As Jeff Goldsmith wrote last week at THCB, it has become politically incorrect to say anything positive about American health care. So, I’m glad that Kevin,MD linked to this post that I had overlooked. Scalpel tells it like it is:
Anyone who is honest and who has even the most basic level of medical knowledge should admit that the quality of healthcare in America is the best in the world.
In support of this woefully unfashionable assertion he offers the following:
Rich people didn’t get that way by being stupid, so when they get cancer they aren’t flying to Europe or Canada to get treated….they are going to MD Anderson or the Mayo Clinic.
Moreover:
The same thing can be said about heart disease, diabetes, musculoskeletal disorders, or any other medical problem you can think of: America treats these conditions better than anyone else in the world.
And it’s not just the wealthy who receive high-quality care in this country:
Poor people in this country still get better care than in any other country. I admitted a penniless patient with bowel obstruction from his colon cancer just last week, and an uninsured man with a large brain tumor last month. Both got the highest quality surgery the world has to offer the very next day.
Everyone with any knowledge of our health care system understands that it needs some work. But that shouldn’t blind us to the reality that, for all its faults, American health care is indeed the best.
And more people need to follow Scalpel’s example and say it out loud.
Comments 21
No one has ever disputed that the US has many of the world’s best acute care facilities. But there are plenty of superb teaching hospitals in the UK, Germany, Netherlands, France, Belgium and other countries. In countries such as the UK and the Netherlands, you are far more likely to be near a centre of excellence than in the US.
‘Poor people in this country still get better care than in any other country.’
This is such awful nonsense that it it would be funny if the issue wasn’t so serious.
Posted 10 Oct 2007 at 6:14 am ¶‘Poor people in this country still get better care than in any other country.’ This is such awful nonsense that it it would be funny if the issue wasn’t so serious.
I’m sorry if this conflicts with your prejudices, but facts are stubborn things. Much of the charity care that we provide to the community (as a not-for-profit hospital) is for just the kind of patient that Scalpel describes.
Posted 10 Oct 2007 at 8:20 am ¶In countries such as the UK and the Netherlands, you are far more likely to be near a centre of excellence than in the US.
Well, they are much smaller countries.
Unfortunately, you make the presumption (incorrectly) that one must be treated in a “Centre of Excellence” to get excellent care, which is false. There are plenty of excellent hospitals that are not primary teaching hospitals, which provide superb care to those with means as well as those without.
Posted 10 Oct 2007 at 1:40 pm ¶God bless you Marc, for trying with this crowd. I’ve only been checking in here for a couple days, and the level of ignorance is breath taking - though they don’t even recognize it - so, good on you for trying.
For the record, I am an intensivist , meaning I take care of the sickest patients in the hospital in the Intensive care unit. American hospitals are great at intensive care and high tech medicine, no argument there. But, don’t delude yourself that I can’t get just as good care in a hospital in Belgium or France or Canada. And don’t delude yourself that we deliver better overall care than anywhere in the world. That is demonstrably false - go to my web site and click on US/World comparisons or go to pnhp.org. I can tell you I spend a lot of my professional time taking care of patients who are critically ill because they couldn’t afford to see a doctor, get their medicines, or just had lousy conitinuity of care due to the way our system malkfunctions.
“Poor people in this country still get better care than in any other country”
On what in the world do you base this? That they can go to an ER when they are nearly dead? Please, do tell why you think this.
“I admitted a penniless patient with bowel obstruction from his colon cancer just last week, and an uninsured man with a large brain tumor last month.”
Do you suppose if the patient with colon cancer had had a rectal exam or a sigmoidoscopy he might not have developed a bowel obstruction or if the guy with the brain tumor had seen a PCP earlier in his llness that he might have a better chance? This is why our outcomes are worse, overall, that the rest of the world. Do we do some things better? Sure we do, but we do lots more worse. And as a finance person, don’t you concede that preventive care is cheaper than acute, delayed care, so that our system doesn’t even make good economic sense, let alone medical sense?
Cheers
Posted 10 Oct 2007 at 3:36 pm ¶‘There are plenty of excellent hospitals that are not primary teaching hospitals,’
As in other countries, but the point I’m making is that the concentration and proximity of top specialists provides greater access to them for people in countries with national health systems.
Posted 10 Oct 2007 at 3:41 pm ¶And as a finance person, don’t you concede that preventive care is cheaper than acute, delayed care … ?
Actually, no. The jury really isn’t in on that. Here’s an article in the NYT that contains the following passage:
“No one really knows whether preventive medicine will save money in the long run … In fact, studies have shown that preventive care … usually ends up costing money.”
And don’t delude yourself that we deliver better overall care than anywhere in the world. That is demonstrably false - go to my web site and click on US/World comparisons or go to pnhp.org.
First, no one beyond the socialized medicine crowd takes PNHP seriously as an objective source of data. Steffie Woolhandler and her accomplices have been fudging data for years.
As to the comparisons on your site, presumably you’re talking about the OECD section. I’m afraid there are serious issues with that data source as well.
Posted 10 Oct 2007 at 8:29 pm ¶“…the concentration and proximity of top specialists provides greater access to them for people in countries with national health systems.”
What is your source for this claim?
So in the UK I would have greater access to a specialist than in the US?
Posted 10 Oct 2007 at 9:38 pm ¶‘So in the UK I would have greater access to a specialist than in the US?’
You would be more likely to simply because of access, not because of ability to pay.
M.
Posted 11 Oct 2007 at 10:03 am ¶So people do not wait, say, more than a week to see specialists in the UK?
I am just not understanding why you say government control and nationalization increases the number of specialists, and does not increase demand for them out of proportion to the supply increase, which would result in long waits, and decreased access.
Posted 11 Oct 2007 at 11:03 am ¶From the OECD paper on waiting times for Surgery:
“A second group of eight OECD countries can be identified, where waiting times are reported to
be low. For these countries policy makers indicate that waiting times are not an issue. These countries are:
Austria, Belgium, France, Germany, Japan, Luxembourg, Switzerland and the United States.”
So seven countries manage to provide care for everyone and not have waiting times as an issue ( http://www.oecd.org/dataoecd/31/10/17256025.pdf )
I do believe America can do this.
Also, Catron, the NYT article also states:
—-
As Dr. Mark R. Chassin, a former New York state health commissioner, says, preventive care “reduces costs, yes, for the individual who didn’t get sick.”
“But that savings is overwhelmed by the cost of continuously treating everybody else.”
The actual savings are also not as large as might at first seem. Even if you don’t develop diabetes, your lifetime medical costs won’t drop to zero. You might live longer and better and yet still ultimately run up almost as big a lifetime medical bill, because you’ll eventually have other problems. That would be an undeniably better outcome, but it wouldn’t produce a financial windfall for society.
—–
So I’m OK with that. But there are certainly certain illnesses where it makes a huge difference, such as cervical cancer whether by PAP smears now or vaccines in the future, providing people with access to these services is the right thing to do.
And PNHP has a point of view, so do I, so do you. I think their research stands up pretty well. Perfect? Of course not, but most of the quibbling I see on this site is because you don’t trust them. So don’t trust them, but don’t trust those who attack them out of hand, either.
Cheers
Posted 11 Oct 2007 at 2:20 pm ¶The issue raised was not waiting times, but access to “Top Specialists” in “Academic Centrtes of Excellence,” which are somehow reduced by nationalization of healthcare. Is this true on the other seven countries? Can anyone get reqady access to “Top Specialists” in an “cademic Centre of Excellence?”
If so, why aren’t the ~mediocre~ specialists in community hospitals out of business? Given the choice, who would choose the mediocre one over the readily available “Top Specialist?”
Posted 11 Oct 2007 at 2:31 pm ¶Typo… Should say:
The issue raised was not waiting times, but access to “Top Specialists” in “Academic Centrtes of Excellence,” which is somehow increased (access, that is) by nationalization of healthcare.
Posted 11 Oct 2007 at 2:55 pm ¶It’s simple - _all_ citizens, not just those with gold plated insurance, can go to the clinics of the very top specialists as a matter of course. Will there be a wait? That depends on the specialty and urgency. For cancer, the UK has a 2 week max target to see a consultant and you can choose where to go.
Is there a difference between US hospitals? Well yes of course and a much wider one than you probably think. Eg:
‘Women treated for cardiovascular disease at the nation’s bestperforming hospitals have a 39 percent lower risk-adjusted mortality rate when compared with
women at the nation’s poorest-performing hospitals, according to the fourth annual HealthGrades Women’s Health Outcomes in U.S. Hospitals study, released today.’
Plenty more on this theme, and there are plenty of 1* hospitals on a 5* scale.
Posted 11 Oct 2007 at 5:28 pm ¶Then who is going to the clinics of the not-very-top specialists? Would you, given the choice?
Posted 11 Oct 2007 at 7:10 pm ¶My guess is that 99% of us are seeing the bottom 99% of specialists, both in the US and elsewhere…:-)
But, seriously, our ability to know who does a good job or not is extremely poor. There is just not enough good data to allow anyone to make a reasonable decision. Coronary bypass surgery (and a couple other tiny spots here and there) is the exception. In PA, in particular, we have a darn good database for bypass outcomes. As it happens, my mother in law may need an open heart procedure for a ascending aortic aneurysm. I’d be guessing to say that the surgeons who do well with CABG do well with this surgery ( or valves, or whatever).
People often ask me, as an intensivist, who is a good surgeon in my hospital. Since all I see are the cases where things aren’t going swimmingly, and I have no idea of the denominator (that is, how many of this type of case a particular surgeon does at my hosptial let alone the other places they work), I really can’t say. I can tell them who I like, who seems bright, et., but they are not always the same people.
Cheers,
Posted 12 Oct 2007 at 10:17 am ¶I happen to agree with you.
The notion that the entire populace has ready access to Top Specialists is BS, nationalization or otherwise.
Rich
Posted 12 Oct 2007 at 12:30 pm ¶‘People often ask me, as an intensivist, who is a good surgeon in my hospital.’
You mean data on surgery outcomes for each surgeon is not collected and published? Are there plans for this?
Posted 12 Oct 2007 at 3:02 pm ¶‘The notion that the entire populace has ready access to Top Specialists is BS, nationalization or otherwise.’
I did not say that. What I’m trying to explain is that there are no barriers to access to the top in say the UK, and many top specialists run clinics where if you don’t see the top guy you’ll be pretty close and have your case discussed with him/her by the other docs. How many of your top specialists are easily accessible by Medicare patients - or the uninsured?
Posted 12 Oct 2007 at 3:08 pm ¶Marc,
So you’re not saying that the entire populace has ready access to top specialists, rather, you’re saying that the entire populace has ready access to top specialists.
But seriously, I understand your point. I just cannot reconcile it with economic reality.
Many people in the US do not have access, or we would not have this discussion. I simply cannot accept that there are no barriers in say, the UK. The barriers must exist, but perhaps they are not as evident, i.e. not related to insurance status or wealth.
You have asserted that the distribution geographically, of top specialists is better, and that there are no significant wait times. If I can drive a few miles to see the top specialist within a reasonable period of time, why see anyone else? What is the incentive to forego the opportunity to have “the best” and settle for less than the best?
We’ll have to agree to disagree on this one. I cannot reconcile it. FYI, in my area, Medicare patients have excellent access. The uninsured less so, unless they are willing to pay, but the nearby academic centers, and several community hospitals, have free clinics which are supervised by, you guessed it, “Top Specialists.”
Posted 12 Oct 2007 at 8:07 pm ¶Medicare is not the problem group for getting access, as reimbursement is at least close to other insurers. In fact, in PA and other states, Medicare is better than private insurance.
Medicaid and the underinsured are the problem:
http://cmhmd.blogspot.com/2007/09/public-citizen-publications-report.html
Chris
Posted 14 Oct 2007 at 12:46 pm ¶‘Many people in the US do not have access, or we would not have this discussion. I simply cannot accept that there are no barriers in say, the UK. The barriers must exist, but perhaps they are not as evident, i.e. not related to insurance status or wealth.’
Rich - of course there are barriers. Socio-economic factors are not as much in play in the UK as the US, but we are trying hard to catch up with your gross disparities, unlike some of our European neighbours.
But - and let’s take a big example - any woman in the UK can see a primary care physician within 48 hours for a breast lump and be referred to see a specialist - typically now in a multidisciplinary breast centre - within two weeks. This is just not available to all in the US, and access to the very top places - eg Sloan-Kettering and MD Anderson - can involve a lot of hoops.
Posted 14 Oct 2007 at 2:21 pm ¶Post a Comment