"Fact and Fiction: Debunking Myths in the US Healthcare System "

Fact and Fiction: Debunking Myths in the US Healthcare System
Umut Sarpel, MD; Bruce C. Vladeck, PhD; Celia M. Divino, MD; Paul E. Klotman, MD

Published: 06/06/2008
Abstract and Introduction
Abstract

... There are many myths commonly held true by both patients and physicians. This inscrutability of the US healthcare system may be the major deterrent to its improvement. A discussion of these myths can lead to increased awareness of the inequality of our healthcare system and the possibilities for improvement.

Introduction

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The goal of this article was to give physicians the groundwork to launch conversations about the US healthcare system. The format for this discussion has been adopted from Dr. Robert Lebow's Health Care Meltdown: Confronting the Myths and Fixing Our Failing System. (1) Lebow identified many myths that are commonly held by both patients and physicians; for this discussion we have focused on 5 common misconceptions. The following myths are not intended to be an all-inclusive list of the woes of our healthcare system. However, they represent key and common misperceptions that are stumbling blocks on the path to improvement.

Myth 1: The US Healthcare System Is the Best in the World

This idea has been called the alpha myth because it is fundamentally the root of all other myths.(1) It is the straightforward belief that Americans have access to the highest quality healthcare available in the world. A different way to present this myth is to state that citizens in other countries experience long waits for healthcare, that they must rely on generalists, and that they suffer worse outcomes as a result. This belief is widespread and well-entrenched in the American mindset. So it is perhaps surprising that in a 10-nation 1990 survey on the level of satisfaction with the national healthcare system, the United States ranked 10th.(2) These results were then reproduced a decade later.(3) Although Americans believe the US system is the best, clearly they are not as satisfied with the healthcare they receive as are citizens of other countries.

In fact, this disparity between perception and reality has been captured in several studies. In the year 2000, the World Health Organization (WHO) dedicated its annual World Health Report to a comparison of healthcare across the globe.(4) In this exhaustive analysis, American superiority was not borne out: the United States ranked 32nd for infant survival, 24th for life expectancy, and 54th for fairness. ... The current US system is known as a regressive system; that is, the poor pay relatively more for healthcare. In fact, the poorest fifth of Americans spend 18% of their income on healthcare, whereas the richest fifth of Americans spend about 3%.(5) In this type of regressive system, it is clear why about 50% of personal bankruptcies in the United States are related to medical bills.(6) Tragically, 75% of individuals declaring medical bankruptcy had medical insurance at the onset of their illness.(6) Overall, the WHO ranked the United States 37th in the world.

Similar results were found by the Commonwealth Fund in a recently released scorecard on the performance of the US health system.(7) Outcomes in the United States were compared against those achieved by top countries or the top 10% of US states, hospitals, or other providers. The scorecard evaluated multiple indicators of health outcomes, including mortality, life expectancy, and the prevalence of health conditions that limit the capacity of adults to work or children to learn. The average ratio score for the United States was a 69 out of a possible 100.(7) The United States ranked 15th out of 19 countries with respect to preventable deaths before the age of 75, with a death rate more than 40% higher than the benchmark countries of France, Japan, and Spain. The United States ranked last in infant mortality out of 23 industrialized countries, with rates more than double the benchmark countries of Iceland, Japan, and Finland. The United States tied for last on healthy life expectancy at age 60.(7)

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Myth 2: There Will Always Be a Certain Segment of the Population that Remains Uninsured

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Myth 3: The Uninsured Have Equal Access to Medical Care Through the Emergency Room

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Myth 4: A Free Market Is the Best Way to Get the Highest Quality Health Insurance for the Lowest Cost

Competition for goods and services generates maximum quality for minimal price. Policy makers often refer to this tenet when defending the multipayer system that exists in the United States. However, a free market only works when the consumer can use buying power to influence the price and quality of goods. In the current healthcare system, insurance is usually purchased by third parties (ie, employers), not by the consumer directly. Also, healthcare is not a discretionary desire; patients cannot delay purchase until prices drop. As a result, the consumer is not in charge of directing the market and thus there is no feedback loop to increase quality or reduce cost. The current system is not a free-market but is instead a for-profit system driven by private insurance providers who are immune to the checks and balances associated with the free-market ideal. This system, which has been in place for decades, has led to increases in healthcare expenditures, poorer health outcomes, and less choice in providers.

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Finally, because of the special nature of healthcare, even a functional free market system would not result in high quality medical care for all its consumers. There is no incentive in a profit-driven market to attend to low-yield issues such as mental healthcare, preventive care, and chronic illnesses. ...

Myth 5: We Just Cannot Afford to Cover Everyone

This myth is founded on the belief that you have to pay more to get more; because the United States already spends too much on healthcare expenditures, the nation cannot afford to cover even more of its citizens. But clearly this logic cannot be entirely sound: every other industrialized nation in the world offers universal coverage, and all accomplish it with lower national health expenditures than the United States. Much of our nation's healthcare money is spent on costs that arise directly from a multipayer system with limited coverage. ...

On average, Americans pay more for the same medications than do patients in other countries.(44,45) This disparity has been defended by the assertion that the United States supports the world by developing more new pharmaceuticals, and therefore these research costs result in higher drug prices. This altruistic rationalization is unfounded: combined, the European nations produce on average the same number of new pharmaceuticals per year as the United States.(1) ...

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Conclusion

In the effort to ameliorate the problems with our healthcare system, recently several programs for reform have been launched...

In the end, these paths at reform suffer from the same fatal flaw: they leave in place the existence of a multipayer, for-profit system. It is this infrastructure that is the Achilles' heel of the United States healthcare system. The crux of effective reform is the development of a simple, streamlined system of universal coverage by a single-payer.

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The largest source of savings in reforming our system would come from cutting the administrative costs associated with multiple private insurance carriers. Competition between for-profit insurance companies drives cost-shifting and ever-increasing out-of-pocket payments for patients. ... Many experts believe that universal coverage would likely pay for itself by creating a more efficient system.

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Myths have the ability to perpetuate themselves in the absence of supporting evidence. The myths concerning the state of the US healthcare system need to be actively dispelled-quickly. ...

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