How good is American health care?

A study in the Journal of the Royal Society of medicine has assessed the effectiveness of health care in 19 western countries and come up with a simple ranking system: a measure of the the number of lives saved relative to expenditures proportional to the GDP. One parameter, called the GDPHE, or GDP Health Expenditure was a measure of how much money the country was sinking into health care per citizen; by dividing this by the mortality rates, they got a measure of the effectiveness of the health care system.

This is a ranking system, and I have mostly a hyper-competitive American audience, so you all want to know whether you win or not, right? You want the data that shows that the US is #1! And here it is, the one result that shows us at the top of the ladder, our average health care as a function of GDP.

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Look at that: we don’t just win, we win big, leaving our closest competitor, Germany, in the dust. We spend 125% of the money Germany does per person. Does it feel good, America? We are tossing bigger buckets of money into health care than anyone else.

But now for the number that really matters, the GDPHE ratio. How many lives are we saving with all that money? Here’s the answer. Look at the last column, which is the ratio of money spent to lives saved.

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Oops. We’re…#17. We’re almost the worst — thanks, Portugal and Switzerland, for neglecting the medical needs of your citizenry more than we do.

Our health care is miserably inefficient, and we pour extravagant sums of cash into it, but you might ask whether it works at all. And the answer is a bit of good news, yes, it does. This study also compared death rates over time and came to the conclusion that, in the US, more than half a million people are alive today who would not have been with the medical care we offered 25 years ago. Medicine in the US is good, it’s just far more economically wasteful than it ought to be.

I’m still thinking I ought to retire to Ireland.

(Also on FtB)

Newage sewage flushed into the Atlantic

The Atlantic published a rather contemptible apologetic for alternative quackery titled “The Triumph of New-Age Medicine, which basically declared victory for the altie wackaloons. The way it did this was devious, and reminded me so much of creationist tactics. First, it declares that “mainstream medicine itself is failing”; it doesn’t really have any evidence of this, it just declares that modern medicine is built around the infectious disease model, and that it hasn’t solved all health problems. Familiar stuff, hey? If a science can’t explain every jot & tittle of every detail of every phenomenon, if there are still open questions and problems, why, it must be wrong!

Secondly, it portrays the altie quacks as nice, caring, sweet people who really, really care about their patients, and their ‘treatments’ as, at worst, totally harmless. Referring to one peddler of holistic care, the author says “Concerns of outright malpractice or naked hucksterism seem grossly misplaced when applied to a clinic like Berman’s.” Why? Because Berman is “gentle” and “upbeat” and has a pleasant demeanor. As everyone apparently knows, con artists must always be rude and pushy and arrogant and nasty and alienating. Oh, wait…no, they’re the opposite of that.

And then, thirdly, is the sly substitution. We’re finding that the best way to manage chronic illnesses like heart disease is with life-style changes that improve nutrition, physical condition, and overall well-being, and reduce the underlying causes. So what does this article do? It credits all that good common sense to the quacks who promote reiki and acupuncture and exotic herbs. You know what my traditional, mainstream, hidebound doctor of real world medicine first prescribed for me at those early signs of heart disease? Changes in diet and more exercise. She didn’t seem to think I needed homeopathic placebos in order to do something that would make a difference.

It was an infuriatingly dishonest article. Now Steven Salzberg, who was also quoted in it, has gotten a good rebuttal published in the Atlantic, and has also been interviewed on MPR on the subject.

I know that when I go to see a doctor, I want to see a commitment to figuring out what works. I am not at all impressed if they’re pushing fraudulent pseudoscientific BS into my treatment, no matter how sweet and smiley and sensitive they are. A good bedside manner is important, but it’s no substitute for incompetence.