Steve Chapman

A hammer is a marvelous tool, but only for the right job. If you took an expensive watch to a repairman and he pulled out a hammer, you would be extremely nervous, if not aghast. Maybe he could find a way to do some good with that implement, but you would be more focused on the damage he could cause.

A similar scenario is playing out in the public anxiety over health care reform. Plenty of people think the existing system is in need of repair. But when they hear about expensive plans that require a more powerful and intrusive federal government, they fear that what is best in our approach to medicine may get smashed in the process.

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What is best in our approach is the exceptional quality it provides. Americans grasp that: A 2006 poll found that 89 percent were happy with the medical care they get. But President Obama and his allies in Congress don't seem to realize how good we have it.

He says though the United States spends more per person on medical care than any other nation, "the quality of our care is often lower, and we aren't any healthier. In fact, citizens in some countries that spend substantially less than we do are actually living longer than we do."

That's one of the favorite rationales for a government-led overhaul. But it gives about as realistic a picture of American medicine as an episode of "Scrubs."

It's true that the United States spends more on health care than anyone else, and it's true that we rank below a lot of other advanced countries in life expectancy. The juxtaposition of the two facts, however, doesn't prove we are wasting our money or doing the wrong things.

It only proves that lots of things affect mortality besides medical treatment. Heath Ledger didn't die at age 28 because the American health care system failed him.

One big reason our life expectancy lags is that Americans have an unusual tendency to perish in homicides or accidents. We are 12 times more likely than the Japanese to be murdered and nearly twice as likely to be killed in auto wrecks.

In their 2006 book, "The Business of Health," economists Robert L. Ohsfeldt and John E. Schneider set out to determine where the U.S. would rank in life span among developed nations if homicides and accidents are factored out. Their answer? First place.

That discovery indicates our health care system is doing a poor job of preventing shootouts and drunk driving but a good job of healing the sick. All those universal-care systems in Canada and Europe may sound like Health Heaven, but they fall short of our model when it comes to combating life-threatening diseases.

Some of those foreign systems are great, as long as you don't get sick. Samuel Preston and Jessica Ho of the Population Studies Center at the University of Pennsylvania examined survival rates for lung, breast, prostate, colon and rectum cancers in 18 countries and found that Americans fared best.

The U.S. also excelled on other measures, such as surviving heart attacks for more than a year. Why? Because our doctors and patients don't take no for an answer. The researchers attribute the results to "wider screening and more aggressive treatment." Another factor is that we get quicker access to new cancer drugs than anyone else.

Critics say all those great medicines and therapies are cold comfort to Americans who lack insurance -- which by any standard is our greatest shortcoming. People without coverage are more likely to do without needed treatment or preventive care and more likely to die from disease or accidents.

But they have it better than you might think. Some 62 percent of uninsured Americans are satisfied with their medical care. That is probably because they get a lot of uncompensated treatment from the most advanced, ambitious and capable medical system in the world.

In Britain, by contrast, having guaranteed access to care doesn't mean you'll actually get it. Twenty percent of British cancer patients who might be cured become incurable while awaiting the treatment they need.

The challenge in this country is to extend coverage to the uninsured without degrading quality for everyone. With a little caution and humility, the president and Congress can find ways to achieve that goal. But first, they need to put down the hammer.


Steve Chapman

Steve Chapman is a columnist and editorial writer for the Chicago Tribune.
 

 
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