How many times have you heard it?
The conversation centers on health care, insurance and the crisis of public health in the United States.
Always, yes, always, during the first couple of minutes of discussion, someone offers the evaluation that almost always shuts down any creative thinking,
"Yes, but the United States has the best health care system in the world."
Oh, really? Why in the world are we so sure about that? And for whom is it the best?
Dr. Barbara Starfield, Johns Hopkins School of Medicine, published an article in The Journal of the American Medical Association (summer 2000) reporting that "the U. S. population does not have anywhere near the best health in the world. . . .Of 13 countries in a recent comparison, the United States ranks an average of 12th (second from the bottom) for 16 available health indicators."
Noting that 40 million Americans (now closer to 45 million) were then without health insurance, the good doctor went on to say, "U. S. children are particularly disadvantaged. But even the relatively advantaged position of elderly persons in the United States is slipping. The U. S. relative position for life expectancy in the oldest age group was better in the 1980's than in the 1990's."
In a follow-up interview with New York Times reporter, Bob Herbert (June 28, 2004), Dr. Starfield noted that four years later the situation was only worse.
What is clear and true is simple to see: we have the most expensive health care system in the world that produces very little in the way of return on investment on a per capita basis in positive public health outcomes.
For all our spending--currently about 15% of the gross national product annually-- we certainly do not enjoy the best health in the world.
What we do have is a very inequitable and unjust system.
If you can pay, you get some of the best care in the world. Maybe that is what people mean who claim so much for the quality of our system in this country.
The often brutal corrollary is simple: If you can't pay or if you are uninsured, you find yourself in a world of hurt, literally. No claims for the best system in the world will be heard from this growing group of Americans.
Then comes the brilliant leadership of State of Texas that forfeits hundreds of millions of federal dollars readily available to bring better health products to the rapidly growing numbers, once at or near the bottom, who are now in a shrinking middle class.
Dollars, by the way, that Texans have paid to Washington in federal taxes. Dollars now at work in New York, Pennsylvania, Oregon, Florida and many other states.
More on this tomorrow.
For today, be careful what you claim about the quality of overall health care in the U. S.
And don't forget, in this country we still believe in the "overall," don't we?
Please tell me we do.
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