5 things that make U.S. health care great

Anyone from outer space reading the news and watching TV would think that the U.S. has some of the worst health care possible. The negativity appears to be pervasive. Controversy over this, outrage over that. Whether it’s inadequate health outcomes, policy debate, or scandals with patient care, the stories and discussion abound.

As someone who grew up and went to medical school overseas and then came to the U.S. for medical residency (along with many others), I find some of this baffling. Let’s start first by agreeing that, yes, the U.S. health care system has big problems. But then, what health care system doesn’t? I’ve seen first-hand the systems in many countries, including the United Kingdom, Australia, and India, and am yet to find one which is perfect. The U.S. health care system compared with other Western nations probably struggles most with inequity and access. Yet at the same time, U.S. hospitals are undoubtedly some of the most advanced in the world. To balance out all the negative that we hear about, I’d like to point out 5 things that make U.S. health care — and particularly hospitals — great:

1. Rapid access to what you need. When you are in hospital, whatever you need is easily accessible and you are more likely to get a rapid diagnosis than in most other countries. Whether it’s a scan, specialist opinion, or other invasive treatment, U.S. hospitals will get what you need quickly, often within hours.

2. Patient choice and empowerment. Being patient-centered is more than just a buzzword. It’s the reality all across the nations’ hospitals. Patients are empowered to ask questions, seek second opinions, and if needed, complain, to an entity that will listen to them. This is not the case in many nationalized systems that adopt a more paternalistic approach. Along the same lines, we take it as a given that we have choice as to what hospital we go to and which doctor sees us.

3. Comfortable environment. Hospitals are more comfortable and accommodating than almost anywhere else in the world. It’s not uncommon in other developed countries to have a dozen or so patients in a single large room. Some industrialized countries still struggle with separating male and female patients into different rooms, a basic matter of dignity denied. While we still want to make hospitals even better, for instance with less noise and more palatable food, let’s not forget how far ahead we are too.

4. Statistics. A lot of the endemic chronic diseases in society are ironically a consequence of the wealth of the country, such as overeating and lack of exercise (everyone has a car, so why walk?). A case perhaps of your biggest strength also being your biggest weakness. Casting aside the bad statistics, which can certainly improve, did you know that the U.S. has some of the best statistics in the world for surviving a heart attack, stroke, and cancer? According to one study in Lancet from 2007, American women have a 63% chance of surviving at least 5 years after a cancer diagnosis compared to 56% for European women. For American men, it’s 66% compared to 47% for European men.

5. Research, innovation and entrepreneurship. American university-affiliated hospitals lead the world in research and development. From life-saving medications developed by U.S. companies to procedures such as heart stents, many of the world’s newest drugs and technologies are developed right here, with millions benefiting from them. Talking a little about physician entrepreneurship, many people see this as a double-edged sword. If it leads to inappropriate prescribing, it is of course a bad thing. But when it leads to innovation and cutting edge new technologies and treatments, what’s wrong with physician entrepreneurs? This drive and motivation is lacking in many Western countries with more centralized systems.

Taking things for granted is part of human nature. Does U.S. health care have major problems to fix? Absolutely. The cost of the system is unsustainable in the long term and we have to improve access for everyone. But we start from a good position. Looking at crude health care statistics such as countries’ ranking can sometimes be misleading and skew certain positive and negatives.

I’d like to leave you with one thought that I would challenge anyone who has been to hospitals in other parts of the world to ponder over, and particularly relevant when one of the biggest complaints about U.S. health care is about inequality: A homeless American entering the doors of a hospital with an acute medical issue — be it sepsis, a myocardial infarction, or a stroke — will get better care than a rich person almost anywhere else in the world.

Anyone disagree?

Suneel Dhand is an internal medicine physician and author of Thomas Jefferson: Lessons from a Secret Buddha and High Percentage Wellness Steps: Natural, Proven, Everyday Steps to Improve Your Health & Well-being.  He blogs at his self-titled site, Suneel Dhand.

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  • QQQ

    “Anyone disagree?”

    Nope! You got it right doc! Love everything you said! However the radicals have other ideas for this great country!

    8 Rules for Radicals, by Saul Alinsky

    How To Create A Social State

    1) Healthcare – Control healthcare and you control the people

    2) Poverty – Increase the Poverty level as high as possible, poor people are easier to control and will not fight back if you are providing everything for them to live.

    3) Debt – Increase the debt to an unsustainable level. That way you are able to increase taxes, and this will produce more poverty.

    4) Gun Control – Remove the ability to defend themselves from the Government. That way you are able to create a police state.

    5) Welfare – Take control of every aspect of their lives (Food, Housing, and Income)

    6) Education – Take control of what people read and listen to – take control of what children learn in school.

    7) Religion – Remove the belief in the God from the Government and schools

    8) Class Warfare – Divide the people into the wealthy and the poor. This will cause more discontent and it will be easier to(Tax) the wealthy with the support of the poor.

  • QQQ

    As of today you can collect your $2,500 saving by calling the government switchboard, they are cutting checks today, call 1-888-SUCKER

  • Eric W Thompson

    I whole heartedly agree. Particularly having lived in many countries. In Germany instead of a joint replacement you are more likely to be taught how to live with your condition. Extreme life saving efforts are reserved for the young and not readily offered to the elderly. These and many more tactics save tons of money.
    Go into our top hospitals and see all the non-US residents who come here for serious care. Many from Europe. I felt like asking a few why aren’t they at home with their superior care?

  • lactmama

    Your post is correct – US hospitals can do many things that hospitals in other countries can not do.

    Issue is not the hospitals or doctors. Lets not even discuss staff shortage or strain on the staffs to keep up the high standards.

    Issue is the communication between primary care doctors and specialists in and out of hospitals, and, how the person who is ill can have a cohesive team working to help him/her.

    Inside of the hospital it is not an issue, USA hospitals have always been top tier – it is the outside that counts. Goal of good medicine is to keep people out of hospitals, give preventive information and to use the hospitals when and as needed. Fewer people getting chronic and deadly diseases because they have changed their life styles.

    And last but not least – to have a medical system where every person is guaranteed good medical care and is covered by insurance that is affordable.

  • JW

    I like your post. Thanks for being positive. I think our system gets a lot of things right, especially the first 3 points.

    Things get done faster here, in most contexts we have a choice about where we go and who we see (Medicaid, sometimes Medicare, and HMOs are somewhat exceptional), and hospital standards are generally higher (my area adopted semi-private rooms as the “worst” available long ago, and I read this is the trend nationally… so even a Medicaid patient will have just one roommate.) All of this should impact morbidity and mortality, as well as patient morale.

    The statistics one would have to check: how much of a 5-year survival rate is because of earlier diagnosis? It would make more sense to use mortality due to specific diseases, when comparing between countries (of course remembering that infant mortality is computed differently, so one can’t count unadjusted life expectancy, etc.)

    I think other countries are beginning to catch up with us in innovation. This is not a bad thing unless red tape or cronyism is stifling ours (both real possibilities).

    An important problem that remains is chronic illness in the poor and underinsured. This problem continues even after reforms. The asset test remains a barrier to disabled patients particularly. Low-income assistance is plagued with the ‘donut hole’ medication gap (which is being phased out tortuously slowly), and even higher deductables under the new plans than previously. Recent reform caused it to be harder for low and even moderate income people to access the better hospitals and clinics (i.e. the ones with more kinds of services and higher trauma rating in the ER).

  • JW

    I like your points, but there is an exception to #6 for people with badly-regarded disease labels. This can be fixed with education, however.

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