A Short American Life

By NICHOLAS D. KRISTOF
The New York Times
May 21, 2007

How’s this for a glimpse into America’s health care mess:

The student winner I’ve chosen to accompany me on a reporting trip to Africa next month is a superb medical school student named Leana Wen. She receives her M.D. this month, and will research health care access this summer at a Washington think tank.

I asked Leana about her health insurance coverage, just in case she catches leprosy on the Africa trip.

“Actually, I was going to become one of the 45 million uninsured for the summer,” she said. “The think tank does not provide insurance for ‘temporary’ employees, and my school did not allow extension of health insurance post-graduation. I still haven’t found a reasonably priced insurance plan for this period.”

Aaaaargh! When a newly minted doctor investigating Americans’ access to medical care has no insurance — then you know that our health care system is truly bankrupt.

Let’s hope that the presidential campaign helps lead us toward a new health care system. John Edwards has set the standard by proposing a serious and detailed plan for national health care reform, and other candidates should follow.

The medical and insurance lobbies have been busy blocking national health care programs since they were first seriously proposed back in the 1920’s — and the result has been millions of premature deaths in this country because of people falling through the cracks. Doctors fighting universal coverage have been saving lives in their day jobs while costing lives with their lobbying.

Over all, a person without insurance is less likely to have diseases diagnosed early, less likely to get routine preventive care — and faces a 25 percent greater chance of dying early.

Americans with good jobs and complex needs receive superb medical care. But a child in Costa Rica born today is expected to live longer than an American child born today.

The U.S. now spends far more on medical care (more than $7,000 per person) than other nations, yet our infant mortality rate, maternal mortality rate and longevity are among the worst in the industrialized world. If we had as good a child mortality rate as France, Germany and Italy, we would save 12,000 children a year.

It is disgraceful that an American mother has almost three times the risk of losing a child as a mother in the Czech Republic. According to a new report from Save the Children, a woman in the U.S. has a 1-in-71 chance of losing a child before his or her fifth birthday.

Some speculate that America’s high infant mortality rate is partly a result of greater honesty about neonatal deaths or of more in vitro fertilizations. But even if those are factors, they don’t explain why a woman is 50 percent more likely to die in childbirth in the U.S. than in Europe.

The existing medical financing system also creates perverse incentives for expensive procedures; that may be why Americans are far more likely than Europeans to get C-sections. Meanwhile, the burden of paying for these second-rate statistical outcomes is crippling American business. By next year, the average Fortune 500 company will spend more on health care than it earns in net income, according to Steve Burd, the head of Safeway. Mr. Burd and other executives have formed the Coalition to Advance Healthcare Reform, creating a corporate constituency for national health reforms.

There’s evidence that the most efficient financing system would be a single-payer structure, such as that found in most Western countries. Some 31 percent of U.S. health spending goes to administration, more than twice the rate in Canada.

So bravo to Physicians for a National Health Program, a group of 14,000 doctors and other health professionals that favors a single-payer system.

But universal coverage is only part of the answer. We also need far greater attention to public health programs focusing on prevention. Two of the most important life-saving health interventions in recent decades weren’t medical at all: the cigarette tax and laws mandating air bags and seat belt use. A national public health campaign on obesity (similar to the one Gov. Mike Huckabee started in Arkansas) should be an essential component of health care reform.

Even if a single-payer system isn’t politically possible right now, universal coverage is feasible through other mechanisms — as Massachusetts has shown. We need to hold the presidential candidates accountable, for universal coverage is an idea whose time came in the 1920s. We should insist we get it before the 2020s.

Nicholas Kristof, The New York Times, Health Insurance, Managed Care, Medicine and Health, Doctors, 2008 Presidential Election