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Health care
reform is
once again
at the top
of the
nation’s
political
agenda. But
in
developing
health
policy, it
is vital to
keep in mind
one
pertinent
fact: for
all its
problems,
the United
States
offers the
highest
quality
health care
in the
world.
Most of the
world’s top
doctors,
hospitals,
and research
facilities
are located
in the
United
States.
Seventeen of
the last 25
winners of
the Nobel
Prize in
Medicine
either are
U.S.
citizens or
work in this
country.
U.S.
companies
have
developed
half of all
the major
new
medicines
introduced
worldwide
over the
past 20
years.
In fact,
Americans
played a key
role in 80%
of the most
important
medical
advances of
the past 30
years.
Nearly every
type of
advanced
medical
technology
or procedure
is more
available in
the United
States than
in any other
country. By
almost any
measure, if
you are
diagnosed
with a
serious
illness, the
United
States is
the place
you want to
be. That is
why tens of
thousands of
patients
from around
the world
come to this
country
every year
for
treatment.
Of course,
critics of
American
health care
often point
out, other
countries
have higher
life
expectancies
and lower
infant
mortality
rates, but
those two
indicators
are not a
good way to
measure the
quality of a
nation’s
health care
system. In
the United
States, very
low-birth-weight
infants have
a much
greater
chance of
being
brought to
term with
the latest
medical
technologies.
Some of
those
low-birth-weight
babies die
soon after
birth, which
boosts our
infant
mortality
rate, but in
many other
Western
countries,
those
high-risk,
low-birth-weight
infants are
not included
when infant
mortality is
calculated.
And life
expectancy
is a poor
measure of a
health care
system. Life
expectancies
are affected
by exogenous
factors such
as violent
crime,
poverty,
obesity,
tobacco and
drug use,
and other
issues
unrelated to
health care.
Consider the
nearly three
year
disparity in
life
expectancy
between Utah
(78.7 years)
and Nevada
(75.9
years),
despite the
fact that
they
essentially
have the
same health
care
systems. In
fact, these
exogenous
factors are
so
distorting
that if you
correct for
homicides
and
accidents,
the U.S.
rises to the
top of the
list for
life
expectancy.
On the other
hand, when
you compare
the outcome
for specific
diseases
like cancer
or heart
disease, the
United
States
clearly
outperforms
the rest of
the world.
Take
prostate
cancer, for
example.
Even though
American men
are more
likely to be
diagnosed
with
prostate
cancer than
their
counterparts
in other
countries,
they are
less likely
to die from
the disease.
Less than
one out of
five
American men
with
prostate
cancer will
die from it,
but 57% of
British men
and nearly
half of
French and
German men
will. Even
in Canada, a
quarter of
men
diagnosed
with
prostate
cancer die
from the
disease.
Similar
results can
be found for
other forms
of cancer.
For
instance,
just 30% of
U.S.
citizens
diagnosed
with colon
cancer die
from it,
compared to
fully 74
percent in
Britain, 62%
in New
Zealand, 58%
in France,
57% in
Germany, 53%
in
Australia,
and 36% in
Canada.
Similarly,
less than
25% of U.S.
women die
from breast
cancer, but
46% of
British
women, 35%
of French
women, 31%
of German
women, 28%
of Canadian
women, 28%
of
Australian
women, and
46% of women
from New
Zealand die
from it.
The same
U.S.
advantage
can be found
for outcomes
with other
diseases,
ranging from
AIDS to
heart
disease.
This should
not be
surprising.
The one
common
characteristic
of all
national
health care
systems is
that they
ration care.
Sometimes
they ration
it
explicitly,
denying
certain
types of
treatment
altogether.
More often,
they ration
more
indirectly,
imposing
global
budgets or
other cost
constraints
that limit
the
availability
of high-tech
medical
equipment or
imposing
long waits
on patients
seeking
treatment.
For example,
more than
750,000
Britons are
waiting for
admission to
National
Health
Service
hospitals at
any given
time, and
shortages
force the
NHS to
cancel as
many as
50,000
operations
each year.
Roughly
90,000 New
Zealanders
are facing
similar
waits. In
Sweden, the
wait for
heart
surgery can
be as long
as 25 weeks,
while the
average wait
for hip
replacement
surgery is
more than a
year.
And, in
Canada more
than 800,000
patients are
currently on
waiting
lists for
medical
procedures.
A study in
the Canadian
Medical
Association
Journal
found that
at least 50
patients in
Ontario
alone have
died while
on the
waiting list
for cardiac
catheterization.
And Canadian
Supreme
Court Chief
Justice
Beverly
McLachlin
wrote in a
2005
decision
striking
down part of
Canada’s
universal
care law,
that many
Canadians
waiting for
treatment
suffer
chronic pain
and that
“patients
die while on
the waiting
list.”
Obviously,
there are
problems
with the
U.S. system.
Too many
Americans
lack health
insurance
and/or are
unable to
afford the
best care.
More must be
done to
lower health
care costs
and increase
access to
care. Both
patients and
providers
need better
and more
useful
information.
The system
is riddled
with waste,
and quality
of care is
uneven.
Government
health care
programs
like
Medicare and
Medicaid
threaten
future
generations
with an
enormous
burden of
debt and
taxes.
Health care
reform is
not a
choice, but
a
necessity.
But in
pursuing
reform, we
should be
guided by
the
Hippocratic
Oath: First,
do no harm.
We should
make very
certain that
the cure is
not worse
than the
disease.
We must do
nothing to
undermine
the
free-market
health care
system that
gives us the
world’s best
care.
-###-
Michael
Tanner is
the Director
of Health
and Welfare
Studies at
the Cato
Institute.
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