We Expect Immortality From Medicine -- and It's Destroying Our Health

President Barack Obama during his first months in office seldom has missed a chance to liken the country's health care system to an unburied corpse, which, if left lying around in the sun by the 111th Congress, threatens to foul the sweet summer air of the American dream. The prognosis doesn't admit of a second or third opinion. Whether on call to the Democratic left or the Republican right, the attending politicians and consulting economists concur in their assessment of the risk posed by the morbid emissions. The country now pays an annual fee of $2.4 trillion for its medical treatments (16% of the GDP); the costs continue to lead nowhere but up. Fail to embalm or entomb the putrefying debt, and it's only a matter of time -- ten years, maybe twenty -- before the pulse disappears from the monitors tracking the heartbeat on the floor of the New York Stock Exchange.

So say the clinicians in Washington, and I don't quarrel with the consensus. If I can't make sense of some of the diagnoses or most of the prescriptions, at least I can understand that what is being discussed is the health of the American economy, not the well being of its people. The symptoms present as vividly as do the manifestations of bubonic plague, showing up as an infection of the body politic caused by the referral of the country's medical care to the empathy of accountants and the wisdom of drug dealers. Thus the suppurating cruelty and the malignant disparities, among which a few of the most apparent attest to the severity of the disorder:

The United States leads the world in the advancements of medical science, its hospitals splendidly equipped with Magnetic Resonance Imaging machines and artificial hearts, its doctors gloriously decorated with Nobel prizes, but between 44,000 and 98,000 patients die every year in American hospitals of iatrogenic infections or as the consequence of a mistaken diagnosis or a bungled operation. American hospitals and doctors are paid for the amount of care they produce, not for its effectiveness or its quality. Medical error ranks as the country's eighth leading cause of death, more deadly than breast cancer or highway accidents.

Americans in 2007 paid $7,421 per capita for health care as opposed to $2,840 paid by the Finns and $3,328 by the Swedes, but life expectancy in the United States is not as long as it is in 30 other countries, among them Finland and Sweden; the first year infant mortality rate in the United States is higher than it is in some forty other countries, among them Slovenia and Singapore. A newborn child stands a better chance of survival in Minsk and Havana than it does in New York or Washington.

The money allocated to health care in most other developed countries (in Canada and France as well as in Germany and Japan) provides medical insurance for the entire citizenry. Not in America; 46 million citizens (15% of the population) are uninsured. Patients with sufficient funds can buy a brain implant or a bionic eye, but an estimated 22,000 people died in 2006 for lack of insurance; 59 million other people reported their inability to receive needed medical attention. Together with the cornucopia of drugs for all seasons the American healthcare shopping mall now offers expensive diagnostic tests that allow upwards of 6 million Americans to enjoy the benefit of high-priced bodily home improvements -- Titanium knees, Peruvian kidneys, two hour erections and a sunny disposition. Of the 1.5 million Americans expected to declare personal bankruptcy this year, 60% will be forced to do so to pay their medical bills. The ratio between the country's shelters for battered women and its shelters for stray animals stands at 3 to 1 in favor of the animals.

The anecdotal testimony is in agreement with the statistical evidence. The news media bring recurrent reports of patients denied treatment because they are too old or too sick to deserve an insurance company's blessing. Friends, family and chance acquaintances tell of near-death experiences in a hospital emergency room or admitting office. The data suggest that any recuperating of the country's health care system requires the solution of a philosophical problem before treating the political and economic trauma.

The heavy cost of the enterprise follows from our asking of medicine more than medicine can deliver -- not only the cure for death, but also the gift of riches. The foolishness of the request was more readily apparent in societies unexposed to the chemistry of birth control pills and the mechanics of a triple coronary bypass. During the first half of the twentieth century even an extended stay in an American hospital didn't hold out a higher chance of recovery, and for most illnesses the treatments were therapeutic, not diagnostic. Doctors relied on common sense, on the natural resilience of the human body and the hope that by tomorrow morning the patient would show signs of improvement. A medical practice was likely to consist of five or six doctors who answered weekend and late-night telephone calls, knew the names and ailments of their patients, tended to think of their profession as a public service, understood that the strength to confront suffering was to be found in the acts of kindness tempered with wisdom and courage.