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Why We Need Health Care Reform

Why We Need Health Care Reform

By Richard Reeves - September 5, 2009

LOS ANGELES -- The United States ranks first in the world in health care, at least if you only count how much we spend on health care. We spend 15.3 percent of our gross domestic product -- all we produce in a year -- according to the Organisation for Economic Co-operation and Development (OECD), which is something like the accounting office of the world's wealthiest countries.

Behind us on the list of top 10 big spenders are Switzerland: 11.6 percent; France: 11.1 percent; Germany: 10.7 percent; Canada: 9.8 percent; Sweden: 9.1 percent; United Kingdom: 8.3 percent; Japan: 8.0 percent; Mexico: 6.4 percent; Taiwan: 6.2 percent.

Those numbers are the first statistics in a remarkable new book, "The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care" by T.R. Reid. Reid, a former Washington Post foreign correspondent, literally traveled around the world seeking treatment for a painful shoulder -- bones that had been screwed together after an injury while he was in the Navy. He had a larger purpose, of course: seeing for himself if Americans really did get the best care in the world.

Not by a long shot, he concluded. Americans are kidding themselves if they think all their money is buying them the best. Here are some other statistics from the book:

The United States ranked 37th of 191 countries in the rankings of the World Health Organization, a United Nations agency, of "overall performance" in delivery of health care. France was first, Italy second.

In the "fairness" section of the WHO report -- that is, whether the best care was available equally in a country -- the United States ranked 54th, behind Bangladesh and the Maldives.

A Commonwealth Fund study of access to medical care in 23 developed countries ranked the United States No. 23. Japan was first. In the section of the Commonwealth study on the number of "Deaths Due to Surgical or Medical Mishaps," the United States was first, with more deaths per capita than any other wealthy nation. On "Avoidable Mortality," Commonwealth ranked the United States 15th. France was first.

In a joint study by Harvard Medical School and Harvard Law School of the number of bankruptcies attributed to medical bills each year, the United States' total was approximately 700,000. The French total was zero. The Italian total was zero. The German total was zero. The Japanese total was zero. The Canadian total was zero.

The United States, with 6.8 deaths per 1,000 births, ranked 10th in infant mortality, according to the OECD. Sweden was best at 2.4. Japan had 2.8. France had 3.6. Poland had 6.4.

The average administration costs, including profit, of American health insurance companies is about 20 percent, according to The Wall Street Journal. The average administration cost of Medicare, run by the United States government, is 3 percent.

The United States ranks 47th in the world, behind Bosnia but ahead of Cyprus, in life expectancy at birth: 77.85 years, according to Central Intelligence Agency data. Japan is first at 81.25 years. Switzerland, Sweden, Australia and Canada also have life expectancies at birth of more than 80 years.

In the statistic that many medical experts consider most revealing, "Disability-Adjusted Life Expectancy" -- that is the number of healthy years after birth, the United States ranked 24th with a DALE of 70 years, behind Israel but again just ahead of Cyprus, according to the WHO. Japan was first with 74.5 years. Australia was at 73.2 years, France at 73.1.

Reid reports that the best American health care is probably the best in the world, but that care is rationed for a lucky few with good insurance or unlimited money. That, of course, is why rich foreigners fly here to the best American hospitals for treatment. But most Americans can't afford their own planes or their own doctors.

He also thinks he knows what has gone wrong in the U.S. health care system: It is badly managed, principally by the private sector, that is, insurance companies, and it has become too complex for anyone -- administrators, physicians or patients -- to understand. The countries that consistently show better medical outcomes than we do simply consider health care to be a right rather than a privilege -- eliminating most all of the middlemen between doctors and patients.

Copyright 2009, Universal Press Syndicate

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