WASHINGTON - As Congress presses forward with
landmark legislation to revamp the nation's health-care system,
lawmakers are grappling with a troubling question:
Americans dying too soon? The answer is yes. When it comes to
"preventable deaths" - an array of illnesses and injuries that should
not kill at an early age - the United States trails other
industrialized nations and has been falling further behind over the
Although the United States
now spends $2.4 trillion a year on medical care - vastly more per
capita than comparable countries - the nation ranks near the bottom on
premature deaths caused by illnesses such as diabetes, epilepsy,
stroke, influenza, ulcers and pneumonia, according to research by the
nonpartisan Commonwealth Fund published in the journal Health Affairs.
last week's marathon health-care debate in the Senate Finance
Committee, Sen. Kent Conrad (D-N.D.) bemoaned the findings.
of these countries have much lower costs than we do," he said, pointing
to a giant blue chart showing the United States in last place. "And
they have higher quality outcomes than ours."
Some lawmakers theorized that the rate could be related to trauma from guns and automobiles.
gun and auto fatality rates are higher here than they are in most
wealthy nations, the statistics underscore more complex, fundamental
challenges, say physicians, economists and other experts who track
health-care systems across the world.
illnesses are a much bigger driver of health-care costs" than trauma
cases such as vehicle crashes and gunshots, said Robert Shesser, head
of emergency medicine at George Washington University. "Because of our
wacky system, some people are bankrupted or avoiding care and some are
getting too much care - they're hogging care."
performance of the U.S. system is a mix, at best, said Mark Pearson,
head of the health division at the Organization for Economic
Cooperation and Development, which analyzes data from dozens of
"Where it's good, it's very,
very good, and where it's bad, it's horrid," he said. The United
States, for example, is the international leader in the detection and
treatment of most cancers, he said. Americans have earlier access to
new medicine and technology, sometimes while the clinical trial is
still under way. Europe, by waiting, often has more information on new
For people with insurance,
"America delivers care in a timely manner," Pearson noted. That stands
in contrast to the situation his own family faces in England, where
relatives have waited weeks for tests or elective procedures.
as many as 80 million Americans are uninsured or underinsured, which
means they have little access to a regular physician, checkups,
preventive services, affordable prescription drugs, dental care or
tracking preventable deaths, researchers count deaths from illnesses or
injuries that either need not happen at all or for which there are
therapies proven to keep someone alive to a certain age. Young children
dying of measles is preventable in developed countries, for instance.
Fatal cases of skin cancer, epilepsy, hernia and surgical complications
should not occur before age 70 and are thus deemed preventable.
are conditions where early care and the right care should be able to
prevent an early death," said Cathy Schoen, a senior vice president at
the nonpartisan Commonwealth Fund. "We shouldn't see people dying of
diabetes before age 50."
more complicated cancers, AIDS and most heart disease, while often
treatable, are not considered preventable, because even with the best
of modern medicine, patients often die before old age.
1997-1998, the United States ranked 15th in preventable deaths out of
19 industrialized countries. In 2002-2003, the nation fell to 19th,
even as costs continued to rise. Up to 100,000 lives could be saved if
the country's health-care system performed as well those in nations
such as France, Japan and Australia, according to the Commonwealth Fund
study, which was based on World Health Organization statistics.
preventable deaths can illuminate strengths and weaknesses in a
health-care system, Schoen said. Nations that dramatically lowered
their preventable-death rates focused on challenges such as controlling
diabetes and reducing hospital-acquired infections, she said.
Looking at the results, Pearson concluded: "The U.S. doesn't take primary care very seriously."
terms of spending, the United States devotes about 16 percent of the
total economy to health care, more than seven percentage points higher
than the average of OECD countries. The average American consumed
$7,290 worth of medical services in 2007, compared with an average of
just under $3,000 in the remaining nations when adjusted for price
differences, Pearson said.
money went to higher physician salaries, larger administrative fees and
higher prices for most medical services. Americans also have higher
utilization rates of prescription medicines, sophisticated technology
such as imaging and surgical procedures such as cataract surgery, knee
replacements and Caesarean sections, according to the OECD analysis.
Conrad, one of the key Senate health-care negotiators, the
international comparisons suggest following the lead of nations such as
Germany, France and Japan that achieve universal coverage through a
blend of private employer-based insurance and nonprofit cooperatives,
with a significant governmental role.
models most efficiently expand coverage, control costs and provide
high-quality care," Conrad said. "You look around the world, and it
just jumps out at you."