Common Misconceptions About Healthcare Reform

[Stephen C Schimpff]

American medicine must change - and the change will be both substantial and difficult to achieve but change is critical if we are to have a well functioning healthcare system that affords all of us safe, quality care at a reasonable cost in a customer-focused manner. Today there are many misconceptions about healthcare reform - misconceptions about who will have access, how much it will cost, who will pay the bills, whether it will benefit those who currently have insurance, whether there will be good preventive care and good coordination of chronic illnesses, whether individuals will still be able to lose their insurance if they change or lose their jobs, whether Medicare benefits will be reduced, whether it will include rationing and whether there will be "death panels." Indeed the misconceptions like these and others are rampant and need to be addressed in a realistic, nonpartisan manner. I propose to explain what must change and why and then to dispel the misconceptions with straight forward factual information so that you can be properly informed. In the process I will explain the need to balance rights such as access with responsibilities such as leading a healthy lifestyle. Beginning with this post, I plan to review the common misconceptions, one or two at a time, entering a new post very few days until completed.
Misconception - America has the best healthcare in the world.
Sorry, but this is just not true. As stated before, we have a medical care system not a healthcare system meaning that we focus on disease and pestilence but not health promotion and disease prevention. We do spend more per capita than any other country but our quality does not measure up to what we spend. We have a higher infant mortality rate [6.9 per 1000 live births] than many countries [e.g., Japan – 2.8, France – 3.9] and our lifespan [77.9 years] has not kept up [Japan – 83, Switzerland – 82]. We have lifesaving vaccines available but they go unused by nearly 20% of infants. We are overweight with only about one-third of us at a healthy weight. About 20% of us still smoke. Regular exams are simply not regular and screenings for preventable or reversible problems like high blood pressure, high cholesterol and cancer are all too often not obtained. In short, the American healthcare system responds, and responds fairly well, to illness and trauma but is not focused on preventive medicine as the numbers above document. Further we do not have coordinated care for those with complex, chronic diseases like heart failure and cancer. These diseases cannot be treated appropriately with our current helter-skelter approach with independent physicians referring to each other as the situation warrants instead of a well-coordinated system for addressing all of the patient’s needs in an organized manner with multidisciplinary teams.
We have incredible resources in people, technology and infrastructure but we do not bring them to bear on the problems of healthcare delivery in an effective manner. This needs to change.

[Stephen C Schimpff]

Thanks to Kevin Montgomery for the added data comparing American healthcare to other countries.

[Lacey Cormier]

since i was a child, thats what ive thought..that america has the best health care system..and i felt very proud of that..i guess not..what our country needs is cooperation from its people and of course financial aid from the government...and if i may suggest to also make elisakits available at every health care station in every community of america..it would greatly help people...

[Kevin Montgomery]

Here are some older stats (from OECD, 2005), but still relevant:

OECD Health Data 2005
How Does the United States Compare

Health spending and financing
Total health spending accounted for 15% of GDP in the United States in 2003, the highest share in the
OECD and more than six percentage points higher than the average of 8.6% in OECD countries. By
comparison, Switzerland and Germany allocated 11 and 11.5% of their GDP to health, respectively, and
Canada and France about 10%.

The United States also ranks far ahead of other OECD countries in terms of total health spending per
capita, with spending of 5,635 USD (adjusted for purchasing power parity), more than twice the OECD
average of 2,307 USD in 2003. Switzerland and Norway come just after with spending of about 3,800
USD per capita. Differences in health spending across countries may reflect differences in price, volume
and quality of medical goods and services consumed.

Between 1998 and 2003, health spending per capita in the United States increased in real terms by 4.6%
per year on average, a growth rate comparable to the OECD average of 4.5% per year.
Over the past decade, the share of health expenditure spent on pharmaceuticals in the United States
increased from 8.6% of total health spending in 1993 to 12.9% in 2003. This remained below the OECD
average of 17.7%. In 2003, the United States was the top spender on pharmaceuticals (with 728 USD per capita, adjusted for purchasing power parity), followed by France, Canada and Italy.
The public sector is the main source of health funding in all OECD countries, except for the United
States, Mexico and Korea. In the United States, only 44% of health spending is funded by government
revenues, well below the average of 72% in OECD countries. The public share of total health spending
remains the lowest of OECD countries, compared for instance with the Nordic countries (Denmark,
Norway and Sweden) where it reaches more than 80% of total health spending.

In the United States, private insurance accounts for 37% of total health spending, by far the largest share among OECD countries. Beside the United States, Canada, France and the Netherlands also have a
relatively large share of funding coming from private insurance (more than 10%).


Resources in the health sector (human, physical)
Despite the relatively high level of health expenditure in the United States, there are fewer physicians per capita than in most other OECD countries. In 2002, the United States had 2.3 practising physicians per 1000 population, below the OECD average of 2.9.
There were 7.9 nurses per 1 000 population in the United States in 2002, which is slightly lower than the average of 8.2 across OECD countries.

The number of acute care hospital beds in the United States in 2003 was 2.8 per 1 000 population, also
lower than the OECD average of 4.1 beds per 1 000 population. As in most OECD countries, the number
of hospital beds per capita has fallen over the past twenty years, from 4.4 beds per 1 000 population in
1980 to 2.8 in 2003. This decline has coincided with a reduction in average length of stays in hospitals and an increase in day-surgery patients.

Health status and risk factors
Most OECD countries have enjoyed large gains in life expectancy over the past 40 years. In the United
States, life expectancy at birth increased by 7.3 years between 1960 and 2002, which is less than the
increase of 14 years in life expectancy in Japan, or of 8.4 years in Canada. In 2002/3, life expectancy in
the United States stood at 77.2 years, below the OECD average of 77.8 years. Japan, Iceland, Spain,
Switzerland and Australia were among the top 5 countries registering the highest life expectancy among
OECD countries.

Infant mortality rates in the United States have fallen greatly over the past few decades, but not as much as in most other OECD countries. It stood at 7 deaths per 1 000 live births in 2002, above the OECD average of 6.1.1 Among OECD countries, infant mortality is the lowest in Japan and in the Nordic
countries (Iceland, Sweden, Finland and Norway), all below 3.5 deaths per 1 000 live births.
The proportion of daily smokers among the adult population has shown a marked decline over recent
decades across most OECD countries. Much of this decline can be attributed to policies aimed at reducing tobacco consumption through public awareness campaigns, advertising bans and increased taxation. In the United States, the proportion of smokers among adults has fallen from 33.5% in 1980 to 17.5% in 2003, the lowest rate among OECD countries along with Canada and Sweden.

At the same time, obesity rates have increased in recent decades in all OECD countries for which trend
data is available. There remain however notable differences in obesity rates across countries. In the United States, the obesity rate among adults (30.6% in 2002) is the highest in OECD countries, followed by Mexico (24.2% in 2000) and the United Kingdom (23% in 2003).2 Obesity rates in Continental European countries are lower, but are also rising. The time lag between the onset of obesity and increases in related chronic diseases (such as diabetes and asthma) suggest that the rise in obesity that has occurred in the United States and other OECD countries, will have substantial implications for future incidence of health problems and related spending.

More information on OECD Health Data 2005 is available at www.oecd.org/health/healthdata.
For more information on OECD's work on the United States, please visit www.oecd.org/us.

Notes/caveats:
1 Some of the international variation in infant mortality rates is due to variations in registering practices of premature infants (whether they are reported as live births or not). In the United States, Canada and the Nordic countries, very premature babies (with relatively low odds of survival) are registered as live births, which increases mortality rates compared with other countries that do not register them as live births.

2 It should be noted however that the data for the United States, the United Kingdom and Australia are more accurate than those from other countries since they are based on actual measures of people’s height and weight, while estimates for other countries are based on self-reported data, which generally under-estimate the real prevalence of obesity.