Medicine | Introduction
The American health care system is the most expensive per capita in the world, with annual health care costs per person of $4,187. Many argue that this sum is money well spent, but others insist that such an outlay does not always translate into the highest quality of medicine. Many people contend that the American medical system does not provide consistently high-quality health care. They maintain that the level of care could be improved if the United States adopted the single-payer health care plan used in Canada.
According to the World Health Organization (WHO), in its World Health Report 2000, the United States ranks thirtyseventh out of 191 health systems, ranking behind nations as varied as Belgium, Colombia, and Malta. One reason for the ranking is that WHO does not consider the American health care system to be financed fairly; for example, a poor person who spends the same amount of money on health care as someone who is wealthier will spend a greater percentage of his or her income on health care costs. Moreover, many Americans are left outside the system—44 million are uninsured. This high number of uninsured Americans can be attributed to the fact that Americans typically obtain health care through their employers. People whose employers do not provide health insurance, and those who are selfemployed or unemployed, are more likely to be uninsured.
American doctors widely agree that the quality of care in the United States has declined. In a survey conducted in fall 2000 by Harvard University and the Commonwealth Fund, 56 percent stated that they believed “their ability to provide quality care has worsened in the past five years.” Doctors also expressed concern about a shortage of nurses, medical errors, and the affordability of prescription drugs. The doctors contended that the level of care would improve if they could spend more time with patients.
In some cases, however, patients would not be well served by spending more time with their doctors. According to Health Letter, a publication of the Public Citizen Health Research Group, federal agencies and state medical boards disciplined 16,638 doctors between 1987 and 1996. The most serious offenses committed by these doctors include sexual abuse and misconduct, incompetent and negligent care, substance abuse, criminal conviction, and the overprescription and misprescription of drugs. The publication concludes: “This country’s system for ensuring medical quality needs to be made much stronger. . . . Most states need to strengthen their medical practice statutes [and] restructure their medical boards.” Another concern, raised by science journalist Daniel S. Greenberg, is that doctors too often order surgeries, particularly hysterectomies and bypass surgeries, whose medical benefit is uncertain. He also questions the need for new and costly medical technology: “The nasty secret of health care economics is that a lot done for patients is useless or dangerous, and costly, and that much that could help them, at relatively low cost, isn’t done.”
Critics of the American health care system assert that this nation should look north for a solution. In History of Medicine: A Scandalously Short Introduction, Jacalyn Duffin states, “The Canadian health care system is the envy of the Western world.” Canada uses a “single-payer system” in which a single government fund within each province pays the physicians, hospitals, and health care providers. Thus the government, not employers, provides health insurance in Canada, and so all Canadians are covered. Advocates contend that all Americans would have health insurance and greater freedom of choice in doctors and hospitals under a single-payer system.
Despite criticisms of health care in the United States, numerous commentators and health care workers praise the successes of American medicine. Julie Chan, a research assistant at the Cato Institute, a libertarian public policy organization, questions the ranking criteria WHO used in its World Health Report 2000. She argues that the organization bases its conclusions on inaccurate and inconsistent data. However, even the World Health Organization is not wholly critical of the American medical system. WHO concludes in its report that the United States is unsurpassed regarding choice in providers, speed of response in emergencies, confidentiality of patient records, and respect for the dignity of individuals.
Doug Bandow, a senior fellow at the Cato Institute, cites advances in medical technology—which have helped the United States achieve a life expectancy rate of 77.26 years and an infant mortality rate of 6.76 deaths per 1,000 live births—as proof of the nation’s excellent medical care. Among these scientific achievements are fetal surgeries, organ transplants, magnetic resonance imaging (MRIs), and gene therapy. Although the United States is not the only nation to take advantage of these new treatments and technologies, Bandow maintains that American medicine is superior to other nations because it rewards innovation and encourages competition.
Many commentators believe that there is no reason to follow Canada’s lead and that the single-payer system is fraught with numerous problems. In an article for Insight on the News, Robert LeBow, former president of Physicians for a National Health Program, claims that despite the purported success of the Canadian system, many emergency rooms have closed and long waits for treatment are common. He also cites a 1999 poll that found that three out of every four Canadians believe that their health care system is in crisis. In addition, 59 percent of Canadian doctors expressed concerns about the quality of health care in Canada in the fall 2000 Harvard University survey. The quality of Canadian health care is also not consistent for all citizens. Political activist Stephen Gowans maintains that many services are no longer covered by the health system, leaving them available only to Canadians wealthy enough to pay out of pocket for them.
As the debate on the quality of health care in the United States suggests, the American medical system is one of the most scrutinized in the world. In Medicine: Opposing View- points, the authors consider the breakthroughs and problems in American medicine in the following chapters: What Problems Confront American Medicine? Is Alternative Medicine Effective? Are New Medical Technologies Beneficial? What Is the Future of Medicine? In their viewpoints, the authors examine the state of the American medical system and what its future may hold.
