News From Terre Haute, Indiana


December 28, 2013

Readers’ forum: Dec. 29, 2013


Don’t be fooled by health care data

In his Nov. 27 column, Ronn Mott writes, “We do not have, in America, the highest-rated health care system. We are not in the top 10 … but somewhere in the middle 30s.”

Comparing the huge heterogeneous population of the U.S. with the homogeneous populations of European countries is an old canard and rarely yields useful data. Any responsible columnist delving into this subject will concede that fact if he takes the time to analyze the data.

The U.S. ranks first in terms of access to advanced medical technology such as CT scanners, MRI machines and Cardiac Catheterizations. As a result, we enjoy among the highest rates of cancer survival in the world for both men and women. Source: Lancet Oncology.

Obamacare is based on the Canadian model. The proportion of middle-aged Canadian women who have never had a mammogram is twice that of the U.S., and three times as many Canadian women have never had a Pap smear. This lack of screening is partly responsible for the fact that the mortality rate in Canada is 25 percent higher for breast cancer.

Infant mortality is one area in which the U.S. appears to be lagging (until one looks at how the data are gathered). U.S. doctors and hospitals do heroic work in saving very-low-birth-weight infants while many nations make little or no attempt at saving such infants. They aren’t even recorded as “live born” and are not counted in infant mortality statistics. (They are counted in U.S. statistics.) British guidelines advise against care for babies born before 22 weeks.

The fact that many poor women in the U.S. fail to avail themselves of prenatal care — even when it’s free — cannot be blamed on the fault of our medical care system.

Harvard’s Regina Herzlinger has written extensively about the medical care industry. She notes that “a public payer can reduce costs only by rationing health care, especially to the sick, who account for most of the expenditures. Thus, the United Kingdom’s single-payer system features the lowest usage of cancer drugs among the Big 5 European economies, and commensurately low cancer-survival rates ... Compared with the United States, the United Kingdom spends less, true, but it also gets less.”

What is the moral justification of having the state decide what medical care to ration? Such policies have an Orwellian odor that most Americans find repellent. The U.S. spends more per capita on health care than other countries because we provide and consume more health care services at baseline.

Nor is it all about medicine. Industry experts note that about 70 percent of medical costs are “lifestyle driven.” The CDC reports that 26.1 percent of American adults are obese. It’s estimated that if we could get Americans back to 1991 weight levels we would save a trillion dollars. Physicians at the famed Cleveland Clinic draw a sharp distinction between “health care” and “medical care.” Health care is (your) responsibility.

Studies demonstrate that Mormons live about 10 years longer than the rest of us. Does Utah have better docs? No. The answer lies in the fact that Mormons embrace lifestyle choices that are less destructive than those chosen by the general population. As with so much in life, personal responsibility plays a major role in remaining healthy.

Utah compares favorably with any country one cares to cite; whereas Texas tends to compare unfavorably. But these outcomes have little to do with the medical care systems in the two states.

Much is made of the fact that U.S. life expectancy is a bit shorter than that of other countries. But if one adjusts for violent crime and vehicular deaths Americans enjoy the longest life expectancy.

While we might debate its affordability, there is no debating the fact that U.S. medicine is the best in the world. When wealthy Americans become seriously ill they seek treatment (here).

As a Canadian friend is always reminding me, “free” medical care is not synonymous with access to quality care on a timely basis. That’s why Canadians flock to the U.S. for medical procedures. The nonpartisan Fraser Institute reports that 46,159 Canadians sought medical treatment outside of Canada in 2011, as wait times increased 104 percent.

— Reggie McConnell

Terre Haute

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