James K. Johnston (letters, July 4) writes a defense of current U.S. health care. While some facts he cites are correct, he ignores larger ones. (1) We have the best medical care in the world even without universal access. The indisputable fact, however, is that though we spend nearly 17 percent of GNP on health care while the best other systems spend 9 to 11 percent. We have shorter longevity, higher infant mortality, and fare worse on many other health outcomes. We do not even have a very good record in treating particular diseases. As measured by five-year survival rates, among the U.S., Canada, Australia, Britain, and New Zealand, we rank fourth in treating colorectal cancer. Non-Hodgkins lymphoma? Third. Kidney transplant? Fifth. Among major diseases, only for breast cancer do we rank first in effectiveness of treatment. And if France, Germany, and the Netherlands are included (arguably the best health systems in the world) the U.S. comes out even worse. Even on elementary things like hospital infection and re-admission rates, we rank poorly.
(2) Johnston says that here people are not deprived of medical care. They are just covered by different systems (employer based, Medicare, Medicaid, V.A., etc.). Indeed, Americans have a variety of insurers, but that hardly stamps out the fact that 45 million do not have any insurance. And yes, hospitals are legally required to treat everyone for emergency care, but that does not cover ongoing treatment of more chronic conditions. Consequently, nearly two-thirds of personal bankruptcies stem from medical debts. And once you have an illness or chronic condition and you lose your employment or wish to work self-employed, just try to get insurance at a remotely affordable rate.
(3) Historically, nationalized health-care systems have been abysmal failures. Mr. Johnston cites Canada and England. That ignores the survival rates above, along with many other studies, including ones showing Canadians and Brits to be much more satisfied with their health care than we are. Moreover, the best other systems are generally not Canada and Britain but France, Germany, and Netherlands. Opponents of reform never mention them. One failure Johnston cites is denial of high-cost drugs and general rationing. But choice of doctor and hospital is more unfettered in all these other countries than it is in the U.S. with our many preferred provider plans. As to rationing and wait lists, the proper question is how severe or long they are. The U.S. wastes billions of dollars on arthroscopic knee surgery for arthritis and spinal fusion for back pain, for example, when clinical studies have shown those to be typically ineffective. Other countries, acting on such studies, ration out much of that care, and we should, too.
Moreover, never do reform opponents mention in their warnings about rationing and wait lists that other countries spend little more than half what we do. Surely, if we spent up to four-fifths, say, of what we currently spend, we could run their systems without any rationing or wait lists. And still walk all the way to the bank with 20 percent savings from reducing the inefficient paperwork and advertising involved in our multiplicity of private, for-profit plans.
For some treatments and conditions, yes, we have the best medical care. For others, hardly. And many of our people do not have access to what we do do well.
Paul Menzel
Coupeville
