When I was growing up, there were quite a few things you couldn’t say on television. Any kind of profanity or sexually explicit language was forbidden. By contrast today, with the growth of cable TV, those limitations are virtually gone. The only restrictions we see now are in the form of political correctness.
There is, however, a doctor who claims there are three things related to health care that cannot be said on TV –– not because they are too explicit not because they are politically unacceptable, but because they are no longer true. In the May 16 issue of the Journal of the American Medical Association, Ezekiel J. Emanuel, MD, PhD wrote an article entitled, “What Cannot Be Said on Television About Health Care,” in which he listed three sentences that, once true, can no longer be said about the United States health care system. Those sentences are:
• “The United States has the best health care system in the world.”
• “Health care is special.”
• “New is better.”
“Best Health Care System in the World”
Although I still hear politicians make this claim, the statistics Dr. Emanuel presents indicate otherwise. We certainly have the most expensive health care system. U.S. health care costs in 2005 were more than $6,000 per person. Switzerland came in second with a per person cost of just over $4,000. Unfortunately the high price doesn’t translate into better health. The U.S. life expectancy of 78 years ranks 45th in the world, well behind Canada, Australia, Japan and most European countries––even behind Bosnia and Jordan. In addition to that, the infant mortality rate of 6.37 per 1,000 live births is higher than almost all other developed countries. So what is all of our money buying?
“Health Care is Special”
According to Dr. Emanuel, in decades past, health care was regarded as so special and important that patients were to receive whatever services they needed, regardless of cost. To decide quality of care based on cost would be a violation of the Hippocratic Oath and would put a price on a human life. But as the prices of pharmaceuticals and health care services grew, insurance premiums went up and services were cut. As a result, some patients today are forced to choose between medicine and food. Gone is the day that health care was considered to be so special that cost was irrelevant. Now health care is measured by the same standards as other goods and services––cost, quality, benefits and value. Just as people evaluate whether a new car is worth the cost, patients are beginning to weigh whether particular health care interventions are worth their cost. Sadly, we’re being forced to ask ourselves, “How much is my life worth?”
“New Is Better”
Americans by nature love new technology. Just watch the lines form when a new computer technology or a new electronic game goes on the market. We get especially excited when a new drug or other medical technology is developed. Doctors and patients alike have been quick to try new innovations––even using them for purposes not supported by published evidence. A good example of this is the fact that one out of every seven prescriptions is for off-label use of a medication (using the drug for a reason that has not been approved by the FDA). Despite our past enthusiasm, Americans are beginning to express skepticism about whether new medical technologies are necessarily better. Dr. Emanuel says he thinks the tipping point of this attitude change may have come with the withdrawal of Vioxx from the market. It’s becoming more and more common to see FDA alerts warning of newfound dangers associated with various drugs. Although Americans are still fascinated with new technology, when it comes to health care, many are adopting more of a wait-and-see attitude. We’re starting to ask, “Is new really better?”
What Happens Next?
Health care was once a sacred cow in the United States and doctors enjoyed a status second only to God. Today health care is just another commodity and doctors are often criticized as they struggle to help their patients while dealing with a growing number of insurance restrictions. These changes in attitude and language demonstrate that Americans are beginning to recognize and acknowledge that our health care system has some deep structural problems. Since acknowledging a problem is the first step to solving it, perhaps we’re on our way toward a solution. Dr. Emanuel says “The next step is for the public to see a solution that they think offers a realistic chance of making the system better.”
Where do you think solution will come from? I’d love to hear your thoughts. If you live outside the U.S., tell us about your country’s health care system and how it does or doesn’t work for you.
Published On: May 24, 2007