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Why do we tolerate our immoral and ineffective health care system?

by: desmoinesdem

Tue Nov 18, 2008 at 14:12:47 PM CST


Via nyceve at Daily Kos I learned about a new study called "Class and Race Inequalities in Health and Health Care." The three authors found that very few Americans lacking health insurance receive organ transplants, although the uninsured often become organ donors.

Eve's diary includes a link to the full report in pdf format and summarizes one of its findings:

Strikingly, lack of insurance was a stronger predictor of organ donation than was any hospital characteristic or demographic factor other than age (older people's organs are more often diseased and unsuitable for transplantation).

Why are the uninsured more likely to become organ donors? Could it be that more of them are dying prematurely?

The authors explain in the introduction why they embarked on this research project:

   "In September of 2005, one of us (Herring), then a third-year medical student, cared for a previously healthy 25-year-old uninsured day laborer who arrived at the emergency department with rapidly advancing idiopathic dilated cardiomyopathy.
   The patient was ultimately deemed unsuitable for cardiac transplantation. The decision on transplantation was driven, in part, by realistic concern about the patient's inability to pay for long-term immunosuppressive therapy and to support himself during recovery. Absent such resources, the likelihood of a successful outcome is compromised. The clinicians caring for him faced a wrenching dilemma: deny the patient a transplant, or use a scarce organ for a patient with a reduced chance of success. He died of heart failure two weeks after his initial presentation. This tragedy inspired us to examine data on the participation of the uninsured in organ transplantation, both as recipients and as donors."

Yes, you read that correctly. The patient was rejected for a heart transplant in part because, lacking health insurance, he was deemed unlikely to be able to buy the immunosuppressing drugs he would need to survive with a new heart.

Republicans scream about "socialism" and "rationing," as if health care is not rationed every single day in this country. Maybe one of my Christian conservative readers can explain why it was ok to deny this young man a heart transplant. If his job had provided health insurance, he might have gotten that heart and be alive today.

Speaking of health care rationing, I learned from this MyDD diary that the academic journal Health Affairs recently published a study comparing care for chronically ill patients in eight countries (Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States).

Click here to read the study, which found that "Chronically ill U.S. patients have the most negative access, coordination, and safety experiences." I've excerpted some passages:

Asked about experiences, U.S. and German patients were significantly more likely than patients in the other countries to report wasted time because of poorly organized care. [...]

The United States stands out in patient costs, with 41 percent reporting that they spent more than $1,000 out of pocket in the past year. [...]

U.S. chronically ill adults were by far the most likely to report forgoing needed care because of costs. More than half (54 percent) reported at least one cost-related access problem, including not filling a prescription or skipping doses, not visiting a doctor when sick, or not getting recommended care (Exhibit 2). [...]

U.S. patients were significantly more likely than those in other countries to report that medical records or test results were not available during a scheduled visit or that tests were duplicated unnecessarily. One-third of U.S. patients reported at least one of these experiences--a rate 30 percent higher than in any other country. [...]

U.S. uninsured adults were significantly more likely than those insured all year to go without care because of costs and to wait when sick. Remembering that all in this study have chronic (often multiple) conditions, a disturbingly high 82 percent of the uninsured did not fill a prescription, get recommended care, or see a doctor when sick because of costs. Uninsured chronically ill adults were also more likely than those with insurance to report errors as a result of higher rates of delays in hearing about abnormal lab tests and wrong-dose/ wrong-medication errors. Not surprisingly, given these experiences, the uninsured were also more negative about the U.S. health system than insured adults were.

Still, the experience of fragmented and inefficient care in the United States cuts across insurance status. Insured and uninsured chronically ill U.S. adults reported similarly high rates of coordination concerns (duplication and records/tests not available) and perceptions of excess care or time wasted because of poorly organized care.

Although insured U.S. adults fared better than the uninsured, they were still more likely than their counterparts in other countries to forgo care because of cost and to encounter poor coordination. Their perceptions of waste, patient-reported errors, and negative system views also remained at the high end of the country range. [...]

Repeating patterns observed in earlier surveys, the United States continues to stand out for more negative patient experiences, ranking last or low for access, care coordination/efficiency, and patient-reported safety concerns. The percentage of chronically ill U.S. adults who reported access problems, errors, delays, duplication, and other symptoms of poorly organized care was two to three times the level reported in the lowest-rate countries in the survey (a 20-30 percentage point spread). Along with Canadians, U.S. patients were also the most likely to indicate a primary care system under stress--lack of rapid access, difficulty getting care after hours, and high ER use.

Americans spend a higher percent of our gross domestic product on health care than any other industrial democracy, yet we don't get good value for money. It's worst for the uninsured, but as the above study found, even chronically ill patients with health insurance reported more problems with health care access than comparably ill patients in other countries.

I hope Congressional Democrats are serious about making big changes to our health care system, because the status quo is immoral and unacceptable.

UPDATE: More evidence that our current rationing of health care is immoral can be found in this diary by nyceve: "Many uninsured Americans endure terrible physical pain."

desmoinesdem :: Why do we tolerate our immoral and ineffective health care system?
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