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August 26th, 2009
11:23 AM ET

The Healthcare Hostage Crisis: Are we getting better care?

Editor's Note: This article continues our 8-part series excerpted from the "Healthcare Hostage Crisis" chapter of AC360° contributor David Gewirtz's upcoming book, How To Save Jobs, which will be available in October. To learn more about the book, follow David on Twitter at http://www.twitter.com/DavidGewirtz. Last week we looked at how much this all costs. This week, we'll start looking whether the extra money we spend is getting us better care.

David Gewirtz | BIO
AC360° Contributor
Editor-in-Chief, ZATZ Publishing

Since America spends far more on health care than any other country, it stands to reason we should be healthier here than people are anywhere else in the world. But are we? Is our health care system working so well, it's worth the vastly greater cost?

One way to answer that is to look at spending variations within the United States. The Geographic Variation in Health Care Spending report released in February 2008 by the Congressional Budget Office compared health care spending across the country. Here's what they concluded about the quality of more expensive health care:

Areas with higher-than-expected Medicare spending per beneficiary tend to score no better and, in some cases, score worse than other areas do on process-based measures of quality and on some measures of health outcomes.

Patterns of treatment in high-spending areas tend to be more intensive than in low-spending areas. That is, in high-spending areas a broader array of patients will receive costly treatments. Those treatment patterns appear to improve health outcomes for some types of patients, but worsen outcomes for others.

Another study, published in the April 2004 issue of the Health Affairs policy journal, reinforced the counter-intuitive observation that higher cost doesn't necessarily yield higher quality. Researchers Katherine Baicker and Amitabh Chandra found:

If spending per Medicare beneficiary increased by $1,000 in a state, there was an associated decrease in most measures of "good" medical practice, including, for example, the share of heart attack patients who were given aspirin (a 3.6 percentage point decrease) or offered advice about smoking cessation (6.8 percentage points) at discharge, the share of pneumonia patients who received antibiotics within 8 hours of arrival at the hospital (2.0 percentage points), and the share of diabetes patients whose blood sugar concentrations were evaluated (3.2 percentage points).

Three years later, in 2007, researcher Chandra paired up with Douglas Staiger. Their article, "Productivity Spillovers in Health Care: Evidence from the Treatment of Heart Attacks" in the Journal of Political Economy looked at how heart attacks were treated in high-spending areas vs. lower-spending areas.

Among heart attack patients, there are usually two approaches: a high-cost surgical treatment and a far lower-cost medical management treatment (diet, exercise, etc). According to Chandra and Staiger, if a patient that truly needed surgical intervention lived in a high-spending area, he or she would usually fare better.

But, if a patient that really didn't need high-cost intervention lived in a higher-spending area, he or she would likely fare considerably worse over the long haul, either through poorer medical management treatment or pressure to undertake higher-cost and possibly unnecessary surgical interventions.

Of course, this research applied more to Medicare spending than for non-Medicare spending, and it doesn't reflect quality of care in the high-spending United States as compared to, say, the United Kingdom or Canada.

It's extremely hard to make these comparisons. For example, if we live shorter lives here in America, but eat nothing but Big Macs, is that the fault of poor medical care, or simply poor life choices? Although there have been many studies on comparative effectiveness, none are universally accepted. Worse, many of the studies have been funded by industry groups with billions and even trillions of dollars at stake, so the conclusions would naturally tend to lean in favor of the vested interest.

But we can look at a few factors and draw some rudimentary conclusions. For example, we can compare infant mortality rates and life expectancy rates among various countries and derive some interesting information.

And that's what we'll do next: we'll see how our health care compares to both India and China - and to Canada and the U.K. The results are demoralizing, at best.

Follow David on Twitter at http://www.Twitter.com/DavidGewirtz.

Editor’s note: David Gewirtz is Editor-in-Chief, ZATZ Magazines, including OutlookPower Magazine. He is a leading Presidential scholar specializing in White House email. He is a member of FBI InfraGard, the Cyberterrorism Advisor for the International Association for Counterterrorism & Security Professionals, a columnist for The Journal of Counterterrorism and Homeland Security, and has been a guest commentator for the Nieman Watchdog of the Nieman Foundation for Journalism at Harvard University. He is a faculty member at the University of California, Berkeley extension, a recipient of the Sigma Xi Research Award in Engineering and was a candidate for the 2008 Pulitzer Prize in Letters.


Filed under: David Gewirtz • Health Care
soundoff (9 Responses)
  1. JDylan

    The opening sentence of this article is a lesson in false reasoning; "Since America spends far more on health care than any other country, it stands to reason we should be healthier here than people are anywhere else in the world." In no way does this represent what the author is trying to sell; it is evidence of a sicker nation, a nation that requires more care. This argument goes hand in hand with comparing death rates or infant mortality with other nations. These things do not represent the quality of healthcare but, the quality of the life people lead. We do not need false claims of a healthcare crisis when the real crisis is financial, qualtity of food and over all way of living; nothing to do with actual healthcare since hospitals have nothing to do with a persons way of living. It's important to point out that the ancient Greeks life expectancy was well into their 70's, aswell, without any healthcare.

    August 27, 2009 at 3:48 am |
  2. RLWellman

    Why is it the Government's job to tell Insurance Companies what they have to cover? Why is it the Government's job to have anything to do with Isurance Companies? The left keeps saying how much insurance costs, if it weren't for the Government, it wouldn't cost as much as it does now!

    If the new Health Care Reform Bill is passed with a public option, how can Insurance Companies compete if the Government won't have to cover the same thing they have to?

    We need reform without the Government running it. If we do what Senator Kennedy wanted, it would be covering only those without health care insurance, not all 300 million Americans. The more the Government gets involved, the more it costs!

    August 26, 2009 at 1:45 pm |
  3. Beverly

    As long as we have drug companies, insurance companies, etc. running our "healthcare" system, I fear not much will change. I have heard nothing about taking power away from these CEOs and their lackies regarding life and death decisions that are being made strictly on a business basis – how much money won't they get to keep in their pockets?

    August 26, 2009 at 1:18 pm |
  4. Carla

    Could you find out more about Australia's national health care? I've talked to people from Australia who say it's wonderful.

    August 26, 2009 at 1:10 pm |
  5. R.C.

    What people at large do not know Medicade has started canceling a lot of elderly people here in Tennessee. The say that if you make over 1,000.00 a month you can afford to pay for your own health care. So they are receiving cancelation letters and a bill for back care that they did not cover.

    August 26, 2009 at 1:05 pm |
  6. Annie Kate

    We may outspend other countries on our health care but it does not appear that we get better treatment. France, Canada, and Great Britian all pay less per capita than we do but each has a longer life expectancy than the US and a lower infant mortality rate – two of the key factors used in comparison of health systems. If we adopted a health system like one of those countries, our health care would probably improve over time, our costs for the government would go down (freeing up money to pay on the deficit), and our personal costs would go down (giving us more of our paycheck to do other things with) while we could still go to our own doctor, get timely care, and have a lot less stress financially and mentally about what do we do if we get sick and have no or inadequate health care.

    August 26, 2009 at 12:23 pm |
  7. Mharlyn Merritt

    This is not about healthcare but how much we as a society value human life.How much attention are we as a nation willing to pay to our own well-being and that of our fellow Americans? I think this has become a devisive issue because it strikes at deeper things like our culture of selfishness.

    August 26, 2009 at 12:12 pm |
  8. Michael C. McHugh

    To me, the main problem has always been the class system in health care, in which some people get the best that money can buy, while millions get none at all–or very little. It's impossible to make all things equal, but the disparities between the haves and have nots in this world has become far too wide in the last 30 years, and not only in health care.

    August 26, 2009 at 11:55 am |
  9. KIm

    We need a vaccination for quadruple reassortant. The new strain and not subtype H1N1. How much has research funding to support health care been cut ? Why do doctors practice defensive medicine and why are 14 thousands a day losing health insurance ? Wonder how long the wait will be before we get our health care system right for the people. Not special interests manipulative of decisions and healthy best interests. Avotre Saunte ! Re-ASS-or-Tant ?

    August 26, 2009 at 11:47 am |