The recurring pronouncement from the right is that Reform will dismantle the 'best health care system in the world' which brings us to Nicholas Kristof's piece in today's NY Times. Nowhere do entities like US insurance companies deny coverage that is necessary to the life of the patient. An insurance bureaucrat with no interest in an actual human being makes these decisions all the time. Whereas in Medicare, for example, I just went through a system of primary care docs and specialists to track down difficulties I was having with heart and lungs. Nobody from the government denied any coverage whatsover, and the cardiologist, Dr. Stevens, gave me the best full battery of stress echoes, EKGs, etc. that the system can produce. And I was never made to feel that my Medicare was somehow less honorable than the checkbook of the affluent patient or the high-cost insurance coverage some folks have. One hopes that this final push to come through with a good healthcare reform bill will allow some of the facts of the worldwide conditions of health care to become apparent to everyone. BP

Kristof:

I regularly receive heartbreaking e-mails from readers simultaneously combating the predations of disease and insurers. One correspondent, Linda, told me how she had been diagnosed earlier this year with abdominal and bladder cancer — leading to battles with her insurance company.

“I will never forget standing outside the chemo treatment room knowing that the medication needed to save my life was only a few feet away, but that because I had private insurance it wasn’t available to me,” Linda wrote. “I read a comment from someone saying that they didn’t want a faceless government bureaucrat deciding if they would or would not get treatment. Well, a faceless bureaucrat from my private insurance made the decision that I wouldn’t get treatment and that I wasn’t worth saving.”

It’s true that Americans have shorter waits to see medical specialists than in most countries, although waits in Germany are shorter than in the United States. But citizens of other countries get longer hospital stays and more medication than Americans do because our insurance companies evict people from hospitals as soon as they can stagger out of bed.

For example, in the United States, 90 percent of hernia surgery is performed on an outpatient basis. In Britain, only 40 percent is, according to a report by the McKinsey Global Institute.

Likewise, Americans take 10 percent fewer drugs than citizens in other countries — but pay 118 percent more per pill that they do take, McKinsey said.

Opponents of reform assert that the wretched statistics in the United States are simply a consequence of unhealthy lifestyles and a diverse population with pockets of poverty. It’s true that America suffers more from obesity than other countries. But McKinsey found that over all, the disease burden in Europe is higher than in the United States, probably because Americans smoke less and because the American population is younger.

Moreover, there is one American health statistic that is strikingly above average: life expectancy for Americans who have already reached the age of 65. At that point, they can expect to live longer than the average in industrialized countries. That’s because Americans above age 65 actually have universal health care coverage: Medicare. Suddenly, a diverse population with pockets of poverty is no longer such a drawback.

That brings me to an apology.

In several columns, I’ve noted indignantly that we have worse health statistics than Slovenia. For example, I noted that an American child is twice as likely to die in its first year as a Slovenian child. The tone — worse than Slovenia! — gravely offended Slovenians. They resent having their fine universal health coverage compared with the notoriously dysfunctional American system.

As far as I can tell, every Slovenian has written to me. Twice. So, to all you Slovenians, I apologize profusely for the invidious comparison of our health systems. Yet I still don’t see anything wrong with us Americans aspiring for health care every bit as good as yours.

Nicholas Kristof

NY Times 11-4-09