Healthcare, Curing the Disease not the Symptoms; Pt. 2: Checking the Rankings

Part 2:

Dr. Mark Hyman wrote last month in his Huffington Post article, Why Health Care Reform Will Fail: Part I -- The Business of Disease: We Pay For What Doesn't Work, "Recently President Obama's rhetoric has shifted from health care reform to health insurancereform. Getting more people access to a system that provides worse outcomes at higher costs is not an option for a sustainable health care system, nor a sustainable economy." The significance of this statement is that not only are we focusing too much energy on trying to reign in costs rather than quality and delivery, but also that if we as a country try and improve the return on our healthcare dollars that will, as a byproduct, save money. So, as with healthcare availability, first you have to evaluate why it is U.S. healthcare is ranked poorly and then determine how to improve those numbers to, in Obama's own words, use a scalpal rather than a hatchet.

The shocking figure relevant to this topic is the 2000 World Health Report ranking the U.S. healthcare system as 37th out of 191 of the world's nations. The most obvious problem with using this number in the debate is that it is nearly a decade out of date. The second problem is how the WHO ranks the systems of various countries. Redington Jahncke, in his September 1st article in The Advocate, does a very thorough breakdown of by what standards the WHO evaluates their ranking, and he points out that it uses a cumulative ranking process which is overwhelmingly weighted, 63%, towards "fairness."
To illustrate, let's use a simple 1-to-10 scale. Under the WHO's "fairness"
weighting approach, a nation whose measure for health or health care ranged
from say 3 for its least advantaged citizens to 4 for its most advantaged
would outrank a nation whose measures ranged from 6 to 10.
So even though the care provided to all citizens is better overall, the difference in quality is what brings the rankig down. He also points out that a certain level of double counting occurs, which can be seen in this method of evaluation, because as part of the ranking, the U.S. is evaluated lower for having a low rating given its advanced technology and wealth. Finally, Jahncke takes a look at how the U.S. ranks in actual health, noting that of the 8 there are only 2 absolute measures, which are responsiveness and life-expectancy. In responsivenes, defined as dignity, autonomy, confidentiality, prompt attention, quality of basic amenities, access to social support networks during care and choice of care provider, the U.S. actually ranks first, a figure not often mentioned in the healthcare debate. The life-expectancy number is not so encouraging however with a ranking of 24th. So it would seem that it would be to the advantage of Americans to focus on this problem of life-expectancy (and affordability) without making too many changes to the existing system, also keeping in mind that of the 23 countries ranked higher, only 6 have populations of more than 30 million and only 1, Japan, more than 100 million.

Obama will often talk about stories he's "read in letters and heard in town halls all across America." In reality though, if you go around enough and ask enough people you can find individual examples to prove any argument. For example, in 2005, my own mother was diagnosed with breast cancer. She had a unique and aggressive strain of the cancer that, had she gotten it less than 10 years earlier, she probably would not have survived. It was thanks to a drug called Herceptin developed in 1998, along with chemotherapy and radiation treatments, that my mom was able to fight the cancer. There was a woman whom my mom often sat next to during her weekly chemo and Herceptin treatments who also had a similar strain of breast cancer. This woman was a nurse from Canada. She had to come to the U.S., and, yes, had to pay exorbitant fees, in order to get the treatment that would ultimately save her life because Health Canada would not allow her the use of Herceptin. So it was thanks to an American drug, developed in America, and used for treatment in America that this Canadian was given the opportunity to fight her cancer.

One strategy that is often used to evaluate the quality of our healthcare more closely is to separate the serious diseases, such as cancer, from those associated with lifestyle choices such as obesity and smoking related diseases. Gary Becker in The Becker-Posner Blog, examines an unpublished study by Samuel Preston and Jessica Ho of the University of Pennsylvania that compares mortality rates for breast and prostate cancer:
Preston and Hu show that this more aggressive detection and treatment were
apparently effective in producing a better bottom line since death rates from
breast and prostate cancer declined during the past 20 years by much more in the US than in 15 comparison countries of Europe and Japan. US death rate rates from
prostate cancer went from about 7% above those of the comparison countries in
1990 to over 20 % below the average of these other countries in recent years, or
almost a 30% greater fall in US rates. American death rates from breast cancer
declined from about 10% above the average of these other countries in 1990 to
slightly lower.
This would actually indicate that the U.S. is in fact, at least with regards to serious diseases such as breast and prostate cancer, performing quite well in treating diseases. So why is our life expectancy so much lower if it seems the U.S. should be more than competant enough to treat disease and illness? The next step is to look at what brings that number lower which it would seem is largely a result of life style choices, and fixing these problems could actually be an effective way in controlling much of the runaway costs of the U.S. system.