America is Sick

Despite evidence to the contrary, we Americans continue to believe that almost all scientific, technological, and economic development of merit had and continues to have its origins in the US. Our country is regarded by some as preeminent in every endeavor and the quality of our lives vastly better than what might be found in any other nation. Abiding faith in the American way persists even in the midst of a sharp divide in our country regarding its governance and its future. It's a comforting fable to think we are better, but sadly it just isn't so.

I want to begin with a caveat. My grandfather was a physician, by all accounts a brilliant diagnostician and head of surgery for two hospitals. As a result I am biased. I have been fortunate to be seen and been treated by exceptional medical professionals and fortunately I have had only a few serious issues over the years. That quality of care is not the case for everyone.

Recently, I had a first hand glimpse of all that can go wrong when one is at the mercy of a system beholden to insurers, and private medical facilities amidst a growing scarcity of qualified physicians and health care workers. Despite the fact that the US leads in one key metric--cost, it lags almost every other western nation in all the other critical measures of healthcare. The US spends nearly $15,000 per capita on health care, more than twice the average of all peer nations. Yet the US scores at the bottom of the list of European and Asian countries in Infant Mortality, Life Expectancy, Unmanaged Diabetes and Childbirth safety. It is third from the bottom in death from Heart Attack. 85 million Americans go uninsured. They either go without care or are crippled by medical debt. More than 60,000 of them die every year because they cannot afford a physician. This is hardly anything we should boast about.

As stark as these statistics are, they do not begin to tell the story of how our country fails patients every single day. Clearly money is a significant factor. While it does not guarantee health, poverty almost certainly leads to chronic health conditions and premature death based on actuarial evidence. Part of the reason for the high cost of health care in America is the disproportionate percentage of funds spent on administrative overhead and the other is insurer profits.

Now I want to be clear, what I am about to describe is not some exceptional case I conjured for the sake of illustration. Although it is the experience of a single individual it mirrors what occurs every day across our land, in big cities and small rural communities. Nor is it limited to individuals presenting with dire and complex cases or those who are indigent. It is a story of an average middle class person whose treatment for a serious but not extraordinary condition progressed to a life threatening one over the course of several days as a result of mishandling of medications, and confusion over physician's orders, which resulted in improper treatment. Together with severe understaffing and inadequate training of healthcare workers these missteps ultimately led to infection, fevers and re-hospitalization twice, with long term consequences and a protracted stay in rehabilitation.

It would be easy and quite wrong to blame a single nurse, doctor or healthcare worker. Mistakes were made--but they were not made as a result of inattention or dereliction, and certainly not by misdiagnosis, but by a system defined by rules and economics that place the patient second to every other consideration. It would also be wrong to conclude our healthcare system is just broken and cannot be fixed. Such a statement would ignore the thousands of patients who are treated successfully every day, the extraordinary research and therapeutic developments that issue from US laboratories and Universities. And there are countless examples of progress toward the elimination of fatal diseases that were pioneered by scientists working in the US and in partnership with other nations.

But all that said, the wealthiest country in the world lags almost every other in the matters that count, keeping its citizens healthy. Nations around the world are providing their citizens with a quality of care that far exceeds what can be found in our country except at extraordinary expense, and clearly they know something we choose to ignore. No healthcare system is perfect but private insurers, hospitals, medical practices, nursing homes, rehabilitation facilities and laboratories and the processes they have agreed upon for managing healthcare in the US do not appear to work for patients' benefit. We might conclude that health is not something which should be managed as a profit making enterprise.

I ran across this quote by Paul Farmer, co-founder of Partners in Health which I think sums up the issue better than most: "If access to health care is considered a human right, who is considered human enough to have that right?" If the richest country in the world cannot humble itself to learn from its peers how to provide what they are able at a fraction of the expense American's bear, what does that say about American exceptionalism? What does it say about our priorities and our rights as its citizens?