In part 1, I discussed the illusions of America's democracy, and pointed to the media as a key player in the web of deceit that has fooled most Americans to think they live in a democracy. I also discussed the lobbysists' role in healthcare reform. Finally, I exposed the truth about the AMA. But there is a bit more about the AMA I plan to discuss in the future. In Part 2, I want to show you just how good U.S. healthcare is.
U.S. Healthcare: The Best in the World?
America’s healthcare system can be thought of as a healthcare syndicate, controlled by a handful of managed care, drug and device maker giants, offering very little competition while extracting exorbitant profits from people in need of medical attention.
Ever since the medical-industrial complex seized the industry, healthcare has become a very lucrative business in America, with investors, providers and caregivers looking to make as much profit as possible. In America, the practice of medicine has been transformed into the business of medicine. As a result, patients are often treated as customers.
For those who are convinced that America has the best healthcare system in the world, let me begin with a very simple question.
How can a nation claim to have the world’s best healthcare system when more than 15% of its citizens have no access to medical care? Remember, a large portion of the healthcare system is comprised of public healthcare, which is supposed to cover the elderly and impoverished. So if the healthcare system is so great, how is it that over 40 million Americans have no access to medical care whatsoever?
Furthermore, how can such a nation spend more than twice the average of developed nations on healthcare, most of which comes from taxpayers and still leave over 40 million without coverage?
Doesn’t something seem wrong with that picture?
Okay, if you still have not been convinced that America does not have the world’s best healthcare system, I’d like to point to America’s relatively poor healthcare statistics.
Poor Health Statistics
Certainly, the United States has one of the most technologically advanced healthcare systems in the world. But the World Health Organization ranks the U.S. healthcare system thirty-seventh in the world in terms of quality, accessibility, cost and other critical factors.
America spends far more than every other nation in the world on healthcare, yet has poor health statistics. For instance, compared to 13 countries, the United States ranks an average of 12th for 16 healthcare indicators:
- 13th (last) for low-birth-weight percentages
- 13th for neonatal mortality and infant mortality overall
- 11th for postneonatal mortality
- 13th for years of potential life lost (excluding external causes)
- 11th for life expectancy at 1 year for females, 12th for males
- 10th for life expectancy at 15 years for females, 12th for males
- 10th for life expectancy at 40 years for females, 9th for males
- 7th for life expectancy at 65 years for females, 7th for males
- 3rd for life expectancy at 80 years for females, 3rd for males
- 10th for age-adjusted mortality
The median ranking for these indicators in order of best to worst was Japan, Sweden, Canada, France, Australia, Spain, Finland, the Netherlands, the United Kingdom, Denmark, Belgium, the United States, and Germany.
America spends a much higher percentage of GDP (2008 data is 18% GDP) on healthcare than every OECD nation, yet is sixth (or seventh, depending on the year) from the bottom in life expectancy.
America also spends 60% more than the second highest spender in the world, Switzerland (per GDP, 2008 data; more recent data points to France; not shown in figure below), but still has a much lower life expectancy.
Japanese citizens have the highest life expectancy of all developed nations with total healthcare expenditures at 8% of GDP. And of course, everyone is provided with affordable access to medical services.
South Korean nationals have the same life expectancy as Americans, but the Korean government spends less than one-half (6.8% of GDP, 2007 data OECD) of the amount spent in America on healthcare.
Myths about Low Life Expectancies
Critics of the relatively low life expectancies in the U.S. point to high rates of tobacco and alcohol use, as well as high-fat diets. But the evidence demonstrates this is clearly not the case. Let’s have a look at the data.
Smoking. According to Dr. Barbara Starfield, the proportion of females who smoke cigarettes ranges from 14% in Japan to 41% in Denmark. In the United States, only 24% of females smoke (fifth best). For males, the range is from 26% in Sweden to 61% in Japan. In the United States, only 28% of males smoke (third best). Despite much higher rates of smoking, these nations are amongst the healthiest in the world.
Alcohol. When compared to other developed nations, the U.S. ranks fifth highest for alcoholic beverage consumption.
Fat Consumption. The U.S. has a relatively low consumption of animal fats (fifth lowest in men aged 55 to 64 years in twenty industrialized countries) and the third lowest mean cholesterol concentrations among men aged 50 to 70 years among thirteen industrialized countries. However, America’s top obesity rate certainly plays a role in its poor life expectancies.
So what’s the source of the relatively low life expectancies in the U.S. compared to other developed nations? Certainly there are a variety of factors, such as America’s obesity epidemic. However, obesity has become a global trend, and thus cannot account for the full magnitude of the disparities found in U.S. life expectancies.
It’s no secret that America has the world’s most expensive healthcare system. It’s also no secret that America’s healthcare system is the least accessible of all developed nations.
What may surprise you is that America leads the world in medical errors. No other developed nation comes remotely close to the number of medical errors per capita seen in the U.S.
Millions of medical errors in the U.S. not only waste billions of dollars, they also result a huge number of unnecessary deaths. This is just one of many problems most are unaware of.
Let’s examine the data.
According to a study of medical literature compiled by Dr. Barbara Starfield of Johns Hopkins University, published in the Journal of the American Medical Association (2000),there is an estimated 225,000 annual deaths in U.S. hospitals due to iatrogenic causes not associated with recognizable medical error, as follows:
- 12,000 deaths/year from unnecessary surgery
- 7,000 deaths/year from medication errors in hospitals
- 20,000 deaths/year from other errors in hospitals
- 80,000 deaths/year from nosocomial infections in hospitals
- 106,000 deaths/year from non-error, adverse effects of medications
This data only includes hospitalized patients. It does not include patients released from care or out-patient iatrogenic deaths. The data also do not include any negative effects related to disability or discomfort.
Thus, American physicians are the third leading cause of death in America at over 225,000, after heart disease and cancer, according to Starfield’s conservative estimates.
If one adds deaths due to recognizable medical error, this would add an additional estimated 44,000 to 98,000 to the total. As striking as these estimates are, they are lower than other studies such as that conducted by the Institute of Medicine in 2003.
Another analysis concluded that between 4% and 18% of consecutive patients experience negative effects in out-patient settings, with:
- 116 million extra physician visits
- 77 million extra prescriptions
- 17 million emergency department visits
- 8 million hospitalizations
- 3 million long-term admissions
- 199,000 additional deaths
- $77 billion in extra costs
Other studies estimate that 20% to 30% of patients receive inappropriate care, contributing to medical waste and unnecessary morbidity and mortality.
As one of the most comprehensive studies ever performed, Drs. Null, Dean, Feldman, Rasio, and Smith examined thousands of research results from numerous peer-reviewed medical journals seeking to obtain a realistic picture of excessive medical cost, morbidity and mortality in the U.S. healthcare system.
The results of this massive effort were beyond shocking (www.lef.org). The researchers showed that 783,936 Americans die every year from conventional medical mistakes, costing a minimum of $282 billion on deaths due to medical mistakes and iatrogenic deaths. To put this into perspective, recall that 60,000 Americans died during the entire in the Vietnam War, which lasted many years.
This report mentions that the actual number of medical mistakes is likely to be much higher due to under-reporting by doctors who fear legal backlash. Some of the results of this study were:
- 2.2 million patients with in-hospital, adverse drug reactions due to prescribed medications
- 20 million unnecessary antibiotics prescriptions issued each year for viral infections (according to Dr. Richard Besser of the CDC in 1995). In 2003, Dr. Besser stated that number to be in the tens of millions.
- 7.5 million unnecessary medical and surgical procedures performed annually
- 8.9 million people exposed to unnecessary hospitalizations each year
- The total number of iatrogenic deaths each year in the U.S. is 783,936
According to this study, the American medical system is the leading cause of death and injury in the United States due to iatrogenic causes, or that due to physicians.
According to Null at el, only between 5-20% of iatrogenic acts are ever reported. If full reporting occurred, the annual iatrogenic death rate would be much higher than 783,936. The authors note the numbers could be even higher if other studies were used; up to nearly 1 million iatrogenic deaths each year in America, or the equivalent of 6 jumbo jets crashing each and every day.
The projected statistic of 7.8 million iatrogenic deaths by Null et al is more than all casualties from wars that America has fought in its entire history.
These projected figures show that a total of 164 million Americans, approximately 56% of the population of the United States, have been treated unnecessarily - nearly 50,000 people per day.
Paying for Universal Care and Not Getting It
As medical costs continue to spiral out of control, it has become critical to scrutinize what Americans receive for each healthcare dollar. Americans have been led to believe that the high expense of healthcare is worth the price in exchange for higher quality. As the data shows, the higher quality is not there; only higher prices.
The U.S. government spends a similar amount on public healthcare (6.5% of GDP, 2007 data, Medicare and Medicaid, but not counting employer and employee deductions) as S. Korea, but only provides partial insurance for about ninety-one million Americans, or 28% of the population via Medicare and Medicaid. In contrast, South Korea provides full healthcare for all of its citizens.
In other words, U.S. taxpayers already pay for universal healthcare without receiving the benefits. As most are aware, America is the only member of the OECD (an organization of developed nations) without a national healthcare program. This has already resulted in major challenges for the U.S. economy because it has established an unfair playing field for global trade.
Despite spending much more than even the world’s second largest spender on healthcare, while leaving more than 40 million Americans without medical access, this massive amount of money is not spent wisely.
Americans receive the least amount of medical services per dollar spent in the developed world. Much of this inefficiency is due to massive profits extorted by HMO and drug industry giants. They have created virtual monopolies and are able to raise prices at will because they have bought off state and federal politicians.
Overall, a good portion of each healthcare dollar spent in America goes to support healthcare parasites that have grown so large they now feed off of healthcare more than they support it.
Furthermore, much of the money earmarked for public healthcare is siphoned off by the private system through excessive drug prices, which are far more expensive in America than anywhere else in the world. America is the only nation on earth that has no price limits on drug prices. As a result, Americans pay far more for prescription drugs than the rest of the world. This means Americans are actually subsidizing the cost of drugs to the rest of the world, despite the fact that most prescription drugs are developed by U.S. biopharmaceutical companies.
The time has come for Americans to ask what they are getting for their healthcare dollar, where all of the money is going, and why costs are permitted to soar without any price controls or real competition.
It is time to ask why industry profits reach new records while clinical outcomes barely budge.
Americans must ask what kind of value they are getting for these excessive costs.
Where is the free market competition?
Where is the performance?
What is America’s healthcare benefit per dollar, and how does it compare to its peers?
For several years, healthcare costs have been rising disproportionately with respect to economic growth, and without a commensurate increase in quality.
Across the board, while quality is increasing at a per annum rate of 2.8%, total medical costs are rising by 8%. As a result, healthcare continues to consume more of the economy at the expense of other industries.
As data reveals, taxpayers already spend enough money for a universal healthcare system. After paying for 59.8% of total healthcare expenditures of $2.2 trillion, taxpayers fund more than $1.3 trillion in healthcare expenditures, or more than 10% of GDP – enough for universal healthcare. In return, Americans receive very little per healthcare dollar.
So where is all of this excess money going?
Much of it is wasted through excessive and unnecessary medical services; a good amount goes towards fraud and bureaucracy. The Congressional Budget Office estimates that $700 billion (nearly one-third of total health expenditures) is spent each year on treatments that have not been shown to improve patient care.
Additional waste can be found in administrative costs. U.S. healthcare system spends six times more per capita on administration than Western European nations. Surely, there is a great deal of room to improve cost efficiency.
And we certainly cannot forget one of the main sources of private healthcare revenues; fraud. According to conservative estimates, more than $60 billion is defrauded in Medicare each year alone. Several government and law enforcement agencies place healthcare fraud estimates as high as 10% of the total annual spending. Other experts have estimated Medicare fraud as high as $220 billion annually, accounting for half of annual Medicare expenditures.
The remainder of excessive healthcare costs goes to boost profits of the private healthcare system through excessive fees and administrative waste.
Why So Many Have Been Misled
America’s healthcare system is clearly the world’s most costly, but is by no means the best. In fact, it is the least accessible healthcare system in the developed world, and accounts for far more medical errors than any other healthcare system in the world. The high rate of medical errors and low accessibility are thought to account for a primary source of mediocre results.
Yet, many Americans continue to insist that they have the world’s best healthcare system, despite compelling evidence to the contrary. In support of these claims, many point to the large number of foreigners who come to America for medical treatment.
What they fail to realize is that foreigners often seek out U.S. hospitals for access to end-of-life procedures and the latest developmental therapies (many for rare conditions).
It is understandable that America has the most advanced therapies when you consider that its healthcare system is designed to spend, spend, and spend. That approach is often good for life-threatening and emergency treatments, but bad for the remainder of healthcare.
Having the best end-of-life medical care says very little about the quality of a healthcare system. In fact, it actually leads to lower quality because excessive spending creates inefficiency, which raises the cost of medical services for everyone. This prevents many from obtaining affordable access to medical care.
Without any doubt, America has the best trauma care and developmental therapies for diseases like leukemia and other relatively rare illnesses and procedures.
But your chances of contracting these diseases are miniscule compared to the likelihood of contracting the top five chronic diseases. According to the Centers for Disease Control, chronic disease is responsible for 70% of all deaths in the U.S. and 75% of all healthcare costs.
Thus, the entire population needs better access to preventative therapies and procedures so the onset and severity of chronic disease is delayed. And costs must not be prohibitive. Once healthcare strategy has been refocused along these lines, a tremendous amount of money will be saved while life expectancies improve. Medical efficiency will inherently increase access to medical services.
Washington must establish certain thresholds of basic medical care guaranteed to everyone. This would not necessarily be a system of universal care, but one of minimal care provided by a nation that calls itself the greatest on Earth.
Advocates of the status quo insist that the free markets offer the best and most efficient means of healthcare delivery. However, analysis of healthcare data indicates the opposite.
Overwhelmingly, studies have shown that patients in for-profit hospitals experience higher medical costs, higher morbidity and mortality when compared to patients in not-for-profit hospitals in the U.S. Much of the difference in cost is due to excessive administrative expenditures (sales, marketing, exorbitant executive compensation). But there are many other factors including massive waste and fraud.
Free market healthcare can only work with proper regulatory oversight which ensures competition, price transparency and harsh penalties for fraud.
If a free market solution cannot be devised that provides more medical coverage to Americans at a lower cost per capita, universal healthcare may become the only viable solution. Thus, it is in the best interests of the industry to unite with Washington to acknowledge these failures and move forward to help restructure the system.
The overlying focus of healthcare reform must be centered upon cost containment. After accounting for medical waste, inefficiency and fraud, up to 50% of total healthcare expenditures could be slashed with proper technologies that streamline medical bureaucracy and healthcare delivery, while aiding regulatory oversight and accountability.
In addition, America must invest in a healthcare platform that promotes disease prevention through healthy lifestyles and affordable medical access.
And Washington must hold providers to higher levels of accountability and price scrutiny. They must place limits on healthcare expenditures and tell the industry to make it work. Healthcare costs must ultimately be capped at no more than 11% of GDP, while access must be increased and quality improved. This should be the goal by 2019.
Once providers are told they are no longer able to raise prices as high as they want; once taxpayer fraud is punished with real prison time; once providers are held accountable; once the proper technologies are integrated, America’s healthcare industry will become an asset to the nation rather than a liability.
The media, Washington and the healthcare industry do not want Americans to learn the truth about healthcare much in the same manner they withhold the truth about many other things because they are members of a very corrupt and greedy mafia, with no regard for the people. They serve the interests of those who hand them money – corporations and wealthy individuals.
At nearly 500 pages, with 150,000 words, this book also contains nearly 200 figures, tables and charts and over 800 references.
I will guarantee you it is the most comprehensive book on healthcare on the market.
Here is an expanded table of contents of America’s Healthcare Solution
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