Archive for January, 2013

Inspite of its Cheerleaders, the American Healthcare System is Crap

January 1, 2013 5 comments

As many of you know, the last 4 years have seen a lot of breathless talk about the effects of ‘ObamaCare’ (RomneyCare) on the future of the ‘best health care system’ in the world. This post, however, is not about my views on the supposed ‘perils’ of ‘socializing the medical system’. Instead I will focus on the myth that the USA has the ‘best health care system’ in the world.

Let us start by asking ourselves- What do people mean when they say that the USA has the ‘best health care system in the world’? What are the criteria for making that statement? What sort of data is used to support the statement? How do the ‘true believers’ in that worldview treat doubters and critics? Who do they blame when available data does not support their worldview?

In my opinion, non-proprietary measures of overall life expectancy are the most objective proxies for comparing multiple healthcare systems. Readers are welcome to suggest other “more realistic or logical” criteria for judging the effectiveness of a healthcare system. In any case, the USA lags behind all other developed countries by all commonly used measure of longevity (average life expectancy, median life expectancy, post-65 life expectancy)- often by more than 2 or 3 years.

There are those who blame the ‘high’ percentage of black people in the USA (10-13% ?) on its less than stellar performance on various measures of longevity. These morons want to believe that blacks are genetically ‘meant’ to die an earlier age. However the statistics from other affluent western countries with a worthwhile black population (especially of Caribbean descent) suggest otherwise. For example- Blacks of Caribbean descent in the UK live longer than indigenous whites matched by income and education. While they may suffer from a different mix of disease conditions, it is clear that blacks have no genetic predication to die earlier than whites. I should also point out that Hispanics who outnumber blacks in the USA are known to live even longer than measurably more affluent american whites.

Another series of ‘explanations’ for the dismal performance of the american healthcare system is based on the solipsistic belief that ‘all those other people are lying’ and ‘only we are telling the truth’. This takes the form of outright lies and a few half-truths about how those ‘other’ countries define and report statistics about live births, incidence of various diseases and causes of death. While explanations based on intentional fudging of statistical data by other countries would be believable if only a few countries consistently outperformed the USA on any measure of longevity- that is not the case. Every developed country and most moderately well-off countries routinely surpass the USA on almost all of those measures. Furthermore the differences in definitions of live births are too small to have any worthwhile (more than a 2-3 week) effect on various statistical measures of longevity.

I also find it hard to believe that white Americans are the most honest and objective people in the world’ for reasons that are only too obvious.

Then there are those who like you to believe that the cost of healthcare in the USA is higher because ‘We spend so much money on developing new drugs and technology to extend human life’. Apart from the bizarre hubris inherent in this line of defense, the statement is factually incorrect- at least as far as developing drugs or technology that actually cure diseases or extend human life.

Let us consider the facts. The biggest improvements in life expectancy are non-medical in nature. The provision of clean drinking water, safe and adequate amounts of food, proper sewage treatment and disposal, public health measures to contain infectious diseases, vaccines for some common and particularly deadly diseases caused the bulk of the increase in life expectancy during the last 150 odd years. We can also add the improvements in workplace safety, cleaner births and abandonment of older dangerous medical interventions (inorganic mercury, inorganic arsenic, lead based medicines and primitive surgery) to the list of non-medical interventions that improved life expectancy. Many western countries had already passed the 60 year mark for average life expectancy in the 1930s before the ‘drug’ or ‘technology’ revolution began in earnest.

Talking about drugs.. anti-microbial drugs, especially anti-bacterial drugs, are the most important class of drugs as far as extending human life expectancy is concerned. It is fair to say that they have extended human life expectancy by somewhere between 10 and 15 years. However almost all of them were introduced between 1930 and the mid-1960s. Moreover their discovery and development was usually heavily supported by government programs such as those run by the american government during and immediately after WW2. Pharma companies merely profited from the fruits of programs run and supported by the government- especially the american government.

Based on the returns for investment, the government support of discovery and development of anti-microbial (and anti-cancer) drugs during the first two decades after WW2 was among the most profitable use of taxpayer money- as far as the taxpayers are concerned. Which brings us to all those other wonderful drugs discovered between the mid-1930s and early-1990s. Contrary to what many of you think, the first of almost every single class of new drugs discovered in that era were discovered in European countries or labs of american companies based in European countries. I can provide you a fairly detailed list of this claim- if you are interested.

The sad truth is that the american research system (academic and industrial) has always been rather inadequate at producing truly innovative drugs. They are however very good at projecting the image of competence and innovation- something that greedy and mediocre minds excel. They are also pretty good at stealing credit for a discovery or developing a slightly better copycat version of an innovation.

But what about all that impressive looking technology which is much more visible in american hospitals. Doesn’t that count for anything? The short answer is that beyond a certain level- diagnostic and intervational technology do not improve global patient outcomes. While they may keep a slowly dying 90-something alive for a few weeks longer, the cost and bullshit associated with expensive technology based systems decreases the availability and quality of care for everyone else. More perversely, they often cause more harm by making questionable medical intervention profitable and more common. Many technologies for catching cancers in their early stages often encourage further diagnostic tests and treatments that do not improve overall life expectancy, while simultaneously causing adverse effects of their own.

It really comes down to the fundamental lie that underlies much of the problems seen in american society today- appearances matter more than reality. The appearance of education, the appearance of reputation, the appearance of action, the appearance of competence and the external appearance and trappings of technology and ‘science’ matter more than the reality.

What do you think? Comments?