…and equal mediocrity for all

What a surprise. Seems the much-vaunted US healthcare system (or rather, LACK thereof) just ain’t all that ‘n’ a bag of chips, after all…

Startling research from the biggest study ever of U.S. health-care quality suggests that Americans — rich, poor, black, white — get roughly equal treatment, but it’s woefully mediocre for all.

“This study shows that health care has equal-opportunity defects,” said Dr. Donald Berwick, who runs the nonprofit Institute for Healthcare Improvement in Cambridge, Mass.


The survey of nearly 7,000 patients, reported today in the New England Journal of Medicine, considered only urban-area dwellers who sought treatment, but it still challenged some stereotypes: These blacks and Hispanics got slightly better medical treatment than whites.

While the researchers acknowledged separate evidence that minorities fare worse in some areas of expensive care and suffer more from some conditions than whites, their study found that, once in treatment, minorities’ overall care appears similar to that of whites.

“It doesn’t matter who you are. It doesn’t matter whether you’re rich or poor, white or black, insured or uninsured,” said chief author Dr. Steven Asch, at the RAND Heath research institute in Santa Monica. “We all get equally mediocre care.”

The researchers, who included U.S. Veterans Affairs personnel, first published their findings for the general population in June 2003. They reported the breakdown by racial, income and other social groups today.

They examined medical records and phone interviews from 6,712 randomly picked patients who visited a medical office within a two-year period in 12 metropolitan areas such as Boston, Miami and Seattle. The group conveys a broad picture of the country’s health-care practices.

The survey examined whether people got the highest standard of treatment for 439 measures ranging from common chronic and acute conditions to disease prevention.

Overall, patients received only 55 percent of recommended steps for top-quality care — and no group did much better or worse than that.

Blacks and Hispanics as a group each got 58 percent of the best care, compared with 54 percent for whites. Those with annual household income of more than $50,000 got 57 percent, 4 points more than people from households of less than $15,000. Patients without insurance got 54 percent of recommended steps, just 1 percent less than those with managed care.

As to gender, women came out slightly ahead with 57 percent, compared with 52 percent for men. Young adults did slightly better than the elderly.

There were narrow snapshots of inequality: An insured white woman, for example, got 57 percent of the best standard of care, and an uninsured black man got 51 percent.

“Though we are improving, disparities in health care still exist,” said Dr. Garth Graham, director of the U.S. Office of Minority Health.

Graham pointed to other data showing enduring inequality in care, including a large federal study last year. He also said minorities go without treatment more often than whites, and such people are missed entirely by this survey.

Some experts took heart in the survey’s relative equality. “The study did find some reassuring things,” said Dr. Tim Carey, who runs a health-service research center at the University of North Carolina, Chapel Hill.

But all health experts interviewed fretted about the uniformly low standard. “Regardless of who you are or what group you’re in, there is a significant gap between the care you deserve and the care you receive,” said Dr. Reed Tuckson, vice president of United HealthGroup, which runs health plans and sells medical data.

No time like the present to start implementing a true single-payer system. It might actually make an improvement overall, simply by eliminating fragmentation and ensuring universal access, as it did in Canada.

Never mind all the naysayers trying to convince us that we have it worse because we “lack choice”, or that long wait times are somehow a fault of the system, instead of where the blame really lies (i.e., with government bean-counters who are trying to cut corners so the rich can have a tax break); we Canucks know the true score. People don’t die waiting in the emergency room here, as the scaremongers of the right-wing “institutes” like to claim. Nor is care withheld. It is, however, often delayed, due to a system which has been for years underfunded by a government habituated to right-wing pro-privatization rhetoric. (Read: BULLSHIT.)

This is undeniably out of touch with the public’s wants and needs. We just don’t have the time or the interest, never mind the money, to go doctor-, clinic-, hospital- or insurance-shopping. And moves toward privatization have done nothing but hurt us. We like our system, we understand that if it were properly managed it would work even better, and we know the US would like it too, if it ever got off its duff and actually IMPLEMENTED something like it.

But noooooo…that would be evil, wicked socialism. And we can’t have that, let alone equality AND quality, all at the same time now–can we? No, let’s just let the “market” go on taking care of it…

…or NOT, as the case in fact is.

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