Yet more gratuitous name-dropping and atypicality
Meeting Senator Durbin (see the other blog) he asked us what we were here for, we said to study US healthcare, and he responded along the lines of whatever you do don’t take it back with you. Which rather set me thinking about why are we here then?
It’s a bit of a truism that America has the best and worst healthcare in the world, but it’s worth thinking what is meant by this. Typically, the point is made about ground breaking innovation – particularly for pharmaceuticals - and contrasts this with the failure to provide proper access for the uninsured (and before any right-wing lunatic anonymouse who might have stumbled here unbidden claims that the uninsured have proper access through an emergency room and that this is better than anything available anywhere else in the rest of the world can I recommend that 1/ you consider the point that waiting until something is an emergency before seeking help is not “proper access” and 2/ you follow the logic of your own position and get rid of your health insurance because if ER based access is so good you are clearly wasting your money).
However I think there is a more interesting contrast to be drawn between the excellence of the really good systems that I and my colleagues are at – Group Health, Kaiser, VA - and much of the rest of the system. I’ve been hugely impressed with the innovation and imagination that I’ve seen in terms of rethinking the process of care, commitment to quality and evidence-based care and use of information technology. So in a sense, those of us inside these systems have much to learn and take back with us. The point is though we are studying the atypical. Extrapolating that US healthcare is therefore superior is like looking at an Aston Martin DB5 and assuming that Austin Allegros had to be good too because both were built in Britain.
Where Durbin is right is that the US system as a whole (or more correctly lack of system) is something which can teach you only what to avoid. The comparison of three simple metrics give some clues (although obviously there is a lifetime’s study in disaggregating some of these effects, it’s not that simple, measurement and comparison issues etc etc). Cost per capita is about 2-3 times the rest of the west , life expectancy is lower than most of the rest of the west and the medical error rate is a third higher than the UK or Germany.
The US is clearly a very diverse country and opinions on all this divide. What is interesting is that the informed voices, regardless of political position, recognize the enormous problems inherent in the system (although in my judgement those on the right are unable to find rational solutions to it because they are hidebound by their ideology – and it’s worth saying that I don’t think the solution here is a single payer system, yet alone a single provider system with equity as a guiding principle like the NHS – so I’m not being a darn socialistic Yurpeen commie here).
What is fascinating though is the self-delusion inherent in the thinking of Red-State America in their refusal to acknowledge the weaknesses of provision of healthcare. This is not meant to patronize, because any attempt to transform the healthcare system will require public support. And interests vested in keeping the current system despite its flaws are very adept at dong two things:
1 Scaring populations into thinking that what they have will be taken away from them
2 Convincing that any progressive reform is a plot of “coastal elites” to show contempt for the “heartlands” [some of this belongs on the other blog, I think]
Drawing on some polling data, and some qualitative arguments from various right wing bloggy types the next post will try to list out the mythology used to avoid addressing the issues and look at some of the facts which debunk these arguments.
It’s a bit of a truism that America has the best and worst healthcare in the world, but it’s worth thinking what is meant by this. Typically, the point is made about ground breaking innovation – particularly for pharmaceuticals - and contrasts this with the failure to provide proper access for the uninsured (and before any right-wing lunatic anonymouse who might have stumbled here unbidden claims that the uninsured have proper access through an emergency room and that this is better than anything available anywhere else in the rest of the world can I recommend that 1/ you consider the point that waiting until something is an emergency before seeking help is not “proper access” and 2/ you follow the logic of your own position and get rid of your health insurance because if ER based access is so good you are clearly wasting your money).
However I think there is a more interesting contrast to be drawn between the excellence of the really good systems that I and my colleagues are at – Group Health, Kaiser, VA - and much of the rest of the system. I’ve been hugely impressed with the innovation and imagination that I’ve seen in terms of rethinking the process of care, commitment to quality and evidence-based care and use of information technology. So in a sense, those of us inside these systems have much to learn and take back with us. The point is though we are studying the atypical. Extrapolating that US healthcare is therefore superior is like looking at an Aston Martin DB5 and assuming that Austin Allegros had to be good too because both were built in Britain.
Where Durbin is right is that the US system as a whole (or more correctly lack of system) is something which can teach you only what to avoid. The comparison of three simple metrics give some clues (although obviously there is a lifetime’s study in disaggregating some of these effects, it’s not that simple, measurement and comparison issues etc etc). Cost per capita is about 2-3 times the rest of the west , life expectancy is lower than most of the rest of the west and the medical error rate is a third higher than the UK or Germany.
The US is clearly a very diverse country and opinions on all this divide. What is interesting is that the informed voices, regardless of political position, recognize the enormous problems inherent in the system (although in my judgement those on the right are unable to find rational solutions to it because they are hidebound by their ideology – and it’s worth saying that I don’t think the solution here is a single payer system, yet alone a single provider system with equity as a guiding principle like the NHS – so I’m not being a darn socialistic Yurpeen commie here).
What is fascinating though is the self-delusion inherent in the thinking of Red-State America in their refusal to acknowledge the weaknesses of provision of healthcare. This is not meant to patronize, because any attempt to transform the healthcare system will require public support. And interests vested in keeping the current system despite its flaws are very adept at dong two things:
1 Scaring populations into thinking that what they have will be taken away from them
2 Convincing that any progressive reform is a plot of “coastal elites” to show contempt for the “heartlands” [some of this belongs on the other blog, I think]
Drawing on some polling data, and some qualitative arguments from various right wing bloggy types the next post will try to list out the mythology used to avoid addressing the issues and look at some of the facts which debunk these arguments.
posted by Exiled in mainstream at 1:17 PM
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