Health Care in the United States

Health care is a subject that occupied much of my professional career, in several ways. As a consequence, I have avoided writing about it, recently, because it was too much like work and because I am not prepared, or willing, to put the time and effort into a professionally competent, journal quality article. Been there; done that, for many years. Therefore, I have simply avoided the topic. No longer. I have something that I simply have to say.

I have been writing and complaining about another area that occupied my professional life, education (and its demise), but in generalities. I am very concerned over the deterioration in education and have identified some of the causes for this lamentable state. Financial considerations in education have forced schools to compromise their quality and the quality of their students. Along with other sources of problems in education and the culture as a whole, there has been a quite noticeable drop in quality in this country and a lowering of our relative position in the world. In this mode, contemplating the problems of deteriorating education, I made the mistake of reading another article, a study published in the New England Journal of Medicine and cited in an article in Business Week. This was a study performed by Rand (hardly a bastion of liberality) and funded by the Robert Wood Johnson Foundation. It was an unfortunate proof of my previous lament for the state of education in the United States. Sadly, I feel that I simply have to comment.

I have been long aware, professionally, that the usual indices of health care quality are distressingly low in the United States. For example, we are below just about ALL other industrial countries in a leading measure, infant mortality. From 17th place in the early 80's, which was quite bad enough, we have now deteriorated to somewhere around 50th place on this measure. That's 50th, folks, below 49 other countries. Other indices are also distressingly bad. As I said, I knew this sad fact and, although I have never completely come to terms with it, I held some rationalizations that let me at least live with it. What I didn't know was exactly how bad it had become and that this absurdly poor care was nearly equal for the rich and the poor.

Public health 'experts' have generally believed that the low measures were almost entirely a function of poor access to the system, or at least poor utilization of resources by the underprivileged, disenfranchised (read black) segment of the population. Well, gentle reader, this rationalization, handy though it was, intuitively true as it seemed, is simply not so. It is much worse that that. Those people already in the system, with access and utilization, aren't faring any too well, either. All of the people in the study group (7000 patients) were in the 'system,' all patients in treatment, and on balance, frighteningly incompetently treated. Across the board, the group received 55% of what a panel of 'experts' deemed to be needed procedures. And here is the real 'kicker'; it was nearly equal for the rich and the poor. Across all measures of quality treatment, the rich patients only fared 3 to 5 percent better than the poor ones.

The treasured conceit, expressed by our current administration and, sadly believed by many of the people that we are number one in health care is so far from true that it has the status of a delusion. Not even close, folks; we are closer to the bottom, much closer, than the top.

Why? Well, it is new knowledge as to how bad it really is so we don't know why. It has not been analyzed. But you can bet me that the deterioration of our educational system, from kindergarten through medical school-and every other post graduate professional or academic education is a major part of the reason. In a recent editorial, I lamented the fact that financial considerations have driven our institutions of higher education to accept students for fiscal, rather than academic reasons. Obviously, this contributes to a watering down of the value and quality of degrees. If poorer students are being graduated because exit criteria have been lowered, it is obvious that this will drag down all of education, from top to bottom. Short sighted political decisions and the immediate self interest of the decision makers have run their inevitable course. We are reaping the rewards of what we have done to education in this country -- and we are all rich or poor, privileged or underprivileged, going down with the ship.