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American health care is far from the best page 2
Michael Hiltzik: U.S. health care system the worst in the developed world

Date published: 7/3/2014

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That's because American standards call for annual or biannual mammography tests beginning at age 40, while British doctors perform them every three years beginning at age 50. So, American doctors will spot cancer at an earlier stage. But that has almost no measurable effect on a woman's likelihood of dying from breast cancer. That figure is about 24.5 per 100,000 population in Britain, 22.6 in the United States.

Numerous factors account for the difference, including the diagnostic pattern. But the American system is vastly more expensive and much more likely to throw up false positives. Plainly, it contributes to another glaring difference between the British and American systems: Britain spends $3,405 per capita on health care, the U.S. $8,500. (The figures are from 2011.)

For that money, the U.S. gets almost no commensurate advantage in overall health. In fact, the inferiority of the American health care system is pervasive, as the National Research Council and the Institute of Medicine documented last year in a comparison of the United States with 16 other high-income developed countries.

Americans have a shorter life expectancy than people in almost all those comparable countries. The difference has been growing and observable "for multiple diseases, biological and behavioral risk factors, and injuries." Among other factors not to be proud of, the United States has the highest infant mortality rate in the group.

The good news in the Commonwealth Fund report is that some of the factors driving the U.S. rank into the cellar are beginning to change, due in part to the Affordable Care Act and provisions of the post-2008 stimulus plan, which encouraged the adoption of health information technology by doctors and hospitals.

The Affordable Care Act, of course, has materially narrowed the gap between America's health care haves and have-nots. "With the enactment of health reform," the Commonwealth Fund says, "the United States should be able to make significant strides in improving the delivery, coordination and equity of the health care system in coming years."

That presupposes that the trends launched by the act continue. Some conservatives no doubt will be making a last stand, insisting to the end that America has "the best health care in the world," despite solid evidence that its outcomes are mediocre to poor--even for those lucky enough to have access to it.

Michael Hiltzik is a columnist for the Los Angeles Times.


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