U.S. healthcare system isn't to blame for citizens' health woes

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this guest blog by Timothy B. Norbeck, CEO of the Physicians Foundation. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

In the interest of full disclosure, I have worked in the healthcare sector and with physicians for the past 50 years.  Like countless other Americans, I am a beneficiary of the marvels of modern day life-saving surgery available in our health care system. And yet, this United States healthcare system has attracted many critics who compare specific health measures in our system with those of other high-income countries to support their argument that we are lagging perilously behind.  

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Efforts to demean and denigrate our system fail to recognize necessary and pertinent facts and are reminiscent of E.B. White's observation that "Prejudice is a great time saver. You can form opinions without having to get the facts." Upon first glance, however, such condemnations could appear to be warranted. After all, as cited by the respected Commonwealth Fund in a report (U.S. Health Care from a Global Perspective) published last October, Americans spent more on health, had a shorter life expectancy and a greater prevalence of chronic conditions than did those living in Australia, Canada, Denmark, France, Germany, Japan, Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom. All of this is true, so case closed-right? Not so fast.

The Credit Suisse Research Institute and other studies have suggested that smaller, more homogeneous and less diverse countries tend to fare better in healthcare and other statistics than their larger counterparts. It is also interesting to note that of the high-income countries with which the U.S. is compared, the collective total of 11 of those countries (excluding only Japan) equal the population of the United States.

One would expect better healthcare statistics and outcomes in much smaller and less diverse nations. That same Commonwealth Fund Report calls attention to another study relevant to healthcare comparisons involving the U.S.  Bradley and Taylor’s 2013 study found that we spend less on social services such as disability benefits, food security, employment programs and supportive housing than do the 12 countries studied. This is a contributing factor to why we spend more on healthcare.

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A report of 15 countries by the Institute of Medicine (IOM) in 2013 concluded that for chronic conditions or diseases, the U.S. has the highest rate of obesity, a high diabetes rate and the second highest rate of heart disease. These sobering statistics are more the product of personal behavior than due to a failed healthcare system.  It is true that some of our citizens cannot significantly alter their own healthcare as a result of genetics, social disparities and just plain bad luck, but many of us have to accept some culpability for our own health conditions as well as for the overall costs involved.

Next: We need to address certain obvious shortcomings

Look at the Medicare figures: According to the Centers for Disease Control and Prevention (CDC), 33% of beneficiaries without multiple chronic conditions or diseases accounted for only 7% of Medicare spending compared to the 14% with six or more conditions who accounted for 46% of total costs.  The Atlantic Monthly reported that these numbers are similar across all ages when considering that 5% of Americans account for 50% of healthcare spending and that 20% of overall spending was attributable to the top 1%.

An article in Health Affairs reported that a "comparison of chronic conditions in the U.S. with 10 European countries reveals a markedly lower prevalence in Europe of heart disease, hypertension, diabetes, arthritis and obesity. This difference . . . may be attributable to a healthier diet and lower poverty rates in Europe than in the United States." In that same article, we learn that "almost 50% of all Americans have multiple chronic conditions in which health costs increase dramatically." This number becomes especially significant when one considers that the CDC estimates that "75% of the nation's aggregate healthcare spending is attributable to the costs of chronic conditions.  

Should the U.S. healthcare system be blamed and held responsible for its citizens' personal behavior and for the social disparities or determinants such as poverty, the conditions in places where people live, learn, work and play?  These are important issues that have a salient effect on health outcomes and costs.

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The CDC reports that people who are obese, compared to those with a normal or healthy weight, find themselves at increased risks for many serious diseases and health conditions including: high blood pressure, Type 2 diabetes, coronary heart disease, stroke and osteoarthritis.  All of this translates into lower life expectancy, higher costs and worse health outcomes. It also notes that the United States is much larger in population, has more immigrants, more diversity and higher poverty than countries used in the comparisons-- and also does not insure all of its people.

 We need to address certain obvious shortcomings and the causes of the problems which adversely impact our health and result in high costs. To start, we must earnestly focus on the social disparities along with our commitment to social services spending, which lags far behind other countries.  At the very least, we must acknowledge that spending less on social services will result in higher health care costs.

Efforts to treat chronic conditions and their underlying causes must be intensified. Former Director of Medicare and Medicaid, Gail Wilensky, PhD, spoke out recently about "the need to improve the conditions that shape early childhood development, noting that conditions such as obesity, cardiovascular disease, cancer and mental health problems often have their roots in the early years of life."  These issues demand increased attention and addressing them will improve our present and future health while reducing attendant costs.  This is far more productive than railing against a health care system for the poor health outcomes that it did not cause!

Next: Daunting challenges

Despite the daunting challenges ahead and the need to face up to our damaging personal behaviors, there is substantial news to celebrate. Our hard-working physicians, nurses, and allied health personnel should take great pride in helping Americans to achieve among the highest life expectancy rates in the world at 75 years of age, and (the highest for those over 80) high survival rates after a diagnosis of cancer and stroke, better control of blood pressure and cholesterol levels and lower death rates for cervical and colorectal cancer – all bolstered by the efforts of hospital systems, expensive new technology and the latest miracle drugs.

To recapitulate, the United States healthcare system is neither responsible for, nor is it the cause of, social disparities that have compromised the health and lives of so many people in our country, which unfortunately fall disproportionately on those who reside in our minority communities. Our healthcare system has not forced anyone to eat, drink, and smoke too much, or exercise too little.  It did not cause the highest death rates from motor vehicle crashes and violence, including homicides, nor did it contribute to our highest incidence of death related to alcohol and other drugs. 

As Cassius said in Shakespeare's Julius Caesar, "The fault dear Brutus, is not in our stars, but in ourselves…"