Top Ten Ways the American Health Care System Fails
March 15, 2014 |
Story at-a-glance
According to a new study, medical experts have
implemented 146 “reversals” in the past decade, meaning
course changes on specific medical practices; reversals
are common across all medical specialties
Between 40 and 78 percent of the testing, treatments and
procedures you receive today are of no benefit, and many
have already been deemed harmful by clinical studies
The US earned a failing grade on nearly every benchmark
in a survey comparing the opinions and experiences of
people from seven different countries about their
respective health care systems
America spends more on health care than the next 10
biggest spenders combined, yet ranks last in health and
mortality among 17 developed nations; we hold the top
rating in one category, however: medical waste
America’s health care system compares unfavorably in
coordination of care, prevention of chronic disease,
medical errors, accessibility and affordability, and
patients’ satisfaction with their doctors and care
By Dr. Mercola
From time to time, medical experts reverse course on certain
practices and procedures when science dictates a change in the
standard of care. One classic example of a "reversal" is when
hormone therapy for menopausal women came to a screeching halt
when so many women developed blood clots, stroke, and breast and
uterine cancers.
In an attempt to determine the overall effectiveness of our
medical care, the Mayo Clinic tracked the frequency of these
medical reversals over the past decade and published a report in
Mayo Clinic Proceedings, August 2013.1
The results are discussed by lead researcher Dr. Vinay Prasad
in the featured video. Prasad and his team found that reversals
are common across all classes of medical practice, and a
significant proportion of medical treatments offer no benefit at
all.
In fact, they found 146 reversals of previously established
practices, treatments and procedures over the past 10 years.
Many new medical treatments gain popularity over older standards
of care due to clever marketing more than solid science.
Conflicts of interest are rampant in medical research. Shiny
new medical treatments nearly always come with hefty price tags,
which helps drive up the already astronomical cost of health
care in this country. In addition to the end of routine hormone
therapy for menopausal women, you will probably recall the
following policy reversals over the past decade:2
Changing the schedule for women's
Pap tests and men's rectal exams, both of which used to
be yearly
Moving the starting age for women's yearly
mammograms from age 40 to 50
Use of COX-2 inhibitors such as Vioxx (a non-steroidal
antiinflammatory drug, or NSAID, that directly targets the
COX-2 enzyme;
Vioxx killed more than 60,000 people before being pulled
from the market in 2004)
More Than Half of All Medical Procedures Are of No Benefit and
Many Actually Cause Harm
The most telling data in the report show just how many common
medical treatments are not helping patients at all—or are
actually harming them. Of the studies that tested an existing
standard of care, 40 percent reversed the practice, compared to
only 38 percent reaffirming it. The remaining 22 percent were
inconclusive.
This means that between 40 and 78 percent of the medical
testing, treatments, and procedures you receive are of NO
benefit to you—or are actually harmful—as determined by clinical
studies. Prasad writes:3
"Reversal harms patients who undergo the contradicted
therapy during the years it was in favor and those patients
who undergo the therapy in the lag time before a change in
medical practice.
Most importantly, it creates a loss of faith in the
medical system by physicians and patients. The solution to
reversal is upfront, randomized clinical trials for new
clinical practices and a systematic method to evaluate
practices already in existence."
In an editorial, John P. A. Ioannidis, MD stresses the
importance of not only promoting effective medical practices,
but also disseminating knowledge about ineffective practices
that should be abandoned.
Many therapies continue long after they are deemed useless or
harmful, due to inertia in the system. He suggests using
incentives to urge physicians to begin testing the effectiveness
of common practices and calls for a renewed commitment to
rigorous clinical research.4
Top 10 Failures of the American Health Care System
In 2007, the Commonwealth Fund conducted a large survey
comparing the health care attitudes and experiences of people
across seven countries: Australia, New Zealand, the United
Kingdom, Germany, the Netherlands, Canada and the United States.5
The results are quite telling about how broken the American
health care system really is.6
Of the seven countries, Americans were the least likely
to report being "relatively satisfied" with their healthcare.
Let's take a look at 10 of the most significant findings of that
survey.
1. We Spend the Most Money on Health Care, But Get the Least in
Return
The US spends more on health care than the next 10 biggest
spenders combined: Japan, Germany, France, China, the U.K.,
Italy, Canada, Brazil, Spain, and Australia, yet the
US ranks last in health and mortality when compared with 17
other developed nations.
Sadly, 30 cents of every dollar spent on medical care in
America is wasted, which amounts to $750 billion annually. That
is the same amount the Department of Defense estimates we spent
on the ENTIRE Iraq War! This $750 billion of waste is made up of
inefficient delivery of care and excessive administrative costs,
unnecessary services, inflated prices, prevention failures,
and outright fraud. The largest defrauder of the federal
government is the pharmaceutical industry.7
Thirty-five percent of Americans have difficulty paying their
medical bills,8
and nearly two-thirds of all bankruptcies are linked to
inability to pay medical bills due to being uninsured or
underinsured. Medical impoverishment is nearly unheard of in
wealthy nations, other than the US, because all have some form
of national health insurance.9
By dissecting medical bills, Time Magazine writer
Steven Brill says we can see exactly how and why you are
overspending and where your money is going. Americans are being
grossly overcharged; even nonprofit hospitals are making greater
profits than some prosperous for-profit businesses. The entire
system unfairly affects the poor and uninsured as they are
charged the FULL inflated price, while those with coverage have
their costs radically reduced through pre-negotiated lowered
rates.
How much will you spend for a hospital stay? Certainly more
than you would pay for even the most extravagant vacation! The
average cost of a hospital say is $18,000, compared to $6,200
among OECD nations, according to this George Washington
University infographic.10
Things add up quickly when you're in an American hospital.
For example, a liter of normal saline rings up at $546.11
This one-liter bag of saline contains about nine grams of salt
(less than two teaspoons), which costs 44 cents to a dollar to
produce. But then the bag makes its way from the manufacturer
through a series of giant group-purchasing middlemen and
distributors before arriving at your hospital's pharmacy. Upon
arrival, that IV bag has a mystery formula applied to it, and a
price is magically determined, which is then recorded on your
hospital's "chargemaster." No one really understands how these
prices are calculated.
Only recently did the federal government release the prices
that hospitals charge for the 100 most common medical
procedures, revealing tremendous and seemingly random variation
in the costs of services.12
For example, if you need a hip replacement, you can spend $5,300
in Ada, Oklahoma, or you can fork over $223,000 for exactly the
same procedure in Monterrey Park, California. You can find out
how your state compares in average fees for service using an
interactive online chart created by the Washington Post.13
2. Our Chronic Disease Rates Are Extraordinarily High
Americans have the second highest rate of chronic disease of
the seven countries examined, with Australia being number one.
With all of the money we're spending, what are we missing? This
statistic reflects poor preventative care and lack of attention
to lifestyle habits, such as diet, exercise, stress, sleep, and
"electron
deficiency" (insufficient contact with the Earth).
The majority of Americans (adults and children) are becoming
insulin-resistant due to their junk food based diets, loaded
with
sugar, processed grains, and chemical additives. Insulin
dysfunction is putting many in a state of perpetual inflammation
and driving up the rates of chronic disease. Americans consume
nearly 4,000 calories per day on average—more than anyone else
in the world.14
Yet, they are malnourished because most of these calories are
from processed food, therefore devoid of nutrition.
3. Poor Coordination of Care
This issue is tied to the problem of waste. We drop the ball
when it comes to managing patient care, especially if you have a
complicated illness requiring multiple providers. As a result,
we have poor access to medical records, duplicate testing, gaps
in communication, confidentiality violations, and rushed and
fragmented health care. According to an infographic based on
data from multiple sources, created by Jonathan Govette:15
3 out of 10 lab tests are reordered because the results
can't be found
68 percent of specialists receive no information from
the primary care provider prior to the referral visit; 60 to
70 percent of referrals go unscheduled; and 25 percent of
appointments are missed
4. Most Americans Do Not Have a Primary Care Provider
One of the reasons Americans' health care is so poorly
managed is that they are least likely to have primary care
providers. There are 0.5 general physicians per 1,000 people in
the US, but the average among OECD nations is 1.23.16
Americans are also the most likely to say that their physician
doesn't know important information about their medical history,
which has dire implications for quality of care and increases
the likelihood of medical errors. And, speaking of errors...
5. Americans Are the Most Frequent Victims of Medical Errors
It can be argued that
medical errors are leading cause of death in the US—higher
than heart disease, higher than cancer. The latest review17
shows that about 1,000 people die EVERY DAY from hospital
mistakes alone. This equates to four jumbo jets' worth of
passengers every week, but the death toll is largely ignored.
Types of errors include inappropriate medical treatments,
hospital-acquired infections, unnecessary surgeries, adverse
drug reactions, operating on the wrong body part—or even on the
wrong patient! One in four hospital patients are harmed by
preventable medical mistakes in this country, and 800,000
people die every year as a result. Of those 800,000, 250,000 die
as a result of medication errors.
6. Fewer Americans Are Receiving Health Care
Americans do have shorter waits for non-elective surgeries,
compared with other developed nations. Only four percent of us
wait more than six months, which is considerably less than the
Canadians (14 percent) or Britons (15 percent). However, when
you consider how many Americans lack access to any health care
at all, the wait-time advantage disappears.
Nearly one-third of Americans are uninsured or underinsured.18
Twenty-five percent do not visit a doctor when they're sick, due
to the cost. Twenty-three percent can't fill their
prescriptions. This is far worse in America than in any of the
other countries surveyed. In Canada, only five percent skipped
care, and in the UK only three percent. As you know, I'm not a
fan of using the standard health care approach in every
situation. However, if you become acutely ill or injured, lack
of access to care can be devastating.
7. We Don't Pay Physicians in Proportion to Their Quality of
Care
Most other countries reward physicians for good care with
financial incentives. For example, in the UK, 95 percent of
physicians are paid, at least in part, according to the quality
of care they deliver. In Australia, it's 72 percent. The US
scores lower than anyone else, at 30 percent.
8. Our Health Care Is Inconvenient
Americans' access to after-hours services (early in the
morning, later in the evening, and on weekends and holidays) is
just mediocre. For access to evening hours, we lag behind
Australia, Canada, Germany, and New Zealand. A full 67 percent
of Americans—more than in any other country—say it's difficult
to get care on nights, weekends, or holidays without resorting
to the emergency room, where care is costlier and, if your
injury is not life threatening, inefficient and time consuming.
Only 30 percent of Americans report that they can access a
doctor on the very day they need one, as opposed to 41 percent
of Britons and 55 percent of Germans.
9. American Physicians Don't Listen to Their Patients
About 70 percent of Americans are satisfied with their
physician's "bedside manner," which is lower than the Canadians,
Australians, and New Zealanders. But we are five percent more
satisfied than the Britons, and well above the Germans or Dutch.
However, when you look at specifics, we compare less favorably.
Americans are less happy about how well their physicians explain
things to them, how long they spend with them, or how smoothly
their appointments go, with respect to things like coordinating
records and scheduling.
10. Most Americans Are Dissatisfied with the Current System
You've probably heard reports claiming that Britons and
Canadians are highly dissatisfied with their health care system,
but this survey proved that Americans have them beat by a
substantial margin. Americans were the least likely
of all seven countries to report relative satisfaction with
their health care system.
Only 16 percent of Americans report being happy, compared
with 26 percent in the UK and 42 percent in the Netherlands.
Thirty-four percent of Americans want a complete overhaul in the
health care system, whereas only 12 percent of Canadians and 15
percent of Britons say the same. So we pay the most for our
health care, but we have the lowest satisfaction ratings—even
lower than those who spend more time "waiting in line." Ezra
Klein of the Washington Post makes an excellent point:19
"There is no other area of American life where we
collectively accept such a bad deal. We spend more than any
other nation on our military, but our military is
unquestionably the mightiest in the world. We spend the most
on our universities, but our universities are the best on
the planet. But we spend the most on our health care—twice
as much as anyone else—and our health system is
mediocre-to-poor, with 47 million of us lacking the
insurance necessary to easily access it."
Affordable Health Care Act: Getting MORE of What Isn't Working
The US does not have a health care system; we have a
disease-management system dependent on expensive drugs and
invasive surgeries. It's a system with a mission to
maximize profits, as opposed to helping people maintain or
regain their health. The
Affordable Health Care Act is likely to make matters worse
rather than better, as the Act does not include any illness
prevention strategies. Nor does it contain any measures to rein
in out-of-control health care costs related to overcharges.
Instead it expands an already flawed model of "care" that is one
of the leading causes of both death and bankruptcy for
Americans.
Ronald Reagan hit it right on the nose when he said,
"Government doesn't solve problems—it subsidizes them."
Integrative medicine (IM) is a better alternative to the current
system, as it offers a combination of conventional medical
therapies and complementary or alternative therapies for which
there is some high-quality scientific evidence for safety and
effectiveness. The more you take responsibility for your own
health by nurturing your body, the less you will need to rely on
the "disease care" system that passes for health care in this
country.
Copyright 1997- 2014 Dr. Joseph Mercola. All Rights Reserved.