Appendix 77a - Uncovered

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

Health vs. Wealth

A question in JAMA:

Should the child of a poor American family have the same chance of avoiding a preventable illness or of being cured from a given illness as does the child of a rich American family? The 'yeas' in all other industrialized nations had won that debate hands down decades ago.... In the United States, on the other hand, the 'nays' so far have carried the day.[924]

Some people are less disappointed than others. Richard Lamm, former governor of Colorado, opened an 1998 editorial in JAMA with, "It would be a tragic public policy mistake to give society all the healthcare it wants and almost as big of a mistake to give it all it needs according to today's medical ethics."[925]

Too Sick to Wait

There are over 40 million people with no health insurance in the United States. "If they're really sick," my classmates protest, "they can just go to the emergency room." Even if it is an emergency, in the face of growing hospital and emergency room overcrowding, substantial numbers of patients with serious problems are leaving emergency rooms without being seen. One study of emergency rooms published in JAMA found that half of the patients who left without being seen had problems the triage nurse described as "urgent." During the week of study, patients waited up to 17 hours to be seen.[926] The researchers note, "Most left, quite literally, because they were too sick to wait any longer."[927]

A doctor comments, "you've also got urban hospitals all wanting to buy helicopters so they can fly out to the suburbs to pick up accident victims who are usually Blue Cross-positive."[928]

Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane - Martin Luther King, Jr.

From the book Humanizing Health Care:

The most dehumanized healthcare in the nation is that offered to a black, lower social class convicted criminal, perceived as politically 'radical' or 'militant,' with a diagnosis of mental illness, in a so-called hospital for the so-called criminally insane.

The most humanized healthcare in the nation is that offered to a white, independently wealthy, U.S. Senator of upper-class family origin, hospitalized for minor surgery at the U.S. Naval Hospital in Bethesda, Maryland, at a time when he is chairman of the Senate committee controlling appropriations for the armed forces.[929]

In a study of 29 countries, 22 beat us - the richest country in the world - for lower infant mortality rates. The percentage of African American women with no prenatal care before the third trimester exceeds ten percent and has been rising in recent years. Quoting from the Journal of Consumer Affairs, "Such a phenomenon is beyond comprehension to maternal and public officials in most European countries where early prenatal care is given."[930]

Quoting from the British Medical Journal, "The consistent and repeated findings that black Americans receive less healthcare than white Americans - particularly where this involves expensive new technology - is an indictment of American healthcare."[931] Of the first 100 heart transplants, for example, over 60 of the donors were black, but there was only one black recipient.[932] Even today, blacks are less than half as likely to get angioplasty or coronary artery bypass surgery.[933]

The United States ranks twentieth in terms of life expectancy for women and twenty first of twenty-nine countries in terms of life expectancy for men.[934] White America, however, ranked twelfth in mortality rates (near Italy and Australia), whereas Black America ranked thirty-third (near Romania and Czechoslovakia)."[935]

The average life expectancy for African Americans is 7 years less than that of white Americans and the disparity has increased over this century.[936] From the New England Journal, "Survival analysis showed that black men in Harlem were less likely to reach the age of 65 than men in Bangladesh.... We conclude that Harlem and probably other inner-city areas with largely black populations justify special consideration analogous to that given to natural disaster areas."[937]

The Bottom Line

A 1997 OECD (Organization for Economic Cooperation and Development) study of 29 industrialized nations showed that, "The United States... spent considerably more per capita on healthcare... than any other country.... [Yet] the United States was the only country that still had less than half of its population eligible for publicly mandated coverage." South Africa used to share this distinction with us. "Everyone has the right to have access to healthcare services, including reproductive healthcare, sufficient food and water, and social security" - South Africa's 1996 Constitution.

"Satisfaction With Health Systems in Ten Nations," a study published in the journal Health Affairs in which randomly selected samples of at least 1,000 adults in each country were surveyed. Canada ranked #1, the U.S. came in last.[938]

"Having grown up in a country where healthcare's bottom line was the patient," writes a Canadian born comic, "it's strange to find myself living in a place where the bottom line is the bottom line." "The preconceived notions Canadians have about their doctors - that they are deserving of respect and admiration - go out the window down here because American doctors aren't in practice, they're in business."[939]

Maybe Ralph Does Get It

According to an executive summary by the General Accounting Office - the watchdog arm of Congress - "If the universal coverage and single-payer features of the Canadian system were applied to the United States, the savings in administrative costs alone would be more than enough to finance insurance coverage for the millions of Americans who are currently uninsured."[940]

Of course a national health insurance plan - basically like having everybody on Medicare - would put private insurers out of business. They have bitterly fought any national health insurance initiatives. From an article called "This Business Called Medicine":

The insurance companies here ran a counterattack that made the National Rifle Association look like Bambi.... Their disinformation campaign about the Canadian healthcare system left Americans thinking that a universal system was some sort of socialist plot that would have them on waiting lists for appendectomies and perishing in emergency waiting rooms while welfare mothers got free collagen implants.[941]

"'Socialized medicine' was constantly used by the opposition in an attempt to confuse the provisions of the national health insurance program" - Harry S. Truman.

In one of the finer examples of "propacanada," according to an article in the New Yorker, "Senator Paul Tsongas said that he might be dead today if he had been living in Canada, because the bone-marrow transplant that he needed when he was sick with cancer would have been unavailable there."[942],[943] Not only are more per capita bone marrow transplants actually performed in Canada (0.91 vs. 0.75 per 100,000), but the technology was actually invented there.[944]

Ralph Nader summarizes in Postgraduate Medicine, "Canadians can choose their own doctor or hospital. All healthcare and prescription drugs are covered, and they don't have to worry about deductibles, co-payments, or medical bills of any type."

The Editor-in-Chief counters, "Dear Ralph, I'm sorry. You just don't get it. If healthcare is a right, so should be rice, beans, tomatoes... and other nutritious foods."[945]

Scarcity Is a Myth

Just like empty housing and the homeless and wasting food and the hungry, about 1/3 of all Americans are either uninsured or underinsured while more than 1/3 of all hospital beds lie empty in this nation. "Rationing in the face of shortage of resources would be a tragic necessity," writes the founders of Physicians for a National Healthcare Program, "but rationing in the context of oversupply of resources is morally indefensible."[946]

Eighty-two percent of a thousand U.S. households agree that, "Medical care has become a big business that puts profits ahead of people."[947] Analysts fear, however, that nothing will change in the U.S. because too many people are making too much money off the existing system.[948]

HMOs - next Appendix.



[924] Reinhardt, UE. "Wanted." Journal of the American Medical Association 278(1997).

[925] Lamm, RD. "Marginal Medicine." JAMA 280(1998):931-933.

[926] Bindman, AB, et al. "Consequences of Consequences for Care at a Public Hospital Emergency Department." Journal of the American Medical Association 266(1991):1091-1096.

[927] Kellermann, AL. "Too Sick to Wait." JAMA 266(1991):1123-1125.

[928] Pekkanen, J. MD: Doctors Talk about Themselves New York: Delacorte Press, 1988:271.

[929] Howard, J and A Strauss Humanizing Health Care New York: Wiley, 1975:21.

[930] Journal of Consumer Affairs 26:246.

[931] Bhopal, R. "Spectre of Racism in Health and Health Care." British Medical Journal 316(1998):1970-1973.

[932] Civil Liberties Review 1974(Fall):8.

[933] Gornick ME, et al. "Effects of Race and Income on Mortality and Use of Services Among Medicare Beneficiaries." New England Journal of Medicine 335(1996):791-799.

[934] Anderson, GF. "In Search of Value." Health Affairs 16(1997):163-171.

[935] Health Matrix 127:141.

[936] Bhopal, R. "Spectre of Racism in Health and Health Care." British Medical Journal 316(1998):1970-1973.

[937] McCord C and HP Freeman. "Excess Mortality in Harlem." New England Journal of Medicine 322(1990):173-177.

[938] Health Affairs 1990(Summer):219.

[939] Dusen, LV. "This Business Called Medicine." Canadian Medical Association Journal 157(1997):1724.

[940] GAO/HRD-91-90.

[941] Dusen, LV. "This Business Called Medicine." Canadian Medical Association Journal 157(1997):1724.

[942] Remakus, BL. "On Propacanada." Internal Medicine World Report 8(1993).

[943] New Yorker 20 April 1992:29.

[944] Woolhandler, S and DU Himmelstein. For Our Patients, Not For Profits Cambridge: Center for National Health Program Studies, 1998:110.

[945] Griffin, GC. "Hats and Beds." Postgraduate Medicine 92(1992):15-23, 27.

[946] Woolhandler, S and DU Himmelstein. For Our Patients, Not For Profits Cambridge: Center for National Health Program Studies, 1998:31.

[947] "A Report on a National Survey." Journal of Health Care Finance 23(1997):12-20.

[948] Dusen, LV. "This Business Called Medicine." Canadian Medical Association Journal 157(1997):1724.



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