As his party gathers to make his presidential nomination official, the Democratic hopeful vows to make universal health-care a reality, and polls show a majority of Americans support that goal. It looks like a slam-dunk for change.
Barack Obama in 2008? No, I’m thinking of Bill Clinton in 1992 who entered his party’s convention riding a seeming tidal wave of support for health-care reform. A year later, he met a television couple called Harry and Louise. We all remember the outcome of that encounter.
The Democrats gathering in Denver are clearly happy about Obama’s chances in November. And those who care deeply about health care, which is surely the vast majority, are no doubt optimistic about his chances for getting a plan through.
After all, an estimated 47 million Americans lack health insurance and the number of underinsured is thought to be 25 million, both shocking numbers. Surely in the face of such need the forces that defend the health-care status quo can be overcome.
And yet the specter of Bill and Hillary Clinton’s defeat in ’93 has to haunt Democrats the way the Curse of the Bambino used to haunt the Boston Red Sox.
I lack the political acumen to guide supporters of health-care reform through the legislative maze. But as someone who is an M.D., who has served as president of one of the nation’s leading medical teaching and research institutions and who has traveled the country listening to people talk about health issues.
I do have this advice: No plan for universal health care will be worth the paper it is written on if it fails to deal with the issue of consistency in medical care.
Consistency – or more precisely, the lack of consistency – is one of the hidden shames of American medicine, and it must be dealt with if we are to have a properly functioning system.
I have often heard it said that the U.S. must have the world’s best health care because Saudi princes, rich Europeans and other wealthy foreigners flock to our hospitals and specialists.
In one sense, that is true. Every year, thousands travel here to get world-class treatment for heart disease, cancer, neurological diseases, joint replacements and so forth. Yet here is the dirty little secret: While the best of U.S. care is arguably the world’s finest, on average our health-care system performs poorly.
The Rand Corporation looked at 30 common medical conditions in a dozen American communities and found that patients get the appropriate treatment only about 55 percent of the time.
This means that roughly half the time people go to doctors, they do not receive the care they should – and that’s for conditions where physicians are in almost universal agreement on treatment guidelines.
For example, anyone who has had a heart attack and is being discharged from a hospital should be prescribed aspirin, beta-blocking drugs and (if they have high cholesterol) lipid-lowering drugs. That is the holy trinity of preventing future heart attacks, and all doctors know it.
Yet the Rand study found that only 6 of 10 patients were going home with these prescriptions in hand. And those numbers varied widely from hospital to hospital. Some get it right close to 100 percent of the time. Some, far less than half.
The best of U.S. health care is the best in the world. But not everyone is getting that care.
It is not only the care that is so inconsistent, it is also cost. According to a Dartmouth College study, treating a Medicare patient in McAllen, Tex., is three times as costly as treating one in Lynchburg, Va.
After adjusting for differences in cost of living and risk factors, it took $3,000 a year to care for a Medicare beneficiary in Lynchburg against $9,000 in McAllen – with no improvement in health outcomes for the Texans.
Commendably, Obama’s plan recognizes the need to “tackle disparities in health care.” The devil, as always however, is in the details.
Other countries with organized health care systems have their doctors practice according to established guidelines. Setting such standards here will meet with great resistance, but it has to be done.
Any health care plan that fails to deal with this consistency issue will be seriously, dangerously flawed. The No. 1 medical challenge we face is variability in the quality of care. It is malady we must cure.
William R. Brody, M.D., Ph.D., is president of The Johns Hopkins University. He is scheduled to speak about the healthcare crisis at The Denver Forum on Sept. 4.
EDITOR’S NOTE: This is an online-only column and has not been edited.
