In his victory speech last week, John McCain finally mentioned health care. Until now, he has hasn’t said much about what is the number two or number three issue (depending on the state or the poll) on the mind of the electorate, and the press hasn’t pushed him on it. But if he continues to discuss health care, voters will hear a familiar old tune—U.S. health care is the best in the world. Said McCain to his supporters: “I will campaign to make health care more accessible to more Americans with reforms that will bring down costs in the health care industry without ruining the quality of the world’s best medical care.” Politicians have used such language before in an effort to persuade the public that the system is not broken, and that a fix will damage it. This time, though, voters may well tune out that song. The system’s warts have grown larger.
Too many Americans are uninsured and have ended up in bankruptcy court or are nearly bankrupt because they cannot pay hundreds of thousand of dollars in medical bills. Even those with insurance can end up in bankruptcy, because health coverage no longer necessarily protects against the high cost of illness. A landmark study by Elizabeth Warren, a Harvard law professor, shows that high deductibles, copayments, exclusions, and other loopholes result in bills that many middle-class people cannot pay.
Too many Americans are also victims of medical mistakes, and nearly every day, fresh evidence arrives revealing how they are harmed. The South Florida Sun-Sentinel just published an AP story about an underweight three-year-old who died after a routine test to see if he was a candidate for growth hormone therapy. The hospital’s outpatient pharmacy prescribed a massive overdose of a drug that started a chain reaction of other medical errors. A piece in the current issue of Forbes begins with a chilling lead about a sixty-year-old retired pharmacist, no less, who went to a Cincinnati hospital for knee replacement surgery and ended up with a life-threatening staph infection that required more two more operations to treat.
Too many people suffer from delayed care—particularly those who are poor and have no medical home, a place where their care can be coordinated and assessed. This month’s issue of Health Affairs highlights the existence of two different worlds for American children. Poor black and Hispanic children who live in disadvantaged neighborhoods with environmental hazards, poor municipal services, and lack of healthy food options have very different health options and outcomes than children from wealthier neighborhoods.
International comparison studies, too, show that American health care is not always the best. A Commonwealth Fund report released last year showed that the U.S. consistently underperforms other nations on various measures, ranking last on such dimensions as access, efficiency, equity, and getting safe care.
This week Senator Edward Kennedy told Roll Call: “We have some of the best hospitals and the best doctors in the world, but we haven’t got a health care system. And it’s measured in the fact that people are—47 million of them—going to the emergency rooms, at close to $500 a whack, which discourages people from going.” Kennedy was exaggerating; surely not all 47 million uninsured land in the ER. But at least Kennedy had the good sense to take care not to leave the impression that American health care is the best in the world.
Undoubtedly reporters on the campaign trail will hear candidates and special interest groups brag about our system, which indeed has some fine attributes, but a growing list of problems too. The trick will be for journalists to challenge the politicians and special-interest representatives, and connect what they say to the mounting evidence that voters are hearing a different melody.