. #8, Astra-Zeneca, is Anglo-Swedish. Their combined R&D spending is slightly higher than the American companies that make up the balance of the top ten.

    Now, what is true is that American capital markets are both bigger and generally friendlier to startups than European capital markets, which means that small biotech companies often migrate to the United States in order to get funding. My sense is that Europe is improving on this score, but in any case this has nothing to do with the state of European healthcare. What’s more, an enormous amount of basic research is done in American universities and the NIH, most of it publicly funded. This speaks well for our system of higher education, but doesn’t really say anything about our healthcare industry, which is famously hesitant to invest in genuinely innovative (but chancy) new ventures. Ironically for big pharma’s cheeleaders, it turns out that America’s titans of capitalism mostly prefer to leave the risky stuff to the feds.

    Sicko

    Posted on by

    Michael Moore’s Sicko opened this weekend in New York City, and I saw it yesterday.

    I laughed. I cried. So did the rest of the audience, which also broke into loud applause several times.

    This is Moore’s most mature film so far, and I mean that in the best possible way. Other Moore films induced anger, outrage, and sympathy, along with the laughs. But Sicko broke my heart.

    As Ezra says, this film is not so much about the health-care crisis as it is a challenge to America’s thick-headed exceptionalism — that “the way we do things is the best way to do things because … it’s the way we do things.”

    More than that, however, it reveals that democracy in America is fading, fast.

    We may call the United States “the land of the free,” but the truth is that most American working folks live constricted lives compared to people in most other western democracies. Our life choices increasingly are being limited by whatever economic boxes we find ourselves in. People who have worked hard and lived by the rules all their lives must choose between medicine and retirement, or medical treatment and keeping their homes. Working parents find that “quality family time” is an unaffordable luxury. And if we are diagnosed with a serious illness, our very lives are forfeit to the whims of the insurance companies.

    The young are crushed by student loans; the middle aged and older live in fear of losing their health insurance. This is keeping the workforce docile and compliant.

    But most heartbreaking of all is the way in which Americans passively accept the status quo. We have the means at hand to improve the quality of our lives — a representative government — and we don’t use it.

    Moore’s film is not without flaws. The Canadian and British health care systems do have problems, which Moore doesn’t mention. (However, those problems are minuscule compared to ours.) Moore tried to show that because the French do not pay for health insurance, health care, and many other services out of their own pockets, les citoyens have plenty of disposable income in spite of the higher taxes they pay. However, I’m not sure the point came across clearly. The trip to Cuba (partly censored by the Department of Homeland Security) was moving, but I wondered how much the Cuban government helped make it so.

    But one point came across clearly — we Americans are being lied to. We’re told that “socialized medicine” means the government will limit our access to health care; or that we won’t be free to choose our own doctors. But Moore shows us it’s American doctors whose hands are tied — by insurance companies — while doctors in Canada and France and elsewhere are free to practice the best medicine they can practice. And their patients are free to choose their doctors.

    Sicko has its signature Michael Moore touches. One segment follows an American woman trying to sneak her sick daughter into Canada to see a pediatrician. A man who lost the tips of two fingers in an accident recalls that he had to choose which finger to restore, since he lacked the money for both. A woman rendered unconscious in a car accident was charged for the ambulance ride because, her insurance provider said, the ambulance hadn’t been pre-approved.

    But then there was Tony Benn, a former member of the British Parliament, explaining how the British managed to create the National Health Service after World War II. “What democracy did was give the poor the vote, and it moved power from the marketplace to the polling station—from the wallet to the ballot…. And in 1948 the people asked, If you can have full employment by killing Germans, why can’t you have full employment by building hospitals? If you can find money to kill people, you can find money to help people.”

    That line got enthusiastic applause from the Manhattan audience.

    The poor in America have the vote, yet many do not choose to vote. Some who do vote cast ballots against their own interests. And many, as we know, are cheated of their ability to vote. But Moore’s movie was less about America’s poor than about America’s middle class; working people with insurance who are betrayed by the system. Surely the American middle class has the vote. Why aren’t we using it to our own benefit?

    OK, we know why. It’s complicated, but we know why.

    Someone in the French segment said something to the effect that The government of France is afraid of their people. Americans are afraid of their government. I’m not sure that’s true. I think Americans are just plain worn down. We’re worn down by the system, by the lies, by working too many hours, by juggling too many responsibilities by ourselves. And most of us don’t realize that we don’t have to live like this.

    Like I said — Sicko broke my heart.

    Inconvenient Facts

    Posted on by

    Rightie bloggers are gleefully linking to an item in the Toronto Star that pans Michael Moore’s new documentary Sicko. The author of the item, Peter Howell, writes,

    We Canucks were taking issue with the large liberties Sicko takes with the facts, with its lavish praise for Canada’s government-funded medicare system compared with America’s for-profit alternative.

    While justifiably demonstrating the evils of an American system where dollars are the major determinant of the quality of medicare care a person receives, and where restoring a severed finger could cost an American $60,000 compared to nothing at all for a Canadian, Sicko makes it seem as if Canada’s socialized medicine is flawless and that Canadians are satisfied with the status quo.

    Moore makes the eyebrow-raising assertion that Canadians live on average three years longer than Americans because of their superior health care system.

    In fact, my painstaking research (5 seconds of googling) revealed that Canadians live on average only 2.5 years longer than Americans because of their superior health care system. However, I would have thought 2.5 years is eye popping, too.

    Since I haven’t seen the film I can’t judge how Moore describes the Canadian health care system, which does have some flaws. However, compared to our system the Canadian system is, um, way better.

    Last week another Canadian, Liam Lacey of the Globe and Mail, wrote,

    As in Bowling for Columbine and Fahrenheit 9/11, Moore uses Canada as an example of a more humane social system. When a Canadian reporter suggested the portrait of the Canadian medical system was unduly rosy, and wait times for care were long, Moore asked the reporter if he’d trade in his health card to join the American system.

    “No,” said the reporter promptly, earning a laugh from the audience.

    Liam Lacey predicts Sicko will be a hit.

    Unhealthy Care

    Posted on by

    I found some newspaper items this morning that provide a good follow up to the “Demand Supply” post from last week. The first is from an editorial in today’s Atlanta Constitution:

    After two decades of steady improvement, the death rate for Georgia babies could soon be on its way up again. While neonatologists in specialized nurseries have achieved remarkable success at saving the lives of medically fragile infants, the rate of babies born too soon to Georgia mothers has been slowly rising since 1994. These babies are at a much higher risk of death in their first 12 months of life.

    More ominously, the percentage of Georgia women getting adequate and early prenatal care has actually declined since 1999. Experts believe the lack of prenatal care, as well as chronic conditions such as diabetes and obesity that are more prominent in young mothers today than a generation ago, will result in higher infant mortality rates in the years to come, as has already happened in Mississippi and several other southern states.

    If Georgia could achieve the U.S. average in infant mortality, the lives of approximately 220 babies would be saved each year. As it is now, approximately 1,100 Georgia babies don’t make it. Merely approaching the U.S. average will require much more intensive, targeted public health nursing in communities where teenage pregnancy rates and births to unwed mothers remain exceptionally high. That intense approach occurs now in only a handful of Georgia counties.

    The price of such early intervention is small compared to the high cost of caring for premature babies, which can reach $4,000 to $5,000 a day in neonatal units and often extends well beyond the nursery in treatment for chronic lung problems, cerebral palsy and other conditions.

    This illustrates nicely why our health care “system” is, essentially, screwy. The U.S. health care industry is driven by profit. On the whole we do a bang-up job at creating and marketing innovative health care products that make somebody a lot of money. But we neglect those functions that are not profitable. Thus, many U.S. hospitals have sparkling state-of-the-art intensive care units for newborns with all the equipment, medicines, bells and whistles one might want. Babies born with health problems get excellent care in them. It’s also very expensive care, and somebody makes a nice profit from selling the equipment, medicines, bells and whistles to hospitals.

    But there’s no profit to be made from providing basic prenatal care to poor, uninsured women, so on the whole we’re not doing that well at all. When compared to babies born in other industrialized nations, U.S. babies come into the world with a higher rate of health complications, which results in infant mortality rates that are higher than they should be, in spite of our superior intensive care gizmos.

    I want to add that you absolutely cannot explain this problem to a rightie. The usual excuse for our infant mortality problem is that in U.S. physicians count some hopelessly compromised infants as “live births” that would be considered “stillbirths” in other countries, even though they might live for a very brief time. Stillbirths are not counted in infant mortality rate, which is calculated from the number of babies born in a nation that die before their first birthdays. Thus, righties argue, our high infant mortality rates are just a statistical illusion. This Wikipedia article discusses the issue.

    On the other hand, as Ampersand documents here, if you factor in stillbirths — thus wiping out the discrepancies — the U.S. still doesn’t compare well. So much for the statistical illusion.

    And if you see the huge differences in infant mortality rates among states and populations within the United States, I can’t see how anyone can claim there isn’t a problem. But righties are wondrous creatures who can not see any problem if it might require a tax increase to fix it.

    See also this editorial in today’s New York Times —

    The explosion in the use of three anti-anemia drugs to treat cancer and kidney patients illustrates much that is wrong in the American pharmaceutical marketplace. Thanks to big payoffs to doctors, and reckless promotional ads permitted by lax regulators, the drugs have reached blockbuster status. Now we learn that the dosage levels routinely injected or given intravenously in doctors’ offices and dialysis centers may be harmful to patients.

    As Alex Berenson and Andrew Pollack laid bare in The Times on May 9, wide use of the medicines — Aranesp and Epogen, from Amgen; and Procrit, from Johnson & Johnson — has been propelled by the two companies paying out hundreds of millions of dollars in so-called rebates. Doctors typically buy the drugs from the companies, get reimbursed for much of the cost by Medicare and private insurers, and on top of that get these rebates based on the amount they have purchased.

    Although many doctors complain that they barely break even or even lose money on the costly drugs, for high-volume providers the profits can be substantial. One group of six cancer doctors in the Pacific Northwest earned a profit of about $1.8 million last year thanks to rebates from Amgen, while a large chain of dialysis centers gets an estimated 25 percent of its revenue, and a higher percentage of its profits, from the anemia drugs. It seems likely that these financial incentives have led to wider use and the prescribing of higher doses than medically desirable.

    You might have seen the television ads in which people declare “I’m ready to start my chemotherapy!” I think those are for Procrit, but I’m not sure. Expensive ad campaigns for prescription drugs have always struck me as weird, but if they didn’t drive up demand for prescription drugs I’m sure the pharmaceutical companies would stop the ads.

    Finally, here is an article that refutes the claim that American cancer patients survive at higher rates because they get advanced drugs that are not available elsewhere.

    The clinical reality for metastatic colorectal cancer is that the FDA-approved combination regimen of IFL (irinotecan, bolus fluorouracil, and leucovorin) plus Avastin increases median overall survival by 4.7 months. This small increase comes with a host of side effects, which impinge upon quality of life, as well as placing a burden on the patient and the healthcare system.

    While this small increase is hailed by the FDA as being impressive, the clinical reality is that there is no cure for metastatic colorectal cancer. The much-vaunted blockbuster drug Avastin is simply an antibody supplement incorporated into an already complex chemotherapeutic drug regimen that may slow down the cancer process depending on the genetic constitution of that individual. The cost of drugs for metastatic colorectal cancer alone would exceed $1.5 billion per year if all the patients in the U.S. received treatment.

    The clinical reality for metastatic breast cancer is similar. The latest treatment with Herceptin followed by lapatinib and capecitabine only increased the median time to progression from 4.4 to 8.4 months. Furthermore, 70% of patients do not respond to Herceptin, and resistance develops in virtually all patients.

    Of these two big killers, both remain incurable, and this sobering fact contrasts with the glowing reports on Avastin and Herceptin emanating from the financial and tabloid media.

    The authors (George L. Gabor Miklos, Ph.D., Phillip J. Baird, M.D., Ph.D.) also say,

    It’s easy to tell when an area has run out of ideas. The hype becomes extreme, and technology substitutes for brainpower. The cancer research area has reached this sorry state. The tiniest increase in the survival time of drug-treated cancer patients or median time to progression is touted as a cure, and wildly unrealistic claims about personalized cancer medicine emanate from the highest governmental and academic sources. …

    …Is the future of cancer medicine one in which doctors become financial advisors, telling their patients whether they can or cannot afford expensive treatments of dubious survival value?

    Although the authors don’t say this explicitly, I infer that cancer research itself is being driven by the desire for new money-making products rather than by science or even the well-being of patients.

    Demand Supply

    Posted on by

    By many tangible measures, the U.S. health care system isn’t much to brag about. For example, the World Health Organization reported that in 2000 the U.S. ranked 24th in the world in “healthy life expectancy.”

    “Basically, you die earlier and spend more time disabled if you’re an American rather than a member of most other advanced countries,” said Christopher Murray (M.D., Ph.D.), Director of WHO’s Global Programme on Evidence for Health Policy.

    In life expectancy, infant mortality, and number of practicing physicians per capita, the U.S. long has ranked near the bottom among the 30 or so wealthiest industrialized nations. And this is in spite of the fact that we spend nearly twice as much per capita on health care as nations that get much better results than we do. We don’t even have as many hospital beds per capita as most other industrialized nations.

    But worry no more, children. I learned today that “US Health Care Saves More Lives Than Socialized Medicine.” Captain Ed writes,

    A new study by the Karolinska Institute in Sweden shows that the American health care system outperforms the socialized systems in Europe in getting new medicines to cancer patients.

    According to the document linked by Captain Ed, “The proportion of colorectal cancer patients with access to the drug Avastin was 10 times higher in the US than it was in Europe, with the UK having a lower uptake than the European average.” In other words,if you are a colorectal cancer patient lucky enough to have health insurance and get diagnostic tests in time, you are far better off in the U.S. than anywhere else.

    What more do you need to know? That proves the U.S. has The Best Health Care in the Worldâ„¢, right?

    I understand the U.S. is still ahead of most other countries in the development of new drugs and high tech gizmos for diagnosing and treating diseases. Unfortunately, hospital care is not the be-all and end-all of health care. Take our famously nasty infant mortality stats, for example. On the whole I don’t believe we’re losing babies because of substandard hospital care. On the contrary; I’ve heard many times that the United States has superior intensive hospital care for high-risk neonates compared to other nations. However, as this abstract says,

    Despite high per capita health care expenditure, the United States has crude infant survival rates that are lower than similarly developed nations. Although differences in vital recording and socioeconomic risk have been studied, a systematic, cross-national comparison of perinatal health care systems is lacking. …

    … Compared with the other 3 countries, the United States has more neonatal intensive care resources yet provides proportionately less support for preconception and prenatal care. Unlike the United States, the other countries provided free family planning services and prenatal and perinatal physician care, and the United Kingdom and Australia paid for all contraception. The United States has high neonatal intensive care capacity, with 6.1 neonatologists per 10 000 live births; Australia, 3.7; Canada, 3.3; and the United Kingdom, 2.7. For intensive care beds, the United States has 3.3 per 10 000 live births; Australia and Canada, 2.6; and the United Kingdom, 0.67. Greater neonatal intensive care resources were not consistently associated with lower birth weight-specific mortality. The relative risk (United States as reference) of neonatal mortality for infants <1000 g was 0.84 for Australia, 1.12 for Canada, and 0.99 for the United Kingdom; for 1000 to 2499 g infants, the relative risk was 0.97 for Australia, 1.26 for Canada, and 0.95 for the United Kingdom. As reported elsewhere, low birth weight rates were notably higher in the United States, partially explaining the high crude mortality rates.

    Conclusions. The United States has significantly greater neonatal intensive care resources per capita, compared with 3 other developed countries, without having consistently better birth weight-specific mortality. Despite low birth weight rates that exceed other countries, the United States has proportionately more providers per low birth weight infant, but offers less extensive preconception and prenatal services. This study questions the effectiveness of the current distribution of US reproductive care resources and its emphasis on neonatal intensive care.

    (The study discussed in the abstract was published in the Journal of the American Academy of Pediatrics [PEDIATRICS Vol. 109 No. 6 June 2002, pp. 1036-1043] and is by Lindsay A. Thompson, MD, MS, David C. Goodman, MD, MS, and George A. Little, MD.)

    Basically, our health care system is good at delivering difficult and expensive stuff but blows at simple, ordinary stuff, like preventive care, compared to other nations. This means we save some lives that might have been lost in Europe, but we also lose lives that would have been saved in Europe.

    How did this come to pass? Certainly we Americans value creation and innovation. But it’s also the fact that our private, profit-based health care system is very good at creating new health care products that will make a lot of money. But where there’s no chance of profit, forget it.

    This is what the “magic of the marketplace” has given us. You know how markets work; where there’s a demand, someone will hustle to provide a supply, and competition encourages the creation of better products at lower cost. Our system is very good at creating new drugs and new technologies and then marketing them to hospitals, physicians, and even potential patients. And I’m not saying this is a scam; many of us have benefited from the drugs and gizmos. The problem is that some parts of the health care process just don’t make any money. And where it isn’t profitable, our system is falling apart.

    Yesterday I wrote about our nation’s emergency rooms. In short, they’re bad, and they’re getting worse. Emergency room capacity is shrinking, although demand is growing. People are dying because they wait too long to get treated.

    Go to Newsweek.com to read the second part of their three-part series on the crisis in emergency medical services. Then ask yourself if this is the sort of emergency care you’d like for yourself or someone you care about. Probably, it isn’t.

    But emergency rooms are big money losers for hospitals. They suck up expensive resources, and often the people who use ERs have no insurance and can’t pay.

    Here’s what the “free market” people never seem to wrap their heads around: Unprofitable demands do not generate supply, even when those demands are desperately needed.

    Put another way, not everything that’s worth having can generate enough profit to pay for itself.

    Most nations come up with a simple answer to this problem: They pay for vital but unprofitable services with taxes. That’s a big part of what government is for, some would argue. But you know American conservatives; they’d rather accept greater suffering and death (as long as it isn’t theirs) than pay taxes that support a dreaded “entitlement” like basic health care. It just sticks in their craw that their tax dollars might be used to benefit someone else. And it never occurs to them that someday they might be the “someone else.”

    Of course, the irony of this is that, thanks to lobbying and other efforts, some parts of the health care industry enjoy generous corporate welfare. But to Republicans welfare is just fine as long as it’s going to them.

    By now “market forces” have so skewed our health care delivery system that, even if we began to allocate our health care dollars according to need rather than profit, it would take years before the neglected parts of our systems were built back up to where they should be.

    While our emergency rooms rot, the health care industry just loves to provide boutique medical services for health care consumers who can pay for them. Expensive mass market ad campaigns are aimed at people with unsightly toenails, male pattern baldness, and erectile dysfunction to drive up optimum demand for the product before the patent runs out. For example, recently I’ve seen ads in which young women are sitting around a table discussing a newly discovered premenstrual syndrome — it sounds just like PMS to me, but apparently it’s much worse — for which there is (surprise!) a remarkable new drug to treat it.

    If you’ve got toenail rot and insurance, Big Pharma wants your business. If you bust your head open and need your life saved in an ER — good luck.

    I’m not a bit surprised that the U.S. is doing a good job of developing and delivering new cancer drugs to patients, because that’s the sort of thing we’re still doing well. But to extrapolate from this news that the entire U.S. health care system is superior to the “socialized” systems of Europe is, um, a bit of a stretch.