The American Health Care Paradox by Elizabeth H Bradley Review
Ii experts nowadays a nuanced instance that we focus as well much on symptoms and also fiddling on root causes.
Let'due south pretend President Obama made a primetime accost last night to the nation about America'south health care issues. "My fellow Americans, I speak to you this evening to offering a proven style to meliorate our broken system with better care at lower price. And no, the answer is not expanding Obamacare. Instead, we should expect overseas and emulate the model of … the Scandinavians."
How practice y'all call up that would play in Peoria? Nosotros're the land of "freedom fries," American exceptionalism and the stubborn belief that we accept the highest standard of living on Planet Earth. Likewise, isn't Scandinavia total of socialists?
Optimistic politicians celebrating America as the greatest identify ever tend to beat out those perceived equally more Eeyore-esque (see Reagan versus Carter, then Mondale, or Clinton versus Dole). For the record, a 2005 quality-of-life ranking past The Economist pegged the US of A 13th out of 111 countries.
Into that political climate walk two Yale wellness experts who brand a sober, well-reasoned case that, in more means than 1, we focus too much on symptoms and too little on root causes. The American Wellness Care Paradox besides demonstrates that we have a lot to learn from the nations of Scandinavia. For starters, our definition of "health care" needs some piece of work.
Politicians and other talking heads ofttimes tout or bemoan the fact that America spends more than on wellness care than whatever other nation. True, up to a point. But if the calculation includes supporting social services, the U.Due south. is nowhere near the top. In 2007, America spent about 25 percent of its Gross domestic product on both combined. That's 13th on the listing, well below Sweden and Kingdom of denmark, among others.
The volume's core finding comes downward to this: "Spurred by individual sector confidence in a growing and profitable health care market, the United States has favored investments in wellness care over social welfare. Co-ordinate to the [book's] numbers, this inequality may result in poorer health than might be attained past recalibrating the residuum of health and social spending."
This is not light plane reading, nor does it pretend to be. The authors brand a valiant endeavor to brand the work more than engaging by putting a "face" on some representative cases where our current system manages to spend huge amounts of coin with a tepid return on investment. Examples abound in emergency rooms, where expanded social services could provide significantly ameliorate patient outcomes at significantly lower costs past giving these patients another option than dialing 911 when they are unable to find help.
The book is not a full domestic downer. We become tours of several innovative health care facilities in New York, Connecticut, California and Oregon, where a more holistic approach to patient care appears to be thriving. Some provide onsite physical educational activity services and nutritional tips and support. Some emphasize issues such as ensuring patients get transportation to appointments, job placement for accident victims and condom housing for survivors of domestic abuse.
In a health care organisation that historically focuses more on symptoms than root causes, change won't exist easy. Even though Obamacare will have "positive furnishings" past improving admission to health care, the authors suggest it "is unlikely to accost fundamental causes of the American paradox of high costs and poor outcomes."
In that location'south another misunderstood root cause to ponder. The flawed American wellness care system is not exclusively a problem of the "poor." Those at greater take chances in the organisation also include relatively isolated people at many income levels who lack supportive family and friends. Without admission to adequate professional assistance, such as social workers or community centers, these vulnerable people ofttimes telephone call for an ambulance when what they actually need is a shoulder to lean on and emotional back up.
Those patient stories assistance humanize the text, but there's no way around it: this book about a complex trouble is a flake of a slog. That's probably to the authors' credit. We've already suffered from way too much partisan over-simplification in our national wellness intendance debate. Republic is messy. And then, besides, are nuanced arguments.
The authors freely acknowledge that the Scandinavian organisation, though bolstered by strong social services, is not perfect. Likewise, the American organisation is not without important merits. Waiting times are longer in Scandinavia, and that region has not yet faced some of America's immigration challenges. "Integrating immigrants is something the United states has washed better than we have in this state," a Norwegian diplomat admits. Further, American drug and medical device innovation far surpasses that of Scandinavia.
Simply tin can a nation too often convinced it does pretty much everything better than pretty much every other nation acknowledge that information technology might benefit from outside ideas? Unfortunately that's a question this valuable book cannot answer.
Michael Causey is a health care blogger at AssurX and the sometime editorial director at FDAnews.
Source: http://www.washingtonindependentreviewofbooks.com/index.php/bookreview/the-american-health-care-paradox-why-spending-more-is-getting-us-less
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