We spend Far More, but Our Health Care is Falling Behind

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the San Francisco Chronicle

We spend Far More, but Our Health Care is Falling Behind

Victoria Colliver

Filmmaker Michael Moore might be onto something in his new documentary, "Sicko." These days, fewer Americans are buying the claim that the United States has the best medical system in the world.

With polls showing that health care is Americans' top domestic concern, politicians are scrambling to propose reforms. Consumers are buying lower-cost online drugs from foreign sources, and some even become "medical tourists" to obtain affordable treatment in other countries. 0710 03

Studies show Americans aren't healthier, nor are they living longer than people in industrialized nations that spend half per capita of what we do on care.

For example, a 2007 Commonwealth Fund study that compared the United States with five other nations -- Australia, Canada, Germany, New Zealand and the United Kingdom -- ranked the U.S. health system last. The study looked at access to health care, efficiency, equity and healthy living, among other measures.

And a 2000 report by the World Health Organization, the most recent available from the U.N. organization, put the United States 37th out of 190 nations in health care services -- between Costa Rica and Slovenia. France was rated No. 1, the United Kingdom in the 18th spot, Canada at No. 30 and Cuba a couple of notches behind the United States in the 39th spot.

In a New York Times/CBS poll conducted in March, health care ranked as the top domestic concern. And in "Sicko," Moore highlights Americans' disillusionment with their health care system, comparing it to systems in other countries, including France, Canada, Britain and Cuba.

Many health experts say Moore might be glorifying other systems -- particularly the once in France. Still, they accept his argument that other nations are doing a better job than the United States in providing coverage for all residents and making sure people have access to primary care and preventive services.

The United States has a private system for all but the poor and elderly. The countries lauded in "Sicko" have national systems funded primarily through the government.

"We, unlike any other country, have 46 million people who are uninsured, and that raises a whole host of health and financial issues," said Ken Thorpe, professor of health policy at Emory University.

Those issues are undermining the health of Americans, several studies have shown. While the United States may have cutting-edge medical technologies, many people lack access to such advanced care, limiting any positive health impact.

"Ours is really is a sick-care system. We have tremendous technical capabilities to deal with people with serious illness," Thorpe said. He argues, though, that it is far more cost-effective to prevent people from getting sick or at least catch illnesses early through better monitoring.

Karen Davis, president of the Commonwealth Fund, a nonprofit foundation that supports health care research, said many of the problems associated with poor primary care can be traced to the fragmented structure of our health care system. U.S. patients often have trouble seeing the same doctor on short notice, see multiple doctors who sometimes fail to communicate with one another and forgo care because they don't want to spend the money.

"We tend to have more medical errors than other countries, in part because of this highly specialized, fragmented system," she said. "More things can go wrong and do go wrong."

Moore's film has been criticized for showing the positive side of health systems in other countries while glossing over negative aspects.

"There's almost only positive attributes about the British, the French and Cuban system. Invariably, no system is perfect. I think this sort of detracts from his credibility on these comparisons," said Stephen Zuckerman, health economist with the Urban Institute in Washington, D.C.

Moore ignores the fact that private coverage still exists in most countries with nationalized health care. And he avoids showing solutions other than adoption of a government-funded system, often known as single-payer.

"He's trying to be entertaining. But if the objective here is to kick off a serious study about the British and Cuba as an alternative to the U.S. system, you need a lot more than what was presented in 'Sicko,' " Zuckerman said.

In "Sicko," Moore addresses one of the biggest criticisms of the Canadian system -- long wait times for care -- by asking patients in an Ontario emergency room how long they had to wait. All respond that they got treated quickly.

But the Commonwealth Fund report found that both U.S. and Canadian patients were more likely to wait six days or more for an appointment. Waiting times for specialists or elective surgery were shortest in the United States and Germany. U.S. patients were less likely than Canadians to have to wait more than four hours in an emergency room, the report found.

Moore also implies that care in Canada, Britain and France is virtually free. He dismisses claims that the French are overtaxed by showing the comfortable life of a French couple who even have money left over to travel.

But la vie francaise isn't entirely en rose. The country has a high unemployment rate of 9 percent along with high taxes. In France, taxes amount to more than 44 percent of gross domestic product, compared with 26 percent in the United States, according to the Organization for Economic Cooperation and Development.

Still, the United States spends a higher percentage of its gross domestic product on health than any other country -- more than 16 percent compared to France's 10.7 percent. The United States spends $6,102 per person in public and private funds compared with $3,159 per capita spending in France.

Americans living in France generally praise the French system.

Roderick Beck, a former New Yorker who moved to Paris this spring, said the profit motive that drives insurance companies as well as physicians is the central problem with the U.S. health system.

"What are those insurance companies doing at the most fundamental level? Collecting cash and paying out benefits," said Beck, 45, who works for a telecommunications firm. "Governments using taxation and a simple health care card do that more efficiently than an insurance based system."

Bruce Gain, 41, a U.S. journalist living in France since 2003, said the French system is better because the government strictly controls prices and the number of doctors per capita is much higher than the United States.

"As far as access to medial technology goes, there are more doctors here to offer the latest treatments and drugs at affordable costs," Gain said.

Davis, of the Commonwealth Fund, said the United States does not need to adopt nationalized health care to improve efficiency. For example, she said, the Netherlands has a well-developed system for after-hours primary care that would reduce emergency room visits.

"There's a lot we can learn from other countries," she said.
Unhealthy comparisons

The World Health Organization in 2000 ranked the United States 37th out of 191 countries in health care services.

U.S. life expectancy is nearly three years shorter on average than Canadians' and about two years less than that of the French.

The United States spent more than $6,000 per person on health care in 2004, about double what France, Germany and Canada spent per capita.

Sources: World Health Organization, United Nations, Organization for Economic Cooperation and Development

© 2007 Hearst Communications Inc.

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