August 15, 2009

Amenable Deaths and Political Power

Within the confines of the debate over health care reform, one of the most important justifications for moving to a public option is routinely obscured by anecdotes of long waits for treatment in Canada or England or (horrors!) France. Namely, just how poorly the health care system of the United States stacks up against those of other industrialized nations. As I noted in a previous post:
The United States spends far more per capita on health care than any other industrialized nation. Yet for all of that expenditure, the U.S. is just 37th in the most recent World Health Organization (WHO) rankings of the world's health care systems, slightly ahead of Slovenia and Cuba, but behind such dynamos as Costa Rica, Dominica, Chile, Colombia, Morocco and Greece. Further, the United States ranks 47th in life expectancy at birth; 29th in infant mortality (down from 12th in 1960); and 14th out of 26 developed nations surveyed for deaths from heart disease. Americans also wait as long or longer for care as people in countries with national health insurance.
Even some of these facts, however, have been tested in conversations I have had on the topic, with questions about how one can possibly compare health care across national boundaries when the lifestyles and dietary habits of Americans, French and Japanese, for instance, are so clearly different. As it turns out, a methodology for doing just that was devised by U.S. researchers in the 1970's; it's called amenable mortality, and it's been used worldwide for the past thirty-odd years.

Amenable mortality captures factors such as children who die younger than age 14 from vaccine-preventable or easily-treatable illnesses like coughs, asthma and measles; adult deaths from breast or colon cancer before age 75 (symptomatic of a lack of timely screens and/or care); deaths from infections or hypertension before age 75 (indicating a dearth of preventative and appropriate care); and the death of diabetics prior to age 50 from complications that can be prevented with proper medical management. These and other indicators are then compiled to create a measure comparable across nations.

So, how does the United States stack up? In the late nineties, two British researchers found that, of the 19 countries they surveyed, the U.S. ranked 15th, behind all but Finland, Portugal, the U.K. and Ireland:

The same researchers followed up five years later, and what they found was even more disturbing. The rates of amenable deaths in all countries had improved, but where all other nations had seen strong gains, the United States had gotten only slightly better. The result? The U.S. now ranks dead last in preventing deaths through accessible, quality health care:

Surely, given this, Americans can't be satisfied with the health care that is available to us as a nation, so what is behind the deep-seated and increasingly fanatic opposition to President Obama's efforts to bring reform? To be sure, there are undoubtedly people who strongly - and in good faith - believe that a single payer or public option system is undesirable. (I have not seen much evidence for that stance, personally, but for the purposes of discussion, let's grant that position, nonetheless.)

What then, to make of the wild and demonstrably untrue claims from Republican political leaders that - among other things - Democratic health care reform will create bureaucratic "death panels" to evaluate the desirability of continuing treatment for the elderly when they fall ill? These assertions - made not only by people of notably dubious intellect like former Alaska Governor Sarah Palin, but respected individuals such as former Republican Speaker of the House Newt Gingrich and allegedly moderate GOP Senator Chuck Grassley - have become part of mainstream discussion, when even cursory examination of the legislation in question indicates that they are wholly and completely... well... lies.

The answer, as Paul Krugman notes in a recent editorial, is political power:
This opposition cannot be appeased. Some pundits claim that Mr. Obama has polarized the country by following too liberal an agenda. But the truth is that the attacks on the president have no relationship to anything he is actually doing or proposing.
And not long ago, some of the most enthusiastic peddlers of the euthanasia smear, including Newt Gingrich, the former speaker of the House, and Mrs. Palin herself, were all for “advance directives” for medical care in the event that you are incapacitated or comatose. That’s exactly what was being proposed — and has now, in the face of all the hysteria, been dropped from the bill.

Yet the smear continues to spread...
Last week, Mr. Grassley claimed that his colleague Ted Kennedy’s brain tumor wouldn’t have been treated properly in other countries because they prefer to “spend money on people who can contribute more to the economy.” This week, he told an audience that “you have every right to fear,” that we “should not have a government-run plan to decide when to pull the plug on grandma."
So much, then, for Mr. Obama’s dream of moving beyond divisive politics. The truth is that the factors that made politics so ugly in the Clinton years — the paranoia of a significant minority of Americans and the cynical willingness of leading Republicans to cater to that paranoia — are as strong as ever. In fact, the situation may be even worse than it was in the 1990s because the collapse of the Bush administration has left the GOP with no real leaders other than Rush Limbaugh.
I believe Mr. Krugman is correct, and that the only solution to enacting true health care reform is to abandon the spurious priority of bipartisanship. It is not needed to pass legislation in either the House or the Senate, and Republicans have made it clear that they are more interested in demonizing Democrats and working against the president using any means available than they are in actually solving this problem. A loyal opposition is important to our system of government; unfortunately, at this point in history - as amply demonstrated by the tactics they have employed - on this issue, we simply don't have one.

For a stark example of just how bad things have gotten in terms of both actual health care in America and the extremism of opposition to reform, be sure to check out this report from Dana Gould on behalf of HBO's Real Time with Bill Maher. [Note: Contains profanity.]

When the only way to bring affordable health care to Inglewood, California is through a Remote Area Medical clinic - something originally devised to serve Third World countries and poor, rural outposts in America like Appalachia - it is clearly time to shut the crazies out.

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