Health Care And Preparedness Report Cards: The System Needs Work

We all know by now that with the twin appointments of Tom Daschle to HHS/health reform czar and Peter Orzsag to OMB that health reform is on the table. The hope is, of course, that not only something significant will be done, but that public health will not be left out of the mix.

One of the frequent excuses used by those who oppose significant reform is some variant of "we have the best health system in the world, so why mess with a good thing?" By the way, the second frequent excuse, expense, won't fly any more: see U.S. 'Not Getting What We Pay For' and American Exceptionalism & Health Insurance Company Costs from our own DrSteveB, but that's a separate topic altogether.

However, three recent report cards by a respected NGO (Trust For Americas Health) and professional organizations (American Public Health Associationand American College Of Emergency Physicians) looking at state level performance all come to the same conclusion: we have a long way to go to claim that quality outcomes should preclude reform, and the recession only makes things worse.

From the APHA [distributed by the United Health Foundation in partnership for APHA and Partnership for Prevention]:

During the 1990s, health improved at an average rate of 1.5 percent per year, but improvements against national health measurements have remained flat for the last four years. Smoking, obesity, and the uninsured are the nation’s three most critical challenges...

"Our collective national failure to successfully address the determinants of health over the past several years is tragically documented in this year’s report," said Reed Tuckson, M.D., United Health Foundation board member and UnitedHealth Group executive vice president and chief of medical affairs. "Without action in these severe economic times, the harsh findings of this report will only be worse next year for our nation, states, communities, families, and individuals. This is a time for urgent and focused action. Our nation’s and our children’s health are too important to do otherwise."

Full report: America's Health Rankings 2008

From TFAH:

"The economic crisis could result in a serious rollback of the progress we've made since September 11, 2001 and Hurricane Katrina to better prepare the nation for emergencies," said Jeff Levi, PhD, Executive Director of TFAH. "The 25 percent cut in federal support to protect Americans from diseases, disasters, and bioterrorism is already hurting state response capabilities. The cuts to state budgets in the next few years could lead to a disaster for the nation's disaster preparedness."

Full report: Ready or Not 2008

from ACEP:

Overall Results: C-

The results of the 2009 Report Card present a picture of an emergency care system fraught with significant challenges and under more stress than ever before. The overall grade for the nation across all five categories is a C-. This low grade is particularly reflective of the poor score in Access to Emergency Care (D-). Because of its direct impact on emergency services and capacity for patient care, this category of indicators accounts for 30 percent of the Report Card grade, so the poor score is especially relevant. This category also incorporates many of the issues that states have identified as their top areas of concern.²⁴ These include:

• Boarding of patients in emergency departments and hospital crowding
• Lack of adequate access to on-call specialists
• Limited access to primary care services
• Shortages of emergency physicians and nurses
• Ambulance diversion
• Inadequate reimbursement from public and private insurers
• High rates of uninsured individuals

The grades for the other categories are slightly better, but not strong enough to pull up the full national average.

Full Report: National Report Card on the State of Emergency Medicine

TIME magazine, in their year-end review hits on one of the issues:

The biggest problem with the U.S. health-care system is that it has long been designed to respond to illness rather than prevent it.

To address that, a separate TFAH report, Blueprint for a Healthier America, was released earlier this year. Yeah, we have to lose weight and stop smoking, but the concentration of what the Feds can do from improving food safety to appointing a Surgeon general and elevating the position back to what it used to be (America's public health spokesperson) in the C. Everett Koop days is a must (do you even know who the current SG is?)

But if you delve into the state by state reports, and look at the federal role, you'll see why Orszag is such a key appointment:

The Blueprint contains an analysis showing a shortfall of $20 billion annually -- across state, local, and federal government -- in funding for critical public health programs in the U.S., based on research conducted by The New York Academy of Medicine and a panel of leading experts. Approximately $1 billion of this shortfall is due to cuts to the U.S. Centers for Disease Control and Prevention (CDC) budget from fiscal year 2005 levels.

The bottom line is that there's a lot broken, and whether it be a pandemic or a natural disaster of a local nature, or continued fallout form people losing jobs and their insurance, the US is not in good shape to weather the storm. Don't let true stories about the excellence of the system sidetrack you for what's going on overall. That's really what it means to see the forest for the trees.