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What's Right about American Health Care


Jeff Brown, MD, has spent the past few weeks discussing the problems with American health care, but it's time to give credit where credit is due. There's also plenty of good.

You know when you Google some subject and it gives you back 9 jillion responses? Surprisingly, "What's right with American health care" comes back with very little.

As I've enumerated the last few weeks, there is plenty wrong with health care and no end of suggestions as to how to fix it. But we wouldn't be having this protracted discussion unless we all had high expectations to begin with. Let's count our blessings a bit and see how far we have come and why hopes are high for the future.

Contrary to what many people think, most of the big gains in our health and the length of our lives come from public health measures, not from individual medical care, as advanced as it is. Clean water; separate sewage; government regulation of devices (i.e. autos), our workplaces (OSHA), foodstuffs and medicines; fluoridation of drinking water; and improved nutrition through better agriculture and the effective transportation of it have all led to the bulk of our improved status.

The other great area where public health measures have had such an impact on our health and longevity is in public education leading to prevention. We are still struggling here, as we do with all efforts at education, but just look at how well we have done reducing tobacco use, teaching family planning, maternity care and learning to improve our diets. Just our cholesterol numbers, otherwise an abstruse measure, has become part of our culture, even to late night comedians. You may still eat in an unhealthy way, but most of us now know the difference now, unlike in the past.

Next, go down the list to mass immunizations to see where medicine itself has had a direct impact on individuals. It continues to do so, most recently with the first vaccine for a cancer and the HPV inoculation against cervical cancer. We all have high expectations for the future of immunizations, too, such as the near-term worldwide elimination of polio. Unlike the financial industry's famous disclaimer that “Past results do not guarantee future returns,” we have every reason to believe that medical science will continue its impressive results in immunizations, as well as a myriad of other fronts — DNA, perhaps, most notably and hopefully.

Infectious disease was once most of the 10 leading causes of death in the U.S. and it’s still a scourge elsewhere. So, let us not overlook antibiotic discovery and invention. The advent of the “shot of penicillin” and its descendants has played an outsized role in framing Americans’ attitudes about what doctors can do. At the time of its introduction, penicillin was viewed as no less than the poster boy for the “miracle of modern medicine.”

Here are just a few facts to impress: over 100 years, infant mortality is down 90% and maternal mortality is down 99%; in 30 years, workplace deaths are down 40%; over 40 years, coronary deaths are down 50%; tooth decay and loss, are down 50%; and, happily, on and on.

American medicine has also advanced tremendously in the field of trauma response and management. Unfortunately, these advances have been gained at the heavy cost of lives in war, on highways and during urban violence. It is mildly comforting that people are always surprised when a victim of trauma does not do well, let alone survive.

Medical science is ripping along at such breathtaking speed that no one can begin to keep up. As I have written previously, the Library of Congress gets 1,500 new medical studies every day! American research is the standard of the world and is (mostly) given freely to benefit the rest of mankind.

Even our much-denigrated access issues are far less bad than many other countries and access will increase when the Affordable Care Act becomes fully implemented. Our situation is still far from adequate, even President Obama would agree, but we can feel proud that our nation values the health and welfare of our citizens so highly. We are willing to spend 18% of our GNP on it — if too inefficiently, wastefully and not thought through.

Space limits how much we can explore the positive side of our health care situation, for it is vast, and American medicine has a lot to be proud of. There’s also stunning technological advances across broad fronts; a multi-million strong force of highly educated and motivated physicians, nurses and support staff; and we happily could go on and on.

In spite of financial, organizational and political issues surrounding how to best utilize these strong resources, we all have high expectations for further advances. Not a bad place to be, the envy of the world, all things considered.

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