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Maybe Now Americans Will Finally Get Affordable Care!

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I'm immensely relieved by the U.S. Supreme Court's decision to uphold key provisions of the Affordable Care Act, as reported here. The ruling represents a crucial step toward fixing my country's dysfunctional health care system. Anyone who denies or doubts that our system is broken should be aware of two profoundly important facts.

First fact: The U.S. spends much more on health care per capita than any other nation on earth. We spent $7,164 per person in 2008, according to the World Health Organization (via Wikipedia). That is over $1,000 more per person than the number two and three-ranked countries, the super-wealthy kingdoms Monaco and Luxembourg, and almost $2,000 more than the fourth highest-spending nation, Norway, which enjoys enormous oil revenues.

We spend almost twice as much per capita as Germany, Canada, France, Sweden and Australia, and more than twice as much as England, Greece, Spain, Italy, Japan and New Zealand. So what are we getting for all our money? Are we getting better health care than all these other countries?

This question brings me to my second profoundly important fact: The U.S. does not rank first in the most basic measure of health, life expectancy. It ranks 38th, behind every other country I've mentioned above, according to the United Nations (again via Wikipedia). We rank in life expectancy just below Cuba, which spends $495 per capita on health care, well under 10 percent of what we spend. In other words, Michael Moore's 2007 documentary film Sicko, which unfavorably compared U.S. medicine to that of Cuba (and Canada, England and France) was not just lefty agitprop; it was based on hard, cold facts.

The Affordable Care Act should help us get better care for less money, first of all by providing lower-cost care to tens of million of uninsured Americans who often ended up getting costly emergency treatment. I'm hoping that the act will also help promote several other health-care reforms, which I wrote about last November.

One would be to move American medicine away from the so-called "fee for service" model, under which doctors are compensated for the quantity rather than quality of their care. An alternative, which has demonstrated its ability to deliver better care at lower cost, gives doctors a flat salary with bonuses for improved patient outcomes.

We also need to reform malpractice laws so that doctors don’t prescribe tests and treatments simply to avoid lawsuits. Finally, the government should provide better evaluations of the efficacy of all medical tests and treatments, so doctors don't prescribe—and, equally important, patients don't demand—unnecessary and even harmful procedures, such as the PSA test for prostate cancer. With all these changes, perhaps the U.S. will start getting truly affordable care.

Photo courtesy Wikimedia Commons.

Addendum: A commenter, Postman1, has repeated the tired old canard that Brits and Canadians, who have socialized medicine, envy U.S. medicine. I responded with a comment, but I thought I'd add a comment on this important issue here. Recent surveys suggest that people in Canada, UK and other nations with socialized medicine are more satisfied with their health care than Americans. If you don't believe a lefty like me, check out the piece from Fox News.

http://www.webmd.com/healthy-aging/news/20041029/us-health-care-satisfaction-trails-others

http://scienceblogs.com/denialism/2009/05/22/are-patients-in-universal-heal/

http://www.foxnews.com/story/0,2933,136990,00.html

The views expressed are those of the author and are not necessarily those of Scientific American.

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