A recently published article in the Lancet, a medical journal in the UK, documents the frequency of death worldwide from causes that are treatable. This death rate is known as “amenable mortality” and is a measure of how able a health care system is in consistently providing known effective medical and surgical interventions on a timely basis. The US, which outspends other first world nations 2:1 on health care, fails to provide world class care for lower respiratory infections, neonatal disorders, non-melanoma skin cancer, Hodgkin’s lymphoma, ischemic heart disease, hypertensive heart disease, diabetes, chronic kidney disease, and the adverse of effects of medical treatment. Dr. Christopher Murray, senior author of the Lancet article and Director of the Institute for Health Metrics and Evaluation at the University of Washington, stated: “America’s ranking is an embarrassment, especially considering the US spends more than $9000 per person on health care annually, more than any other country. Anyone with a stake in the current health care debate, including elected officials at the federal, state, and local levels, should take a look at where the US is falling short.”
The bottom line: The US does not have the best health care system in the world. Rather, we spend top dollar for a mediocre care system. Why? Because poor quality care costs more. If we really did have the best health care system in the world, we would be spending less on health care.
How can that be? Doesn’t top dollar payment get the buyer best quality in the market? Cheap consumer goods are always lower quality, right? That is a characteristic of free markets, as is the corollary that the higher the price for a product, the lower will be the demand. But health care delivery is not a free market, because health care itself is not a commodity. Demand for health care is not inversely related to price. No one buys an appendectomy because it is on sale. People buy appendectomies because they have appendicitis, a condition which a doctor identifies for them. Demand for health care is determined by epidemiology, or the frequency of disease and injury, not buy price. The higher the quality of a health care system, the better the system is at meeting the epidemiologic demand for health care service, the cheaper will be the overall cost of care.
In the US, because we pretend that healthcare is a market commodity, we would rather make a sale than actually care for our patients. Thus, we advertise medications directly to patients, as if a patient can really understand the indications for drug treatments and the long, rapidly read list of possible treatment complications. Demand for drug therapy is increased, sales are increased, but patients, who are often overmedicated, are poorly served. Providers of care receive better payment for highly intensive services, and are therefore incentivized to look for and treat cases of late stage disease, rather than pursue public policy that leads to early intervention and prevention. In the US, we overtreat endstage disease and overlook opportunities for early intervention, because making sales and profits are the driving motivators of American medicine.
Real health system reform begins with the premise that market forces do not make health care delivery more efficient. Real health system reform requires quality improvement and sharpens administrative efficiency. Anything else, whether it is called Obamacare or Trumpcare, is nothing but more market pretense and sloppy care which will increase the burden of amenable mortality.