What troubles me most about the current debate on health care are the questions that are not being asked. The unifying theme of one side of the debate is that government involvement in health care is bad and single-payer is an evil to be opposed with every resource.
You would think that a whole host of questions would trouble those making these types of arguments.
The first question is how did other developed countries end up with single-payer as part of their health care systems and how do they outperform ours in statistical outcomes at one half to two thirds our per capita expenditure? If single-payer were such a problem, how could the European and Asian countries that use single-payer end up with health care systems that rank substantially better than our 37th in the world according to the WHO (World Health Organization,)?
Another question is how does one of the most socialist-like systems, Italy, achieve a No. 2 ranking in the WHO comparisons when we the most consumer-driven system in the world ranks so much lower? How can more consumer involvement and less government fix our problems in light of Italy’s experience?
Another question is why do systems that use private insurance companies have many of the same problems we have?
Our health care system is really not a system in the way that other countries of the world manage their health care. Our health care is more like a collection of independent cowboys vying for health care profits while the consumer, driven most of the time by urgent need, is at their mercy. When we call our insurance company to ask why we are being denied coverage, we are not treated like valued customers.
It is as if there is a segment of so called experts in health care completely unaware of the realities of health care systems in the rest of the world. They seem to be unaware that it isn’t just the out of control cost that is killing us but the lack coverage, lack of quality, lack of guidelines for the consumers of health care, impact of catastrophic illness or a host of other problems.
Take for example our quality issues (the US medial error rate is 5 to 9 times those in some countries). Recently a friend questioned my medical error rate data and so I gave him this explanation. Japan has a medical error rate one fifth of ours and given my experiences in Japan with GE Healthcare I explained how Japan’s low error rate is achieved.
Japan’s health care system is driven by quality methods developed in industry that uses measurement of outcomes. Hospitals and physicians try to make procedures error proof from prescribing drugs to preparation for surgery. It is only in the last five years that I have seen Six Sigma methods introduced into U.S. hospitals. Before that those of us who worked as consultants and worked to improve quality in hospitals and introduce statistical methods were met with blank stares. The typical response is that “We (the hospital) are trying to give quality care to everyone.” My answer was, “If you look at the numbers, you are failing.”
In fact, many U.S. health care institutions base strategies more on drug and equipment companies’ input than on actual outcome data. A few like Mayo that are very outcome driven suffer in our system because they don’t pile on the procedures and drugs for increased reimbursement.
Another aspect of Japanese health care is that the physician team working on a single patient in Japan is very collaborative. In the US physicians working on the same patient often only communicate through the nursing staff. This results in some really bizarre proceedings.
Last year, my father, who was 93 at the time and lives in Detroit, had some breathing difficulty in a bout with the flu. He is generally doing fairly well for someone his age and was on no medication. His heart was always considered healthy. When he was admitted to the hospital he was seen by different specialists each of whom examined him and recommended medications and more tests. After several days his breathing difficulty cleared up and he wanted to go home. Several of the specialists after prescribing medications signed release forms. Other specialists, especially the heart guy, gave orders for him to remain in the hospital and have more tests. My sister, missing work, went on several occasions to the hospital expecting to take him home and came home alone disappointed. My father was becoming really annoyed at all this, which just caused another doctor to prescribe more drugs to keep him calm.
The bottom line was that he left the hospital after about eight days, feeling lousy, taking about 15 pills a day. There had been no definitive diagnosis of any problem other than the breathing difficulty he had with the flu, which had cleared up in two days. He quit taking all the medication after he returned home and soon began feeling his old self again. But the image of all those specialists prescribing drugs and never talking to each other was more like a Keystone Cop comedy than an example of a health care system. I am convinced all the drugs prescribed with little or no concern for interaction was a major cause of many of the symptoms that seemed to come up out of nowhere during his hospitalization.
Horror stories abound
Whenever I tell this story, I hear another example just as bizarre from someone else. I’m sure that anyone who calls himself a health care expert but who doubts we are in serious trouble delivering quality health care with our high-tech and well-trained doctors is not being honest.
All the Western European and Japanese governments played a major role in the development of their health care systems, all of which work better as a system than ours. Is our government so corrupted by powerful interests that it cannot begin to address problems that European and Asian governments work effectively to solve?
Unfortunately I believe many of those arguing for less government have intimate knowledge of the answer to this question because they are employed by the powerful interests.
Joseph Geck is a businessman in Waukesha.