SMOKINCHOICES (and other musings)

January 31, 2013

18 mo IOM study > USA low rank

Land of the free, home of the unhealthy

  (Comment to follow:)

 By Robert J. Samuelson

It turns out that being American is bad for your health, relatively speaking. Anyone interested in health care ought to digest the findings of a massive new report from the National Research Council and the Institute of Medicine, which compared Americans’ health with that of people in other advanced countries. After spending 18 months examining statistics and studies, the panel reached a damning conclusion: The United States ranks below most advanced countries.

Consider: Life expectancy at birth is 78.2 years in the United States, lower than the 79.5 year-average for the wealthy countries belonging to the Organization for Economic Cooperation and Development; Japan’s life expectancy is 83. Among 17 advanced countries, the United States has the highest level of diabetes. For 21 diseases, American death rates were higher in 15 (including heart and lung diseases) than the average for these same countries.

Here, in somewhat clunky language, is the report’s sobering summary:

  • “The U.S. health disadvantage is more pronounced among socioeconomically disadvantaged groups, but even advantaged Americans described as ‘white, insured, college-educated’ appear to fare worse than their counterparts in England and some other countries.”

What to make of this?

  • The report’s most important contribution is to show that much of the U.S. “health disadvantage” doesn’t reflect an inadequate health-care system but lifestyle choices, personal behaviors and social pathologies. The gap in life expectancy is concentrated in Americans under 50. Among men, nearly 60 percent of the gap results from more homicides (often gun-related), car accidents (often alcohol-related) and other accidents (often drug-related) than in comparable nations. For children under 5, car accidents, drowning and fire are the largest causes of death.

Teen pregnancy is another big problem. Among girls 15 to 19, the pregnancy rate is about 3.5 times the average of other advanced societies.

The health-care system can’t cure these ills, which are social problems with health consequences. Those who expect the introduction of the main elements of the Affordable Care Act (“ Obamacare”) in 2014 to improve Americans’ health dramatically are likely to be disappointed. The lack of insurance is a problem, but it is not the main health problem, in part because the uninsured already receive much uncompensated care.

  • To be fair: Some of these social problems show progress. America’s slippage is mostly relative to better outcomes elsewhere. Since 1980, the U.S. murder rate has dropped by roughly half (but remains higher than in many peer countries); traffic deaths per miles traveled have fallen by more than half since 1975 (though decreases abroad are greater); teen birth rates have fallen to a seven-decade low (but are higher than in most wealthy nations); and U.S. life expectancy is rising (but more slowly than elsewhere).

Nor does the new report exonerate the U.S. health-care system from blame for the “health disadvantage.” Despite enormous spending, the system is “deeply fragmented across thousands of health systems and payers … creating inefficiencies and coordination problems.”

Much specialized care is high quality; recovery rates for hospitalized U.S. stroke and heart attack victims are higher than in many wealthy nations. Cancer treatment is superior. But primary care is weak. Only 12 percent of U.S. doctors are general practitioners compared with 18 percent in Germany, 30 percent in Britain and 49 percent in France. One study found Americans “receive only 50 percent of recommended” treatments.

The report’s authors searched in vain for an overarching explanation for the peculiar determinants of Americans’ health. But it missed the most obvious possibility: This is America. The late sociologist Seymour Martin Lipset argued that American “exceptionalism” is a “double-edged sword.” Values we admire also inspire behaviors we deplore.

  • The love of freedom and disdain for authority may encourage teen pregnancy and bad diets. The competitive nature of society may spawn stress that hurts the health of even the well-to-do. The suspicion of concentrated power may foster a fragmented delivery system. Commendable ambitiousness may push doctors toward specialization with its higher income and status.

Ever optimistic, Americans deny conflicts and choices. We excel at self-delusion. Asked by pollsters to rate their own health, Americans say — despite much contrary evidence — that they’re in better shape than almost anyone. We think we’re No. 1 even if we aren’t.

Robert J. Samuelson writes for the Washington Post Writers Group.

(Jan’s comment:

While I quite agree with a number of the conclusions cited above, I do take issue with a few of them.  Most glaringly, that Cancer treatment is superior, for surely, it is not.  There are far too many Health professionals who once finding that they are themselves now facing this prognosis, reject standard treatment and simply opt for time with family and then hospice.  There are other options, with better chances for survival and none of the harmful side-effects or scars.  I, along with a growing population remain opposed to the toxic, painful allopathic standard treatment which is harmful to the body as it kills off healthy tissue with the diseased,  and is harmful to the body’s own immune system which is needed for a full and complete recovery.  

It would be wrong to fault the healthcare system en masse (tho, I do because it is run from the profit motivation rather than as it was intended, as an instrument of healing and teaching in service to those in need, lifting physical burdens of pain, hurt and disease).  Instead, this study has ascribed the responsibility (loosely) at the feet of the suffering masses  because of their life-style choices, behavioral tendencies and social pathology which is loosely interpreted (by me) as a reactionary public.   Can we look at some of these burgeoning masses to see what they have going for them?  

So many of them are being raised by sitters, nannies or TV’s,  rife with Wall Street and Madison Avenue messaging of what to dream for and want.  This is possible?  Yeah, sure – - there is seldom adequate parenting in the home to care for these kids because they are just trying to make rent and buy some food.  So the normal inculcating of ‘family values’ and training – - their NEEDS have mostly never been met.    The parents working at low wages, dawn to dusk with nothing to show for it, let alone plans or hopes for their young simply don’t include an education which could or would have lifted these offspring into possible if not optimal expectations. 

Many grow-up  while observing life kinda like a crap- shoot, depending on ones color and neighborhood,  with friends shot dead or done in by gangs (part of them or not).   Yet, quite independent of the neighborhood or color,  1 in 10 of our children have some sort of disability in a broad spectrum from ADD to flat out Autism, disabled by the “cradle to the grave” medical care by means of literally hundreds of  ‘protective’ inoculations.   

The laws of our land have failed a large majority of us and it just might get a lot worse before it gets better.  Everything from the penal code to the Highest court.    People are hearing “all is broken” – can’t fix it.  Gets very discouraging.  

As to the ethics. . . . just look at the landscape;  pretty bleak.  Too few cops, scant protective services watching out for those kids. So many broken families,  and its looking like nobody cares.    Not really. 

Then we have those protectors and law-makers from coaches in our sports, counselors, cops,  congressmen, teachers, Priests and Ministers to Justices all moving to their own private drum beat.  They have their own agenda and it isn’t in sync with the “common good”.  For at least a generation . . . it’s become what ‘I want, what I need.’  As a society, we can’t get there from here.   Its so much bigger than how healthy our bodies are. . . what is our species doing to itself?  

We are  all connected, but you’d never know it from how fearful people are.   How hopeless many lives are. . .how lonely. We all need each other but don’t see the walls we’ve put up for our protection. . .but we aren’t safe – - that’s isolation!  For a nation regarding itself as religious and based on the so-called religion of our fathers,  we don’t appear to have a clue about love, respect, truth, honor, or striving for excellence and trying to be the best we can be.

As to the Medical care – I do agree  strongly with the need for more general practitioners rather  than the emphasis on specialization.   When the sick go to a doctor, he wants help and or to be fixed, made well,  not a referral to yet another doctor, specialist or otherwise, plus the additional cost which most can’t afford. The mercenary way it is practiced now reflects just what it is, a disgraceful “for profit business,”  not a calling to serve his fellow man.  

I also agree that the American system is deeply fragmented which would have and still could be solved with the single- payer system which would better serve our multitudes – - and far more efficiently and markedly cheaper.  That would not preclude those who wish to avail themselves of particular or different medical services from doing so if they are so inclined.        

American exceptionalism  is a reality, and again, I agree!   But I don’t fault this attribute – it’s the way we are.  Point instead to the social, legal and political systems which collectively seem to have lost their way  “off the mark” of the “Golden Rule”   and for the “Common Good.”   My last point of departure regards the “LOVE OF FREEDOM.”  This does not designate disdain for authority, and can in fact, respect it.  But that is not to say that one will acquiesce to often- seen bottom-of-the-deck dealing.    Sorry, but that is not to be tolerated.  . . .off with their heads . . .  Jan)

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