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Back in the 1970s when I took my first graduate course in health policies, I was surprised to find the U.S. was not first in stuff like life expectancy and infant mortality. I think we were 5th in infant mortality and about 12th in life expectancy.

What surprised me even more was to discover our health and medical personnel were as ignorant as I had been. I landed a research assistant position with the College of Nursing in Cincinnati. I advised graduate students on their master’s theses and some faculty on their research. One day the Dean asked me to give a lecture to the graduate students on how to read statistics, graphs, and charts they were likely to come across in their readings.

So, I made a number of overheads (this was before PowerPoint) of tables, graphs, and charts from medical and nursing journals. The charts and graphs were largely mortality and disease rates. Some data were over time while others compared rates by sex, race, State, nations, etc.

In the middle of my lecture, a student asked, “Why aren’t you using real data?”

“I am,” I replied. “These are from medical and nursing journals.”

“Can’t be,” she shot back. “We are near the bottom on some things.”

“Yes we are.” I answered.

“That can’t be. Everyone knows we are number 1,” she insisted.

A few years later I was at a party where I got in a conversation with several Louisville cardiologists. One commented about being lucky to be in the U.S. where we were less likely to die from heart disease. I pointed out that his claim was not close to being true. The doctors admitted they had never seen international comparisons but everyone just knew the U.S. was best and it was obvious, to them, that Americans were the least likely to did from heart disease.

Much has changed in the past 40 years. The good is that our health professionals are now aware of our poor performance. For the past 20 years, my nursing and pre med students have been aware that our vital statistics are at the bottom of industrial nations and even behind some developing ones. The bad part is that our ranking as slipped even more in international rankings. The CIA lists us as 34th in infant mortality, just behind Cuba. For life expectancy, 33rd overall with 34 nations living longer than U.S. males and 35 countries where females live longer than our females. Overall, we die four years sooner than people in Japan and three years sooner than people in France, Canada, Australia, Sweden and several other nations.

What is most disturbing about all of this is that for this poor performance we are paying nearly twice as much for our health care as nations where babies die less and citizens live longer. And they cover 100% of their citizens will we leave 15% without coverage and many more with inferior coverage. What is going on? And will Obamacare fix it?

While nations have accomplished this is different ways (see Frontline’s “Sick Around the World” for 5 examples), the most glaring difference between the U.S. and all others is that they treat health care as a human right where we treat sickness and injury as a way to get rich. Only England has a truly socialist system, but the other nations with free market solutions reduce incentives for extreme profits. Take the case of Florida governor, Rick Scott. As CEO of Columbia HCA he became a multimillionaire. In addition to the legal profits, the company was accused by the Bush administration of cheating the U.S. government out of $3.4 billion dollars by overcharging Medicare, Medicaid, and Tricare. The company pleaded guilty to some fraud charges and paid a fine of $1.7 billion dollars. Two points here: 1. Scott was and is a big time Republican and the deal was cut with the Bush administration. 2. It is common for white collar criminals to pay about 50% of what they are accused of stealing as the government costs to prosecute is often so expensive and big corporations have more lawyers than the government can put on the case.

Bottom line is that the U.S. government spends nearly the same amount on health care per capita as other nations. But our overall costs are nearly twice their’s because we have such a huge for-profit mark-up.

Can ACA fix it? The short answer is “No.” By that I mean it will not be of much help catching up with the rest of the world. In the big picture, it still treats sickness and injury as commodities for profit. And Congress has made sure the program is so understaffed that we can expect Rick Scott like fraud to continue if not expand. Historically, medical fraud does increase when new programs are implemented and before proper safeguards are put in place.

But there will be some minor improvements. Moving some working poor out of emergency rooms into clinics and doctor’s office will save money. Likewise, the increased preventive care focus will reduce some future costs. Already, we have seen costs rising slower than anytime in the past 50 years.

ACA is a wee bit of an improvement to our dysfunctional system. But we are not likely to gain on those nations with better health measures. We might even slip further behind, but at a slower rate than it would be without Obamacare.

If there is a silver lining in all this, it is the nation is engaged in a serious conversation about health care. Our health providers recognize how far we are behind the rest of the world. Nurses overwhelming support single payer or government option plans (e.g., Medicare for all). While the conservative AMA supported Obamacare it still opposes a public option. But only 1 in 5 doctors belong to the AMA. Several medical societies have endorsed single payer options and recent polls find a majority of doctors now support either a government option or single player plans. Unfortunately, health care providers and single payer advocates were banned from participating in writing the ACA law. They were not even allowed to testify before Congress.

Rather than listen to our health care professionals about how to fix our broken system, we’ve let the politicians, profiteers, and talking heads take over the discussion. The result is that too many in the general public are still ignorant about our poor health measures. Like those nursing students of 40 years ago, many still think we have the lowest infant mortality and longest life expectancies. We need to change the conversation to the real problems with our health care. Why is our infant mortality so high and why aren’t we living as long as people in other nations? How do nations like Canada do that with half the money we spend? Only then will be on the road to healing our dysfunctional system.

Wed Oct 30, 2013 at 11:11 AM PT: Thanks for the rescue and recommend. I went to bed early and was busy today until now. Thanks again.

Originally posted to SocioSam on Tue Oct 29, 2013 at 03:23 PM PDT.

Also republished by Community Spotlight.

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