Wheres the beef? 100,000 die.
Written by Jeffrey R. Waggoner, MD   
... but if America is last and becoming more last as time goes on, it would seem that the goal of incremental change is slowing the rate at which the U.S. falls further behind the rest of the world.

A standard defense against criticism of America’s health care system is to attack the bias of the critic. Dismissing a study as lacking objectivity is a facile means of skirting its implications. When the study comes from The London School of Hygiene and Tropical Disease, this defensive maneuver would seem to have been blunted.

It’s difficult to label hygiene and tropical diseases as being either liberal or conservative, Republican or Democrat, socialist or capitalistic. Thus, the implications of a study authored by Ellen Nolte, Ph.D., and C. Martin McKee, M.D., D.Sc must be considered on their own merit.

If so, they are more nails in the coffin of the supposition that America’s health care system is the world’s best.

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It would seem that the system is nailing closed the coffins of 100,000 of its citizens every year.

“Measuring the Health of Nations: Updating an Earlier Analysis” (“Health Affairs”, 27, no. 1, 2008: 58-71) looks at rates of "amenable mortality," i.e. “deaths from certain causes before age 75 that are potentially preventable with timely and effective health care.” The study used World Health Organization data on death caused by preventable conditions such as treatable cancers, diabetes, and cardio-vascular disease.

When compared to 17 other industrialized nations, America ranks last in rate of amenable mortalities. Worse, it also ranks last in the decline of this rate during the period of 1997-98 and 2002-2003. Simply by reducing its mortality rate to the average of the other 17 countries, America would save the lives of 101,000 Americans. The implications? By spending more on health care than the citizens of all other industrialized nations, Americans have purchased the greatest chance of dying needlessly. But not to worry—things are probably getting worse.

Presidential candidates are calling for “incremental change” in America’s health care system, but if America is last and becoming more last as time goes on, it would seem that the goal of incremental change is slowing the rate at which the U.S. falls further behind the rest of the world. Of course the reassuring part of all this is that Americans are paying more to be last.

Where’s the beef?

Why does America buy two pieces of stale bread sitting immediately on top of each other and call it a hamburger? This is not a debate about the size of the hamburger patty—there ain’t no patty.

The problem with these numbers is that they are numbers. Health care lacks the drama of a cataclysmic collapse of a building or bodies floating in hurricane driven waters. A movie producer tried to dramatize 100,000 needless deaths and was dismissed as being histrionic. These deaths occur one at a time. They are anonymous losses, unnamed tragedies. They will never occur all at once in an event that can be hawked with a promise of “film on the five o’clock news.”

If health care were a hamburger, Americans would be enraged. Where’s the beef? would be answered by howls of rage.

Where’s the beef? Check the obituary column of your local newspaper.

Dr. Jeff Wagonner

About the Author

J.R. Waggoner, M.D. practiced family medicine for thirty years in Aurora, Colorado. He also worked as a consultant and herded cats as the managing general partner of a general partnership of physicians. Three years ago, he left his practice to study health care policy and write. During his time away from clinical work, he has written two books and worked as a Senior Clinical Content Specialist and freelance writer.

His current book Medical Metamorphosis: The three step cure for America's health care crisis is available at 

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