Cell 2 Soul: The Humane Health Care Blog

Our Moral Stain

"When it comes to health care, most liberals are committed above all to ensuring that every American has insurance. In their view, the greatest achievement of the health care reform act is to finally erase the moral stain of the United States' being the only major developed country without universal coverage. But we also hold the questionable distinction of having the world's most expensive health care system - what about cost control?

This is a fine opinion piece by a thoughtful academic physician.  Reading it made me think, "We have met the enemy and it is us."  As a physician, I particpate in the scandalous cost of health care every day.  All of us do unnecessary tests.  All of us prescribe expensive meds when cheaper ones would work.  All of us do more procedures than needed because that's where our reimbursement comes from.  It's one thing to recognize this in the quiet of one's home -- it's another reality in the clinic.

Emanuel's essay is a good springboard for thought.  See: Download What We Give Up for Health Care

 Image is from CartoonStock.com

Health Care Quality in the U.S.

June 24, 2010

According to new annual report from the Commonwealth Fund, a private foundation that focuses on health care, the U.S. health system presents a rather dismal picture in terms of overall quality of health care.

The analysis comparing the nations spending and health outcomes with seven other industrialized nations, found that despite outspending the other competitors, the Americans are getting less for their money and are languishing behind in common health issues.

The Commonwealth Fund's president, Karen Davis, stated, "On many measures of health system performance, the U.S. has a long way to go to perform as well as other countries that spend far less than we do on healthcare, yet cover everyone.

"It is disappointing, but not surprising, that despite our significant investment in health care, the U.S. continues to lag behind other countries.”

America scored poorly in most of the five key areas of health service in comparison to the other six competitors despite the country’s healthcare system being the most expensive in the world.

The rankings of the 7 countries
The Commonwealth Fund report was based on a survey of both patients and primary care doctors for the years 2007, 2008 and 2009 in Australia, Canada, Germany, the Netherlands, New Zealand and the United Kingdom.

The focus of the report was five essential measures of health care- access to care, equity, quality, efficiency and the ability to live long, healthy, productive lives.

The overall winner was Netherlands scoring the highest in the list. The country topped in access and in equity, and ranked second in quality of care.
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The Dutch were closely followed by UK and Australia while Canada ranked sixth and America fared the worst in the list.
                                                                                                                                                                                                                                                             
US healthcare system the most expensive in the world
The United States scored poorly in most of the five key areas of health service despite the country’s healthcare system being the most expensive in the world.

The other six countries spend approximately half that of the United States yet are able to provide better universal care to its citizens.

In 2007, the nation spent $7290 per person which was more than double that of Canada, three times more than New Zealand and also much higher compared to the $3800 per person, spent in the Netherlands.

Some specific findings In areas of providing safe care, the United States ranks last and second last on coordinated care.

Patients with a chronic condition in the nation are most likely to be given the wrong medication and the wrong dose and delays in being informed about abnormal test results.

Another major problem is efficiency. The nation also ranks last on spending on administrative costs, use of information technology, duplicate medical testing and re-hospitalization.

In addition, the nation fared the worst in infant mortality and healthy life expectancy among older adults.

A large number of Americans go without care because of the cost. The report pointed out that the United States was the only country on the list that does not give all citizens healthcare coverage.

The authors of the report stated, "For all countries, responses indicate room for improvement. Yet, the other six countries spend considerably less on health care per person and as a percent of gross domestic product than does the United States.

“These findings indicate that, from the perspectives of both physicians and patients, the US health care system could do much better in achieving value for the nation's substantial investment in health."

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Marginal Notes: A Socratic dialog on health care reform (VI)

Toward the evening of a long day, the philosopher Socrates finally makes his way to the home of Hippocrates, the father of medicine.  >>more

The final in a series of Socratic dialogs on health care reform.  Apropos of these discussions, interested readers may wish to peruse previous conversations with Aeschylus, Plato, Aesculapius, Apothos, and Litigius.

 

Brian T. Maurer has practiced pediatrics as a Physician Assistant for thirty years.  His "Marginal Notes" column appears periodically in the Cell2Soul Blog. The title "Marginal Notes" is taken from a quote by Henry David Thoreau: "I love a broad margin to my life."

Marginal Notes: A Socratic dialog on health care reform (V)

After leaving the pharmacy of Apothos, Socrates finds himself pursued by Litigius the solicitor. >>more

The fifth in a series of Socratic dialogs on health care reform.  Apropos of these discussions, interested readers may wish to peruse previous conversations with Aeschylus, Plato, Aesculapius and Apothos.

 

Brian T. Maurer has practiced pediatrics as a Physician Assistant for thirty years.  His "Marginal Notes" column appears periodically in the Cell2Soul Blog. The title "Marginal Notes" is taken from a quote by Henry David Thoreau: "I love a broad margin to my life."

Marginal Notes: A Socratic dialog on health care reform (IV)

The philosopher Socrates seeks advice from Apothos the sorcerer for a potion or pill to dampen the discomfort in the wound on his foot and learns a bit about standards of practice in the pharmaceutical industry.  >>more

 

The fourth in a series of Socratic dialogs on health care reform.  Apropos of these discussions, interested readers may wish to peruse previous conversations with Aeschylus, Plato and Aesculapius.

 

 

Brian T. Maurer has practiced pediatrics as a Physician Assistant for thirty years.  His "Marginal Notes" column appears periodically in the Cell2Soul Blog. The title "Marginal Notes" is taken from a quote by Henry David Thoreau: "I love a broad margin to my life."

 

 

Marginal Notes: A Socratic dialog on health care reform (II)

After speaking with the tragedian Aeschylus, Socrates encounters his former political science student Plato, who relates the latest debates in the Senate and explains the Athenian health care system from his perspective. >>more

The second in a series of Socratic dialogs on health care reform.  Interested readers may access the first conversation here.

Brian T. Maurer has practiced pediatrics as a Physician Assistant for thirty years.  His "Marginal Notes" column appears periodically in the Cell2Soul Blog. The title "Marginal Notes" is taken from a quote by Henry David Thoreau: "I love a broad margin to my life."

Marginal Notes: Counting Costs

Barbershop Quartet by Norman Rockwell

“I gotta tell you, this Obama character scares the bejesus outta me,” the man in the barber chair said.  “All this talk about death panels deciding when to pull the plug on us older folks. Next thing you know, we’ll have socialized medicine, and then no one will get proper care.”

Peyton pulled the barber drape off the man’s chest and brushed a few freshly clipped grey hairs off the man’s shoulders.  Slowly the old man climbed down from the chair and made his way across the linoleum tiled floor to the ancient cash register.  He handed Peyton a twenty dollar bill and waited for Peyton to count out his change.  >>more

 

Brian T. Maurer has practiced pediatrics as a Physician Assistant for thirty years.  His "Marginal Notes" column appears periodically in the Cell2Soul Blog. The title "Marginal Notes" is taken from a quote by Henry David Thoreau: "I love a broad margin to my life."