HOW CAN WE GET BETTER HEALTH CARE?

CAN WE GET BETTER HEALTH CARE IN AMERICA?

                           NEW ENGLAND JOURNAL OF MEDICINE, SEPT. 20, 2007

   We spend more money on health care than any other nation.  Yet we rank poorly in nearly every category.  How can this be?  Too many Americans, don’t get the health care,  get it too late, or receive poor quality care.  The poor in american need more attention if we are ever to achieve better health care.

   Among 30 other nations, we are at the bottom on most standards.  The only place we lead is in life expectancy of our citizens over 65.  Perhaps this is due to universal Medicare coverage.  We rank 42nd among 190 nations in infant mortality and 46th in average life expectancy. We are not homogeneous like many countries.  A large discrepancy occurs in geographic areas, race, and ethnic groups. 

   There are five factors that must be considered: genetics, social circumstances, environment, behavioral patterns, and health care.  Behavioral causes account for nearly 40% of all deaths in America are due to smoking, obesity, and lack of exercise.  Is changing people's behavior the duty of the doctor?  We have changed people's behavior in America by requiring seat belts, smoking restrictions, and awareness of high saturated fat in our diets.

STOP SMOKING PRESSURES HAVE WORKED

    In 1955,  57% of people smoked.  Today its 23%.  There are still 45 million smokers in America and tobacco kills 435.000 of them annually.  These people die 14 years earlier than the non-smokers and the last 10 years of their lives are spent with shortness of breath, cardiac problems, and numerous pains.  

   Smoking mothers have premature infants. The majority of smokers are in the lower incomes, have a mental illness, or are substance abusers.  Some segments of America already have low rates of smoking. Physicians 2%, post graduates 8%, and residents of Utah 11% and California 14%.

THE OBESITY CHALLENGE

   It is not as possible biologically to stop eating as it is to stop smoking.  There is no addictive analogue to nicotine in food.  There also is no second hand exposure to obesity.  The food industry is less concentrated than the tobacco industry.  We really have no tools to treat obesity. 

   We could designate favorite foods and penalized foods, subsidize some foods, and even increase taxes on other foods.  Labels with more accurate caloric labeling of content and ingredients, especially with fast foods, could also be implemented..  Yet, all  this is politically unpalatable.  Schools could ban sale of soft drinks and provide more nutritious choices, and more physical education in schools would also help.

WHAT CAN WE CHANGE?

Well, we certainly  can’t change our genes.  Poor people die earlier and many others have more disabilities than those in higher incomes.  They have unhealthy behavior in part because of inadequate food choices and lack of recreations opportunities. 

   Yet other countries have their poor people.  Social policies as education, taxation, transportation and housing have health consequences.  There is a widening gap between the rich and poor.  All this may increase the health problems we have in America today.

   Heath care receives a great amount of money and a lot of attention.  Heart disease care has accounted for half of the 40% drop we have seen in mortality.  Premature deaths now only account for 10% of the death rate.  We spend 16% of our gross domestic dollars, over one trillion dollars,  on health care.  Other countries spend less than 10%. 

   The poor represent most of the 45 million Americans that lack medical insurance.  This leads to poor health. But environmental factors are also very very important.  Lead paint, polluted air and water, dangerous neighborhoods, and lack of outlets for exercise, also contribute to premature death in our society.

   We lead the world in diagnostic and therapeutic medical technologies.  We also outspend all other countries in the use of alternative medicines, cosmetic surgeries, and health cures.  We get all excited about particular illnesses that affect all income segments of America as aids, breast cancer, and virus infections.

   We emphasize the value of individual responsibility and this makes us reluctant to intervene in changing behavioral choices of people.   The poor will continue to be underrepresented and not much is likely to change. One consolation is that our country has never been healthier, even though it trails other countries.  It would be certainly to our advantage however to improve our health care.  This would result in a more productive workforce, reduce the monetary costs of medical care, and also improve people’s lives. 

We are number one in wealth, in Nobel Prize winners, and in military strength.

Why can’t we be number one in health?

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