Free Market Fundamentalism Is Killing Us

Posted by Barbara O'Brien at 5:00 AM on May 12, 2007.

By many tangible measures, the U.S. health care system isn't much to brag about. For example, the World Health Organization reported that in 2000 the U.S. ranked 24th in the world in "healthy life expectancy."

"Basically, you die earlier and spend more time disabled if you’re an American rather than a member of most other advanced countries," said Christopher Murray (M.D., Ph.D.), Director of WHO's Global Programme on Evidence for Health Policy.

In life expectancy, infant mortality, and number of practicing physicians per capita, the U.S. long has ranked near the bottom among the 30 or so wealthiest industrialized nations. And this is in spite of the fact that we spend nearly twice as much per capita on health care as nations that get much better results than we do. We don't even have as many hospital beds per capita as most other industrialized nations.

But worry no more, children. I learned yesterday that "US Health Care Saves More Lives Than Socialized Medicine"! Keep reading to learn more!

I learned about the triumph of the U.S. health care system from rightie blogger Captain Ed , who wrote,

A new study by the Karolinska Institute in Sweden shows that the American health care system outperforms the socialized systems in Europe in getting new medicines to cancer patients.

According to the document linked by Captain Ed, "The proportion of colorectal cancer patients with access to the drug Avastin was 10 times higher in the US than it was in Europe, with the UK having a lower uptake than the European average." In other words, if you are a colorectal cancer patient lucky enough to have health insurance and get diagnostic tests in time, you are far better off in the U.S. than anywhere else.

What more do you need to know? That proves the U.S. has The Best Health Care in the World™, right?

I understand the U.S. is still ahead of most other countries in the development of new drugs and high tech gizmos for diagnosing and treating diseases. But there's more to health care than, say, the development and marketing of extracorporeal shock wave lithotripters. Take our famously nasty infant mortality stats, for example. On the whole I don't believe we're losing babies because of substandard hospital care. On the contrary; I've heard many times that the United States has superior intensive hospital care for high-risk neonates compared to other nations. However, as this abstract says,

Despite high per capita health care expenditure, the United States has crude infant survival rates that are lower than similarly developed nations. Although differences in vital recording and socioeconomic risk have been studied, a systematic, cross-national comparison of perinatal health care systems is lacking. ...

... Compared with the other 3 countries, the United States has more neonatal intensive care resources yet provides proportionately less support for preconception and prenatal care. Unlike the United States, the other countries provided free family planning services and prenatal and perinatal physician care, and the United Kingdom and Australia paid for all contraception. The United States has high neonatal intensive care capacity, with 6.1 neonatologists per 10 000 live births; Australia, 3.7; Canada, 3.3; and the United Kingdom, 2.7. For intensive care beds, the United States has 3.3 per 10 000 live births; Australia and Canada, 2.6; and the United Kingdom, 0.67. Greater neonatal intensive care resources were not consistently associated with lower birth weight-specific mortality. The relative risk (United States as reference) of neonatal mortality for infants <1000 g was 0.84 for Australia, 1.12 for Canada, and 0.99 for the United Kingdom; for 1000 to 2499 g infants, the relative risk was 0.97 for Australia, 1.26 for Canada, and 0.95 for the United Kingdom. As reported elsewhere, low birth weight rates were notably higher in the United States, partially explaining the high crude mortality rates.

Conclusions. The United States has significantly greater neonatal intensive care resources per capita, compared with 3 other developed countries, without having consistently better birth weight-specific mortality. Despite low birth weight rates that exceed other countries, the United States has proportionately more providers per low birth weight infant, but offers less extensive preconception and prenatal services. This study questions the effectiveness of the current distribution of US reproductive care resources and its emphasis on neonatal intensive care.

(The study discussed in the abstract was published in the Journal of the American Academy of Pediatrics [PEDIATRICS Vol. 109 No. 6 June 2002, pp. 1036-1043] and is by Lindsay A. Thompson, MD, MS, David C. Goodman, MD, MS, and George A. Little, MD.)

In short, we have excellent, state-of-the-art facilities for treating seriously compromised newborns, but we have more seriously compromised newborns than we should because too many women don't have access to good prenatal care. Basically, our health care system is good at delivering difficult and expensive stuff but blows at simple, ordinary stuff, like preventive care, compared to other nations. This means we save some lives that might have been lost in Europe, but we also lose lives that would have been saved in Europe.

How did this come to pass? Certainly we Americans value creation and innovation. But it's also the fact that our private, profit-based health care system is very good at creating new health care products that will make a lot of money. But where there's no chance of profit, forget it.

This is what the "magic of the marketplace" has given us. You know how markets work; where there's a demand, someone will hustle to provide a supply, and competition encourages the creation of better products at lower cost. Our system is very good at creating new drugs and new technologies and then marketing them to hospitals, physicians, and even potential patients. And many of us have benefited from the drugs and technologies. The problem is that some parts of the health care process just don't make any money. And where it isn't profitable, our system is falling apart.

A couple of days ago I wrote about our nation's emergency rooms. In short, they're bad, and they're getting worse. Emergency room capacity is shrinking, although demand is growing. People are dying because they wait too long to get treated.

Go to Newsweek.com to read the second part of their three-part series on the crisis in emergency medical services. Then ask yourself if this is the sort of emergency care you'd like for yourself or someone you care about. Probably, it isn't.

But emergency rooms are big money losers for hospitals. They suck up costly resources -- equipment and supplies that are crazy expensive have to be on hand to deal with whatever calamity comes through the door. But at the same time, often the people who use ERs have no insurance and can't pay. Even when the "customer" can pay, because of the huge overhead costs of running an ER the hospital still isn't going to make a profit, because the insurance companies will only pay so much.

Here's what the "free market" people never wrap their heads around: Some things, even essential things, cannot generate enough profit to pay for themselves.

Most nations come up with a simple answer to this problem: They pay for vital but unprofitable services with taxes. That's a big part of what government is for, some would argue. But you know American conservatives; they'd rather accept greater suffering and death (as long as it isn't theirs) than pay taxes that support a dreaded "entitlement" like basic health care. It just sticks in their craw that their tax dollars might be used to benefit someone else. And it never occurs to them that someday they might be the "someone else."

Of course, the irony of this is that, thanks to lobbying and other efforts, some parts of the health care industry enjoy generous corporate welfare. But to today's Republicans welfare is just fine as long as it's going to them.

By now "market forces" have so skewed our health care delivery system that, even if we began to allocate our health care dollars according to need rather than profit, it would take years before the neglected parts of our systems were built back up to where they should be.

While our emergency rooms rot, the health care industry just loves to provide boutique medical services for health care consumers who can pay for them. Expensive mass market ad campaigns are aimed at people with unsightly toenails, male pattern baldness, and erectile dysfunction to drive up optimum demand for pharmaceutical products before the patent runs out. For example, recently I've seen ads in which young women are sitting around a table discussing a newly discovered premenstrual syndrome -- discovered by a pack of marketing executives, no doubt -- for which there is (surprise!) a remarkable new drug to treat it.

If you've got toenail rot and prescription drug benefits, Big Pharma wants your business. If you bust your head open and need your life saved in an ER -- good luck.

I'm not a bit surprised that the U.S. is doing a good job of developing and delivering new cancer drugs to patients, because that's the sort of thing we're still doing well. But to extrapolate from this news that the entire U.S. health care system is superior to the "socialized" systems of Europe is, um, a bit of a stretch.

Tagged as: health care, market fundamentalism, healthcare crisis

Barbara O'Brien has guest blogged at the Take Back America Conference, Glenn Greenwald's, Unclaimed Territory, and Crooks and Liars. She is the "owner/proprietor" of The Mahablog.