If the two area congressmen who held town hall meetings last week — Democrats Frank Pallone and Rush Holt — came away with anything, it was that the current versions of the House bills have left many people with grave doubts about whether they will make things better rather than worse.
One's attitude toward reform depends in large measure on one's perception of whether it is needed. Many of those who turned out at the forums — the majority appeared to oppose the House bills — insist the United States offers the best health care in the world. Given how fundamental that question is to the whole health care debate, it's essential that it be explored in far greater depth in public discussions.
Few would argue that the United States doesn't have some of the best hospitals, specialists and technology in the world. Most people like their doctors. Most people who have never had to battle their health insurers or hospitals over bills or coverages find little fault with them.
But a 2000 World Health Organization study of health care in 191 countries ranked the United States 37th, behind most advanced Western democracies. A 2007 Commonwealth Fund study comparing health care in the U.S., Australia, Canada, Germany, New Zealand and Great Britain ranked us last or next to last on most measures of performance, including quality of care and access to it.
A 2008 mortality study in the journal Health Affairs found the U.S. had the highest rate of deaths among 19 countries from conditions that could have been prevented or treated successfully. The Urban Institute released a study this month that found the U.S. performed better than other advanced nations in some areas and worse than in others. The study noted that only 45 percent of Americans thought the U.S. had the world's best health care.
The American system does some things well, and others not so well. We are the only advanced nation in the world without universal coverage. Access to care and the quality of care are far more uneven than in western Europe and some Asian nations. We have high rates of infant mortality, rank near the bottom of industrialized nations in healthy life expectancy at age 60, fare poorly in coordinating the care of the chronically ill and have a higher incidence of fatal surgical and medical mistakes.
The debate needs to get beyond the fear-mongering and the belief that to look to European models for answers moves us toward socialized medicine. That is patent nonsense. There are nearly as many different models in Europe as there are countries, and many of those nations — Germany, France, Italy, to name a few — have features worth emulating. And almost all of them are built around private insurers.
Our health care system is broken. The reforms on the table today don't go far enough to repair the damage. And given the tenor in Washington and the belief that more compromises to what's on the table now will be needed to get any bill passed, it's likely any reforms will be weak medicine at best.
Citizens need to do their homework. They need to take a hard look at our system, compare it with others and insist our politicians come up with a patient-centered model rooted in improved access and care, reduced bureaucracy and transparency in billing and health outcomes. The system should build on what we do well and borrow from what others do better.
