To Stay Alive and Healthy, Head for the Border

What’s wrong with this picture? Americans’ health has failed to improve for the fourth year in a row, as America’s Health Rankings, released earlier this week, reports. Yet the country spends more than $2 trillion a year (one-sixth of our total economic output) on health care, more per person than any other nation.

We’ve all read how a big chunk of the nation’s health dollars go for insurers’ administrative costs, drug companies’ marketing and advertising, and other things that do exactly zero to keep people healthy and alive. But in a refreshingly direct analysis, experts led by neurologist Marc Nuwer of the David Geffen School of Medicine at UCLA argue that the problem with our health-care system is that we persist in thinking like Americans. As they explain in two papers in the current issue of the journal Neurology, we “prize individual choice and resist limiting care. We believe that if doctors can treat very ill patients aggressively and keep every moment of people in the last stages of life under medical care, than they should. We choose to hold these values. Consequently, we choose to have a more expensive system than Europe or Canada”—and one that does not keep us healthier or alive longer.

First, the sobering findings of the Health Rankings, which are based on 22 health measures:

    • The prevalence of obesity has more than doubled in the last 19 years.

    • The U.S. is 28th in healthy life expectancy at 69 years. In Japan it’s 75.

    • The U.S. has the worst mortality rate from treatable conditions of 18 other industrialized countries. That’s four spots worse than 5 years ago. In other words, get sick here and you’re more likely to die than you are in Canada, France, Britain and 15 other countries. Our mortality rate after age 75 is 50 percent higher than in France, Japan, Spain, Italy, Canada and Australia. In 1997, the U.S. ranked 15th in this mortality rate. Since then, Finland, Portugal, United Kingdom and Ireland have passed us.

    • The U.S. is 20th of 21 developed nations for child well-being, reflecting high infant mortality rates, a high percentage of low-birth-weight infants, and a low rate of immunizations.

    • The U.S. health care system performance is worse than that of Australia, Canada, Germany, New Zealand, and the United Kingdom—though we spend twice as much as these countries per person on health care.

“These statistics indicate that what we are doing as a nation is not working,” said Dr. Georges C. Benjamin, executive director of the American Public Health Association. “We know improvement is possible because other nation’s have achieved far better health outcomes at less cost, indicating that we, too, can do the same.”

Earlier this year I wrote that this pablum our political and business leaders keep feeding us about how the American health-care system is “the best in the world” (an argument that special interests have long used to block health-care and health-insurance reform) is completely bogus. The U.S., as I wrote then, is “well behind other developed countries on measures from cancer survival to diabetes care that cannot entirely be blamed on the rich-poor or insured-uninsured gulf.” These data underline that.

But back to Marc Nuwer’s diagnosis. The UCLA neurologist and his colleagues make these points:

    • 31 percent of what we spend on health “care” goes toward administration. “We push a lot of paper,” says Nuwer. “We spend twice as much as Canada, which has a more streamlined healthcare system that demands doctors complete less paperwork.”

    • 10 percent of what we spend goes to defensive medicine, such as expensive tests ordered by doctors afraid of missing anything, however unlikely. “Doctors don’t want to be accused in court of a delayed diagnosis, so they bend over backwards to find something, even if it’s a rare possibility, in order to cover themselves,” says Nuwer. I have to add that much of this is driven by patients and their families who have no understanding that the test will not lead to anything actionable. Hint: when your doc orders a test, ask if the results will tell her something about how to treat you that she doesn’t already know.

Part of the problem, says Nuwer, is that doctors are oblivious to the price of whatever they’re prescribing. “Does a fancy electric wheelchair cost $500 or $50,000?” he asks. “Most doctors have no clue. We need to give physicians feedback about the dollar signs behind their orders.”