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Friday, October 4, 2013

"In Health, We're Not #1," Conservative Columnist Robert Samuelson

We're #1!

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It turns out that being American is bad for your health, relatively speaking.
Anyone interested in health care ought to digest the findings of a massive new report from the National Research Council and the Institute of Medicine, which compared Americans’ health with that of people in other advanced countries. After spending 18 months examining statistics and studies, the panel reached a damning conclusion: The United States ranks below most advanced countries.
Robert J. Samuelson
Samuelson writes a weekly column on economics.


Consider. Life expectancy at birth is 78.2 years in the United States, lower than the 79.5-year average for the wealthy countries belonging to the Organization for Economic Cooperation and Development (OECD); Japan’s life expectancy is 83. Among 17 advanced countries, the United States has the highest level of diabetes. For 21 diseases, U.S. death rates were higher in 15 (including heart and lung diseases) than the average for these same countries.
Here, in somewhat clunky language, is the report’s sobering summary:
“The U.S. health disadvantage is more pronounced among socioeconomically disadvantaged groups, but even advantaged Americans [described as ‘white, insured, college-educated’] appear to fare worse than their counterparts in England and some other countries.” 

Alan: Great Britain's National Health Service is often portrayed as a debacle. In fact, over 60% of Brits like their healthcare. Even so, notice that "low man on the socialist healthcare pole" provides better healthcare - in the main - than the United States. The jury is in: socialized healthcare does a better job than America's free market health insurers. (See links at bottom of this post.)
What to make of this?
The report’s most important contribution is to show that much of the U.S. “health disadvantage” doesn’t reflect an inadequate health-care system but lifestyle choices, personal behaviors and social pathologies. The gap in life expectancy is concentrated in Americans under 50. Among men, nearly 60 percent of the gap results from more homicides (often gun-related), car accidents (often alcohol-related) and other accidents (often drug-related) than in comparable nations. For children under 5, car accidents, drowning and fire are the largest causes of death.

Alan: Samuelson says America's "health disadvantage" is attributable to "bad behavior" with no acknowledgment that "behavior" is a core component of how we rank a nation's "health culture." Make no mistake: behavior is integral to the overall evaluation of a country's health. The fact that "heroic medical techniques" can successfully patch bullet holes in the brain does not mean that a gun-crazed, murderous culture gets high marks for health care, certainly not for Public Health. In any integrated scheme of things, Public Health (which Americans set apart from our "health care system") is more important for favorable health outcomes than the practice of technological medicine itself. Ask anyone with emphysema if s/he would prefer the ministrations of heroic "technological medicine" or a public health culture that prevented them from smoking in the first place. Intoxicated by science and technology, we ignore the critical role played by culture - most specifically by public health culture. Healthcare system worthy of the name consider prevention and health maintenance more central to their mission than after-the-crash damage control.
Teen pregnancy is another big problem. Among girls 15 to 19, the pregnancy rate is about 3.5 times the average of other advanced societies. “Adolescent motherhood affects two generations, children and mothers,” the report notes. Adolescent mothers often don’t finish high school. “Their children face a greater risk of poor child care, weak maternal attachments [and] poverty.” Similarly, the incidence of AIDS in America is nearly nine times the OECD average.
The health-care system can’t cure these ills, which are social problems with health consequences. 

Alan: Narrowly speaking, "the health-care system can't cure these ills." But that's not the point... no matter the prurient seduction of "sound bites." At issue is the dismissal of public health - and public health culture - as integrated components of any health-care system and it is precisely this dismissal that makes American health-care the worst in the developed world with overall outcomes slightly ahead of Slovenia. At bedrock, the daily bread of American conservatives is deliberate decontextualization of integral truth. Without submitting every issue to procrustean beds, American conservatism - as it has evolved under aegis of anarchic apocalypiticism - has no intellectual integrity. Nothing. Nada. Zilch. Niente. Nihil. See "Republicans for Revolution" - http://paxonbothhouses.blogspot.com/2012/09/republicans-for-revolution-by-mark-lilla.html

Those who expect the introduction of the health-care system can’t cure these ills which are social problems with health consequences. Those who expect the introduction of the
main elements of the Affordable Care Act (”Obamacare”) in 2014 to improve Americans’ health dramatically are likely to be disappointed. The lack of insurance is a problem, but it is not the main health problem, in part because the uninsured already receive much uncompensated care. (Alan: See links at the bottom of this post.)
To be fair: Some of these social problems show progress. America’s slippage is mostly relative to better outcomes elsewhere. Since 1980, the U.S. murder rate has dropped by roughly half (but remains higher than in many peer countries); traffic deaths per miles traveled have fallen by more than half since 1975 (though decreases abroad are greater); teen birth rates have fallen to a seven-decade low (but are higher than in most wealthy nations); and U.S. life expectancy is rising (but more slowly than elsewhere).
Nor does the new report exonerate the U.S. health-care system from blame for the “health disadvantage.” Despite enormous spending, the system is “deeply fragmented across thousands of health systems and payers . . . creating inefficiencies and coordination problems.” 

Alan: Private health insurers, participating in so-called "free markets," created the most wasteful health-care system on earth, a system that -- in addition to leaving a third of the nation uninsured or underinsured -- was already in bank-breaking free fall when Obamacare was enacted. See the National Geographic link at http://paxonbothhouses.blogspot.com/2013/09/great-video-explanation-of-american.html
Much specialized care is of high quality; recovery rates for hospitalized U.S. stroke and heart attack victims are higher than in many wealthy nations. Cancer treatment is superior. But primary care is weak. Only 12 percent of U.S. doctors are general practitioners compared with 18 percent in Germany, 30 percent in Britain and 49 percent in France. In 2009, Americans visited doctor’s offices an average of 3.9 times; the OECD average is 6.5 times. Patients may not get needed care; one study found that Americans “receive only 50 percent of recommended” treatments.
The report’s authors searched in vain for an overarching explanation for the peculiar determinants of Americans’ health. But it missed the most obvious possibility: This is America. The late sociologist Seymour Martin Lipset argued that American “exceptionalism” is a double-edged sword.” Values we admire also inspire behaviors we deplore. The emphasis on individual autonomy and achievement may aid a dynamic economy — and also feed crime and drug use.

Alan: The pending success of Obamacare will demonstrate the superiority of a social contract based on The Common Good and the correlative inferiority of Rugged Individualism. Conservatives realize - and rightly so - that Obamacare's success will open the door, forevermore, to the full menu of citizen services offered throughout western Europe where "socialized capitalism" prevails. See "Brazen Lies About Obmacare" - http://paxonbothhouses.blogspot.com/2013/09/brazen-lies-about-obamacare.html
Similar tendencies affect health care. The love of freedom and disdain for authority may encourage teen pregnancy and bad diets. The competitive nature of society may spawn stress that hurts the health of even the well-to-do. The suspicion of concentrated power may foster a fragmented delivery system. Commendable ambitiousness may push doctors toward specialization with its higher income and status.
Ever optimistic, Americans deny conflicts and choices. We excel at self-delusion. Asked by pollsters to rate their own health, Americans say — despite much contrary evidence — that they’re in better shape than almost anyone. We think we’re No. 1 even if we aren’t.

http://articles.washingtonpost.com/2013-01-16/opinions/36384458_1_life-expectancy-health-care-affordable-care-act
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