You often hear the old saw “the US has the best health care system in the world” with the follow on being that we need to be very careful not to ruin all that quality care through health care reform. But read Overtreated: Why Too Much Medicine is Making the US Sicker and Poorer, by Shannon Brownlee of the New America Foundation (the New York Times’ 2007 economics book of the year). Her essential point is that we don’t have the best medical care in the world, just the most expensive. In fact if you look at typical quality of care measures, Ms. Brownlee says, our system ranks somewhere in the mid-30’s.
Among the book’s most interesting points: We spend $2.1 trillion per year on health care (greater than the entire GDP of Italy) with about 1/3 of that being for care that is unnecessary. We pay 2X per capita what Western Europe pays for healthcare. We rank low in the developed world in infant mortality, life expectancy and other key measures.
Why the low ranking and waste? Among the reasons the book cites: a fee for service system the encouraged procedures rather than managing outcomes (some of the best outcomes come from facilities that have salaried doctors . . . see the Mayo Clinic), lack of overall good case management (for example, we tend to go to a disparate group of expensive specialists rather than GP’s who know us and manage the big picture), and flat out chaos in the system (citing especially lack of strong care management in hospitals and of good electronic medical records).
There’s a road map for reform here reflected, though still high level, in the initial Obama and other Democratic health care plans. We should follow it. In doing so we won’t be ruining a best in class system but establishing one.
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