Study: Insured cancer patients do better

Joe Hill · Dec 20, 2007

The US health profiteer system is deadly, hyperexpensive, and the shame of the Western world. Congress and the Bush Mafiosi should be divested of their socialized health care until we all get it. Good idea, John Edwards!

Study: Insured cancer patients do better

By MIKE STOBBE, AP Medical WriterThu Dec 20, 7:50 AM ET

Uninsured cancer patients are nearly twice as likely to die within five years as those with private coverage, according to the first national study of its kind and one that sheds light on troubling health care obstacles.
People without health insurance are less likely to get recommended cancer screening tests, the study also found, confirming earlier research. And when these patients finally do get diagnosed, their cancer is likely to have spread.
The research by scientists with the American Cancer Society offers important context for the national discussion about health care reform, experts say — even though the uninsured are believed to account for just a fraction of U.S. cancer deaths. An Associated Press analysis suggests it is around 4 percent.
Those dealing with cancer and inadequate insurance weren't surprised by the findings.
"I would just like for something to be done to help someone else, so they don't have to go through what we went through," said Peggy Hicks, a Florida woman whose husband died in August from colon cancer.
Edward Hicks was uninsured, and a patchwork health care system delayed him from getting chemotherapy that some argue might have extended his life.
"He was so ill. And you're trying to get him help and you can't, you can't," said his 67-year-old widow.
The new research is being published in CA: A Cancer Journal for Clinicians, a cancer society publication. In an accompanying editorial, the society's president repeated the organization's call for action to fix holes in the health care safety net.
"The truth is that our national reluctance to face these facts is condemning thousands of people to die from cancer each year," Dr. Elmer Huerta wrote.
Hard numbers linking insurance status and cancer deaths are scarce, in part because death certificates don't say whether those who died were insured.
An Associated Press estimate — based on hospital cancer deaths in 2005 gathered by the U.S. Agency for Healthcare Research and Quality information and other data — suggests that at least 20,000 of the nation's 560,000 annual cancer deaths are uninsured when they die. Experts said that estimate sounds reasonable.
CUT

"Insurance makes a big difference in how early you are detecting disease," said Ken Thorpe, an Emory University health policy researcher.
In the new study, researchers analyzed information from 1,500 U.S. hospitals that provide cancer care. They focused on nearly 600,000 adults under age 65 who first appeared in the database in 1999 and 2000 and who had either no insurance, private insurance or Medicaid.
Researchers then checked records for those patients for the five years following. They found those who were uninsured were 1.6 times more likely to die in five years than those with private insurance.
More specifically, 35 percent of uninsured patients had died at the end of five years, compared with 23 percent of privately insured patients.
Earlier studies have also shown differences in cancer survival rates of the uninsured and insured, but they were limited to specific cancers and certain geographic areas.
The new findings are consistent across different racial groups. However, the fact that whites have better survival rates cannot be explained by insurance status alone, said Elizabeth Ward, the study's lead author.
The researchers were not able to tell if the numbers were influenced by patients' education levels, or by other illnesses.
Experts said the study also hints at problems with quality of care after diagnosis: such as whether the patient got the appropriate operation from a high-quality surgeon, whether the tumor was thoroughly evaluated by a high-quality pathologist, and whether there was access to needed chemotherapy and radiation.
"The differences that we see in outcomes after people are diagnosed, even among those with early stage disease, suggests that problems with quality of care may be an important reason," said Dr. John Ayanian, professor of medicine and health care policy at Harvard Medical School. He didn't participate in the cancer society study.
The study makes an even stronger statement about the role insurance plays in the timing of screenings and how that can raise the likelihood of a late-stage diagnosis, experts said.
A Kaiser Family Foundation survey last year of 930 households that dealt with cancer found that more than one in four uninsured patients delayed treatment — or decided not to get it — because of the cost.
Such was the case of Edward Hicks.
The retired laborer, had surgery for colorectal cancer in 2005 and was thought to be clear of the disease. Chemotherapy was suggested after the surgery, but he didn't get it.
In February of this year, his wife grew worried when he lost energy and appetite. In April, he told her he felt a lump in his stomach.
Hicks, who lived in Fort Meade, Fla., couldn't get an appointment with a specialist, but a family doctor checked him into a hospital and specialists saw him in late May. They said he was terminal but that chemotherapy might extend his life a little, his wife said.
She was able to get donated chemotherapy drugs from a pharmaceutical company, but it took time to arrange the treatments, which didn't start until mid-June. Meanwhile, her husband's health deteriorated. In July, after just a few treatments, he stopped the chemo, saying it was too hard. He died on Aug. 21, at age 64.
Friends and family told Peggy they believe he would have lived longer had he got chemo earlier, when he was stronger. She doesn't agonize over that, she said, trusting in God's will.
But the devil's in her mailbox — she is facing a $21,000 hospital bill and other costs from his death.http://news.yahoo.com/s/ap/20071220/ap_on_he_me/cancer_uninsured

Solidus · Dec 20, 2007

While I can agree that vast swaths of our political elite are overcompensated for their work, I disagree that further socialization of our health care system is the answer.

The article mistakes correlation and causality. The cause of cancer paitients success / failure is if they get treatment early / often enough. Not possesion of insurance. While it is true that people with insurance (or more accurately subsidies) are more likely to visit the doctor for treatment / diagnosis; this is correlation not causality.

Socializing health care will not make any of the treatments cost less, it simply changes who pays for them. We should instead focus on making the treatments actually cost less, which requires competition and a free market, both of which are largely lacking in the current US health care industry.

Would you prefer expensive treatments that "someone else" pays for, or would you prefer making treatments cheaper so more people could afford them on their own?

J

barefootguy · Dec 20, 2007

Solidus said:
Socializing health care will not make any of the treatments cost less, it simply changes who pays for them. We should instead focus on making the treatments actually cost less, which requires competition and a free market, both of which are largely lacking in the current US health care industry.

This is simply false. The two main reasons that health care costs so much is a. hospitals/drug companies can get away with charging so much and b. the overhead of insurance companies is insane. Hospitals/drug companies are able to charge what they do because none of the insurance companies has enough of a market share to impose cost controls. If we had a single payer system where the government was the only entity negotiating with hospitals/drug companies, we would have much more leverage and therefore have an easier time keeping costs in control. We don't even allow Medicare to negotiate with drug companies, that would at least be a good start. Another reason health insurance is so expensive is overhead. The overhead in private insurance is 20-25%, while that of Medicare is 4-6%. The free market is the best method to deliver goods 90%+ of the time, but it simply does not work with health care. People don't shop around when it comes to their health care, nor do they want to. They want the best possible care regardless of the cost. It is unconscionable that we have a system where if two people are diagnosed with the same cancer, one might live and the other might die just because of differences in their economic situations.

Solidus · Dec 20, 2007

barefootguy said:
This is simply false.

No it's not. Allow me to elaborate.

barefootguy said:
a. hospitals/drug companies can get away with charging so much

They get away with it because people don't care how much it costs, they don't see the bill ... or rather they only see a fraction of the bill. If insurance companies were forced to compete for (unsubsidized) individuals then they would have a tremendous incentive to compete over price (in addition to quality).

How does having the government pay for health insurance stop 'them' from charging so much?

barefootguy said:
b. the overhead of insurance companies is insane.

No it's not. While the overhead is larger in private insurance, overhead does NOT equal waste.

The monitoring, marketing and overhead costs of private insurance are what allow more expensive medical treatments through the door. It is precisely because competing insurance companies spend money evaluating the appropriateness of claims that they are willing to pay for so many heart bypasses, extra tests, private hospital rooms and CT scans. [1]

The lower reported administrative costs for Medicare are unsurprising, in that Medicare spends substantially less on such functions as marketing, risk evaluation, claims scrutiny, and compliance with the regulatory requirements of the individual states. This does not mean that the higher reported administrative costs of private health insurance are “wasteful.” Instead, they serve the interests of consumers by reducing the extent to which insurance creates cross-subsidies among consumer classes; such cross-subsidies reduce the economic benefits of risk-pooling. [2]

Medicare has lower overhead because is doesn't bother to check if the money is being used efficiently. This is NOT a 'good' thing.

Nevermind that with the taxes to fund a single payer system Medicare level costs get expensive quick.

In addition, the federal government must acquire revenues through a tax system that creates economic distortions, that is, that imposes economic costs upon the economy in addition to the revenues generated. The lowest plausible assumption about the magnitude of that “excess burden” of the tax system raises the true cost of delivering Medicare benefits to 24-25 percent of Medicare outlays, or about double the net cost of private health insurance.[2]

Or on par depending on the assumptions of private insurance, that article assumed 11-14%.

barefootguy said:
If we had a single payer system where the government was the only entity negotiating with hospitals/drug companies, we would have much more leverage and therefore have an easier time keeping costs in control.

How would the government use this 'leverage' to keep costs in control?

barefootguy said:
People don't shop around when it comes to their health care, nor do they want to. They want the best possible care regardless of the cost.

You're correct people don't shop around for health care ... mainly because they can't. When they can, we find they do want to ... otherwise we wouldn't be having this debate.

Health maintenance organizations were popular 15 years ago, but Americans didn’t like being told that they couldn’t have a treatment, or that they would have to wait. That experience showed that Americans are willing to pay for insurance company overhead costs, if it means they sometimes get more in return.[1]

What do you know, when people were able to shop around they chose the option with higher overhead costs because of the benefits offered. If Americans want quality regardless of cost how does a single payer system improve quality?

barefootguy said:
It is unconscionable that we have a system where if two people are diagnosed with the same cancer, one might live and the other might die just because of differences in their economic situations.

Cancer treatments are not a right. Health care is not a right. Nor should it be.

How is it more 'conscionable' that one might live or die based on your place in line for surgery?

The current problems with our health care system (both the insurance side and the actual delivery) is due to government interference. More government intervention is NOT the solution. A return to free market principles, that work for EVERY OTHER form of insurance, is what is required.

Why is it that no one ever complains about the 'astronomical' overhead in auto insurance? Or how we would all have lower rates if only the government could 'leverage' all of us into a single payer auto insurance system? Or how mechanics and tow truck drivers get away with charging 'so much'?

Maybe it's because the free market does a better job of meeting our needs than central planning government could ever hope for.

J

[1] http://www.nytimes.com/2007/03/22/business/22scene.html
[2] Medical Progress Report 5 | Comparing Public and Private Health Insurance

1069 · Dec 20, 2007

Joe Hill said:
The US health profiteer system is deadly, hyperexpensive, and the shame of the Western world. Congress and the Bush Mafiosi should be divested of their socialized health care until we all get it. Good idea, John Edwards!

I just watched Sicko again; it was very... elucidating.
I mean, I already knew some of this stuff, but Moore really threw it into sharper relief by contrasting America's deplorable health care system with the universal health care offered by every other nation in the industrialized world.

And there was little of his usual bombast; the only hint of it- and I had to laugh- was when he arrived at Guantanamo Bay with his three boatloads of sickly 9/11 rescue workers and started shouting through that bullhorn: "Hello! I have three boatloads of 9/11 heroes here, who are in need of medical attention! They're only asking for the same medical treatment you're providing for the evil-doers!"
... or something to that effect. It was really funny.
Then this siren started going off, and MM was like, "Let's turn the boat around and get the hell out of here."

:lamo

Solidus · Dec 21, 2007

1069 said:
I mean, I already knew some of this stuff, but Moore really threw it into sharper relief by contrasting America's deplorable health care system with the universal health care offered by every other nation in the industrialized world.

That's not really that hard when you cherry pick your comparisons. [1, 2]

[1] "Sicko" Health Care Reform
[2] Two Health Care Documentaries

metreon · Dec 22, 2007

Solidus said:
Socializing health care will not make any of the treatments cost less...

Originally Posted by barefootguy
This is simply false...

Originally Posted by Solidus
Allow me to elaborate.

You never really did, so stop making false promises and unsubstantiated denials.

Solidus said:
... If insurance companies were forced to compete for (unsubsidized) individuals then they would have a tremendous incentive to compete over price (in addition to quality).

You are forgetting one thing: they are competing on the basis of cost, not quality necessarily. The typical consumer has no basis to judge quality, and insurance companies know it.

Solidus said:
How does having the government pay for health insurance stop 'them' from charging so much?

Because most of industrialized world has some form of universal health care...they would have no choice. The negotiating power of a big player. They are not going to get a better price anywhere else, assuming of course drug costs are directly negotiated as such. The only tricky part is keeping drug company influence from tainting the process of the establishment of universal care, or a single payer plan, for that matter. Corruption always remains an potential issue in any organization, private or public.

Solidus said:
No it's not. While the overhead is larger in private insurance, overhead does NOT equal waste.

Actually it frequently does, because its economic efficiency is largely disconnected with the efficiency of providing healthcare. Creating a multitude of confusing policy distinctions, types, and provisions is one of the legal ways insurance companies can effectively reduce the rate at which healthcare is reimbursed, and it requires greater overhead to both administer and maintain this legal morass, even though it generates greater profitability for the insurance company. The customer never finds out until it is too late, and insurance is so boring, customers will never have some way of comparing it on a realistic basis. Even hardened contract attorneys get confused figuring out exactly what might be covered or not a priori in a typical insurance contract. In this free-market model of yours, inefficiency in service results in greater profits. How do you get around that?

Also, your narrow focus on insurance company overhead omits the parallel phenomena: the exponentially larger administrative overhead of hospitals dealing with the multitude of policies within one insurance company much less hundreds of policies from dozens of other insurance companies. That is another reason why administrative costs for health care are double to three times higher than in countries with universal care. Cost is not purely defined by just the budget of the universal care plan.

Solidus said:
Medicare has lower overhead because is doesn't bother to check if the money is being used efficiently. This is NOT a 'good' thing.

Corruption and fraud exist in almost all large organizations, not just Medicare. It is a weakness of single payer plans also and why I think universal care with reimbursement based on a broader longitudinal wellness index as opposed to "per procedure" would be better. As the NYT article you posted opines: "When they aren’t paying directly, patients will seek extra care and doctors will be happy to oblige." There would be not as much motivation for that to happen if the doctors are not paid per procedure. Medical treatment plans would therefore be less a laundry list of physicians' economic wishes, less conciliation to hypochondriac patients, and more a well-intentioned well-informed treatment.

Solidus said:
Nevermind that with the taxes to fund a single payer system Medicare level costs get expensive quick. Or on par depending on the assumptions of private insurance, that article assumed 11-14%.

The Manhatten Institute for Policy Research article cited blatently ignores the obvious savings incurred by lower hospital administrative costs afforded by a single payer plan as well as other trickle-down cost efficiencies from the routine medical treatment of those who might otherwise leech exorbitant costs as uninsured emergency room patients. Preventative, routine, and timely treatment is magnitudes times cheaper than unplanned, unexpected, and too-late treatment.

Although I would agree replacing many insurance companies with one big insurance company is not what I would prefer, since the procedurally-based abuse potential remains, the author overstates the problems of single payer, and frankly, limits his discussion of its larger economic significance to its direct federal budgetary cost, presumably to remind people that the wealthy will have to pay more for the uninsured because he thinks they will participate more in such a healthcare system than if given straight subsidies through the usual convoluted means which they can't understand or effectively use. In other words, he is acknowledging what I stated above: our healthcare system creates its economic efficiency by making the use of its service either non-existent or inefficient for anyone but the rich.

Instead of waiting for an appointment as one might in a universal care system, in our present system, some get no treatment, others get treatment denied or poorly reimbursed, leaving only a few really satisfied with the treatment they recieved. Perhaps that's why Businessweek reported this summer only 40% of Americans are satisfied with our health care system, while 65% of French say they are satisfied with theirs.

Solidus said:
You're correct people don't shop around for health care ... mainly because they can't. When they can, we find they do want to...

What people want and what is actually possible are two different things, to paraphrase the author of your own article.

Solidus said:
What do you know, when people were able to shop around they chose the option with higher overhead costs because of the benefits offered.

Choosing between two evils does not make one actually 'good'. HMOs were aggressively for-profit bearing little resemblance to an institution that might be established ostensibly for the public good. Now with HMOs fading away, we have mostly insurance, yet do you really believe people are greatly satisfied? A Harvard study found recently that half of all bankrupcies are linked to health care expenses from being underinsured or uninsured. Is that reason for celebration?

Solidus said:
If Americans want quality regardless of cost how does a single payer system improve quality?

Having some treatment is better than having no treatment at all. How difficult is that for you to understand? It represents a quantum level rise in the quality of treatment for those previously untreated.

Solidus said:
Cancer treatments are not a right. Health care is not a right. Nor should it be.

Why not? You are merely stating your premise, not your rationale. If you agree with the MIP article, how can you justify "subsidies", but not universal health care? It seems a bit hypocritical to me to argue one is the establishment of a "right", implying the other not. Besides the government provides many permanent services not defined as "rights" and more trivial than healthcare to the public good, so what is your semantic hang-up? Just call it a service if you don't want to bestow the rank of right to it.

Solidus said:
How is it more 'conscionable' that one might live or die based on your place in line for surgery?

It happens in the free-market healthcare system every day anyway, so you are not stating much difference. Get a grip on reality. Most "rationed" healthcare services I have read about usually triage the importance of surgeries. More trivial surgeries have longer waits than important ones critical to survival. You conveniently omit that "detail". All healthcare systems triage according to likely outcome.

Solidus said:
The current problems with our health care system (both the insurance side and the actual delivery) is due to government interference. More government intervention is NOT the solution. A return to free market principles, that work for EVERY OTHER form of insurance, is what is required.

As I pointed out, you make no convincing case for that at all. Even less convincing, how has the government inflated the costs of our current healthcare system to double that per capita of countries with universal care? Our healthcare system is largely a free market still. That would suggest the problem is the free market regulation of healthcare, through its many adversarial pieces, none of which seems to actually be pro-consumer. Even the trial lawyers seem a bit mercenary and shortsighted in their self-serving roles. The government as far as I can tell is the only potential bastion of protection for the consumer left, despite its swelling partisan fickleness.

Solidus said:
Why is it that no one ever complains about the 'astronomical' overhead in auto insurance?

Because, (1) it involves a trivial economy compared to healthcare, (2) auto insurance does not directly threaten one's abilty to survive, live. It is not life or death.

I also thought I would mention, this cancer report is not the first such comparison of insured vs. uninsured. Uninsured children suffering from typical childhood trauma, no genetic disorders or chronic diseases, also died at twice the rate as insured children within the same hospitals no less. Time to treatment then would have been virtually identical then, the only difference being poor treatment. Gives one pause to reassess Solidus' critique of the possible cause of greater cancer deaths being linked to the uninsured patient's responsibility rather than just the level of care.

From the start you have failed to make a real case in my opinion, partly because no one ever said health care in any form would be a "free lunch" yet you pretend it is a debating point. However, statistics do show over and over, per capita costs are much lower in countries with universal care, despite the greater useage. They also show high satisfaction rates with their healthcare systems. Some say 47 million are uninsured in the U.S., the more cynical say it is only 30 million. Whether 20% or 10% of the population is uninsured it is morally incomprehensible given the high economic and social costs of their eventual emergency but substandard treatment which raises everyones outlay, but at the same time leaves the poor little better off than they were. Half of personal bankrupcies derive from healthcare cost overruns. Less than half the U.S. public is satisified with their healthcare system. Failure certainly has been repeatedly shown in the U.S. healthcare system, but success? You have not effectively elaborated your thesis, ...at all.

Donc · Dec 22, 2007

Here’s a prime example of our corporate owned healthcare, and one of the sicko stars.:thumbdown

<Source: ABC News

WESTWOOD -- A Northridge teenager awaiting a liver transplant died Thursday after she was pulled off of life support.

CIGNA Insurance Company initially refused to cover the cost of the transplant for Natalee Sarkisian, saying the surgery was too experimental.

On Thursday, friends, family and members of a nurses association held a protest outside CIGNA headquarters in Glendale, urging the insurance company to reconsider.

But the decision came too late for Natalee. Just after six o'clock tonight, her condition worsened.

Natalee's family took her off life support and she passed away.>

http://abclocal.go.com/kabc/story?section=news/local&id=5848163

Joe Hill · Dec 24, 2007

The very terms given them makes it obvious which would be more beneficial and economical for the majority of the country. "for-profit" benefits the industry, "socialized" benefits the People.

Myth: The U.S. has the best health care system in the world.

Fact: The U.S. has among the worst health statistics of all rich nations.

Summary

The U.S. does not have the best health care system in the world - it has the best emergency care system in the world. Advanced U.S. medical technology has not translated into better health statistics for its citizens; indeed, the U.S. ranks near the bottom in list after list of international comparisons. Part of the problem is that there is more profit in a pound of cure than an ounce of prevention. Another part of the problem is that America has the highest level of poverty and income inequality among all rich nations, and poverty affects one's health much more than the limited ministrations of a formal health care system.

Argument

Let's review the health care statistics first, and analyze them afterwards. All statistics here are for the year 1991; they have generally become worse for the U.S. since then.

Health Care Expenditures (percent of GDP) (1)

United States 13.4%
Canada 10.0
Finland 9.1
Sweden 8.6
Germany 8.4
Netherlands 8.4
Norway 7.6
Japan 6.8
United Kingdom 6.6
Denmark 6.5

Doctors' incomes: (2)

United States $132,300
Germany 91,244
Denmark 50,585
Finland 42,943
Norway 35,356
Sweden 25,768

Percent of population covered by public health care:

ALL NATIONS (except below) 100%
France, Austria 99
Switzerland, Spain, Belgium 98
Germany 92
Netherlands 77
United States 40

Average paid maternity leave (as of 1991; this changed with Clinton's
signing of the 1993 Family and Medical Leave Act):

Sweden 32 weeks
France 28
United Kingdom 18
Norway 18
Denmark 18
Japan 14
Germany 14
Netherlands 12
United States 0

Life Expectancy (years):

Men Women
Japan 76.2 82.5
France 72.9 81.3
Switzerland 74.1 81.3
Netherlands 73.7 80.5
Sweden 74.2 80.4
Canada 73.4 80.3
Norway 73.1 79.7
Germany 72.6 79.2
Finland 70.7 78.8
United States 71.6 78.6
United Kingdom 72.7 78.2
Denmark 72.2 77.9

Infant Mortality Rate (per 1,000 live births):

United States 10.4
United Kingdom 9.4
Germany 8.5
Denmark 8.1
Canada 7.9
Norway 7.9
Netherlands 7.8
Switzerland 6.8
Finland 5.9
Sweden 5.9
Japan 5.0

Death rate of 1-to-4 year olds (per community of 200,000 per year):

United States 101.5
Japan 92.2
Norway 90.2
Denmark 85.1
France 84.9
United Kingdom 82.2
Canada 82.1
Netherlands 80.3
Germany 77.6
Switzerland 72.5
Sweden 64.7
Finland 53.3

Death rate of 15-to-24 year olds (per community of 200,000 per year):

United States 203
Switzerland 175
Canada 161
France 156
Finland 154
Norway 128
Germany 122
Denmark 120
United Kingdom 114
Sweden 109
Japan 96
Netherlands 90

Note: the murder rate for the above age group is 48.8 per 200,000. Even
subtracting this entirely still puts the U.S. near the top of the list.

Premature Death (years of life lost before the age of 64 per 100 people):

United States 5.8 years
Denmark 4.9
Finland 4.8
Canada 4.5
Germany 4.5
United Kingdom 4.4
Norway 4.3
Switzerland 4.1
Netherlands 4.0
Sweden 3.8
Japan 3.3

Percent of people with normal body mass:

Men Women
Germany 53% 37
Finland 51 37
United Kingdom 46 38
Canada 52 29
Switzerland 49 30
France 44 30
Denmark 44 25
United States 47 22
Sweden 44 25

Percent of people who believe their health care system needs fundamental change:

United States 60%
Sweden 58
United Kingdom 52
Japan 47
Netherlands 46
France 42
Canada 38
An explanation of America's poor health care statistics

Sharp readers will notice that the last chart may mean different things to different people. Conservatives think the U.S. health care system needs reform because there is too much government involvement in health care; liberals because there is not enough.

So let's clarify this statistic with a few others. Americans are the most dissatisfied with the quality and quantity of their health care. Of the 10 largest industrialized nations, the U.S. ranked dead last in health care satisfaction, with an approval rating of only 11 percent. (3) There's no putting a positive spin on this statistic; any president with such a low approval rating would be impeached!

Most of this dissatisfaction stems from the high expense and unavailability of U.S. health care. During the 1993 debate on health care reform, polls consistently showed that two-thirds of all Americans supported the idea of universal coverage. (4) Polls also showed that Americans didn't want to pay the higher taxes to achieve this goal, which many pundits took to be an amusing example of public inconsistency. Actually, the public was entirely consistent. Other nations manage to cover everybody, and at lower cost.

Nor is America's international reputation in health care as high as many Americans boast it to be. "Ask anyone you know from a foreign country... which country is the envy of the world when it comes to health care," Rush Limbaugh wrote in See, I Told You So. But according to a Gallup poll published by the Toronto Star, only 2 percent of all Canadians believe that the U.S. has a better health care system than their own. (5)

The fact is that America does not have the finest health care system in the world; it has the finest emergency care system in the world. Highly trained American doctors can summon Star Wars-type technology in saving patients who have become seriously injured or critically ill. But as far as preventative medicine goes, the U.S. is still in the Stone Age. It should be no surprise that in America's health care business, entrepreneurs will take a pound of cure over an ounce of prevention every time.

But in reality, what affects the health of Americans lies more outside the formal health care system than within it. In Europe during the last century, life expectancy nearly doubled after nations purified their drinking water and created sanitation systems. In America during this century, the highest cancer rates are found in neighborhoods around the chemical industry. (6) A healthy diet and exercise provide better health than most medicines in most circumstances. Other nations have realized that factors outside the hospital are more important than factors inside it, and have used this bit of wisdom to lower their health care costs.

Perhaps the greatest reason why Europeans are healthier than Americans is because they have reduced poverty, especially child poverty. The link between poverty and poorer health has long been proven. One survey reviewed more than 30 other studies on the relationship between class and health, and found that "class influences one's chances of staying alive. Almost without exception, the evidence shows that classes differ on mortality rates." (7) The American Journal of Epidemiology states that "a vast body of evidence has shown consistently that those in the lower classes have higher mortality, morbidity and disability rates" and these "are in part due to inadequate medical care services as well as to the impact of a toxic and hazardous physical environment." (8)

And in an even more important finding, studies from Harvard and Berkeley have proven that income inequality -- not just absolute poverty -- is equally important. (9) States with the highest levels of income inequality also have the highest mortality and morbidity rates. The reason why relative poverty matters is because prices and opportunities are relative too - the U.S. may have the best medical technology in the world, but at $10,000 a procedure, who can afford it?

Many reasons contribute to the worse health of the poor. Political scientist Jeffrey Reiman writes: "Less money means less nutritious food, less heat in winter, less fresh air in summer, less distance from sick people, less knowledge about illness or medicine, fewer doctor visits, fewer dental visits, less preventative care, and above all else, less first-quality medical attention when all these other deprivations take their toll and a poor person finds himself seriously ill." (10) And this is not to mention that the poor work and live in more polluted, hazardous and strenuous environments.

These deprivations are especially hard on infants in their critical development years. The U.S. has tried to combat this problem by offering universal prenatal and postnatal health care, much like Europe does. But the U.S. is fighting against a head wind because it has levels of poverty that Europe does not. Again, a person's health is affected by more factors outside the formal health care system than within it. It's not enough to give a few programs to a person in poverty; what's needed is removing that person from poverty completely.

"When I look back on my years in office," says C. Everett Koop, Reagan's former Surgeon General, "the things I banged my head against were all poverty." (11)

If America is to improve its health statistics, it must not only pass universal health care, but reduce poverty as well.

The U.S. has the best health care system in the world

Jerry · Dec 24, 2007

Joe Hill said:
The US health profiteer system is deadly, hyperexpensive, and the shame of the Western world. Congress and the Bush Mafiosi should be divested of their socialized health care until we all get it. Good idea, John Edwards!

So vote for Hillary!!

National Health *insurance* (not to be confused with health *care* ) for everyone, even 25 year old "children" who are classified as "poor" even though they make so much they have to pay the Capitol Gains tax Hillary helped impose on "the richest Americans".....

...they think we don't see right through this ****.....

Cold Highway · Dec 25, 2007

Insured cancer patients do better......Gee no ****. Instead of trying to create more government bureaucracy how about we figure out why the hell medical insurance is so damm expensive and figure out ways to reduce to skyrocketing costs.

Study: Insured cancer patients do better

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Study: Insured cancer patients do better

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