The biggest problem with the U.S. health-care system is that it has long been designed to
respond to illness rather than prevent it. According to an analysis by the Commonwealth
Fund, a foundation that funds health-care research, half of American adults in 2005 did
not receive recommended preventive care, which includes vaccinations1, cancer screenings
and blood-pressure checks. When we do get our cardiac health checked, too often it's
because we've been rushed to the emergency room suffering from chest pains. When we do
get a cancer evaluation, too often it's a diagnosis of advanced disease that has spread
beyond the initial tumor site.
Not only is this a deadly way to practice medicine, but it's also a breathtakingly
expensive one. In 2005 Americans paid out a record 16% of our gross domestic product
for health care - a cool $2 trillion - making us the world's top spender on health care
per capita. You might think we'd be getting some bang for those bucks, but our leading
killer remains what it has been every year since 1900 (with the exception of 1918, when
influenza claimed more lives): heart disease, which kills nearly 650,000 of us each year.
"The reason we rank so poorly is that we don't provide a basic-wellness infrastructure,"
says Dr. Mehmet Oz, director of the cardiovascular institute at the Columbia University
Medical Center and a host on the Discovery Health Channel.
There are a lot of ways to measure the effects of America's after-the-fact health-care
philosophy, but the most telling might be what epidemiologists call preventable deaths.
Certainly, plenty of deaths due to illness are not preventable, but there are many other
conditions that a decent health-care system should be able to detect and fix well before
they become life-threatening. Most of the leading killers in the U.S. - including
pneumonia2, diabetes and stroke - fall into this category. According to a Commonwealth
Fund report issued this year, 101,000 deaths from 2002 to 2003 could have been avoided
with access to timely and effective health care. This rate places the U.S. 19th - last -
among industrialized nations.
President-elect Barack Obama's first challenge in improving the U.S.'s health scorecard
will be to transform this entrenched3 symptom-centric mentality into a more proactive one,
embedding prevention and wellness programs more aggressively into primary care and
ensuring that every American takes advantage of these services by expanding insurance
coverage to pay for them - beginning with mandated4 policies for children. That's a good
place to start, since by many measures, it's kids - particularly the very youngest - who
most need help.
In 2005, the most recent year for which data are available, about 7 babies out of every
1,000 live births in the U.S. died before their first birthday. That rate represents a
2% reduction in deaths from the year before, which continues the steady improvement seen
throughout the 20th century. But globally, it still places us 29th in the world, behind
Cuba and Singapore and on a par with Poland and Slovakia.
It's not just the tragic nature of a dying baby that makes those numbers so terrible.
It's also that infant-mortality rates can stand as a valuable proxy for many critical
features of a health-care system - how accessible basic services such as prenatal care5
and birthing6 are, as well as the quality and affordability of that care. And our rate
exposes a familiar but ugly truth about our system - that those variables change
depending on where you are and who you are. Non-Hispanic black women, for example,
are three times as likely as Cuban-American women and twice as likely as non-Hispanic
white women to suffer the loss of a baby - mostly because of a disparity in access to
birthing and postnatal care. And infant-mortality rates along the two coasts tend to be
lowest, where denser populations translate to greater availability of these services.
The wedge that continues to widen these gaps is insurance; non-Hispanic blacks make up
half our nation's uninsured, which leaves them without access to the regular health
care that can educate mothers-to-be about proper nutrition and pregnancy care. Without
such services, more babies are born in distress and are unable to survive their first
Also driving the infant-mortality rate are women at the other end of the economic spectrum,
who take advantage of reproductive technologies such as in vitro fertilization. Such
procedures boost the chances of multiple births, which in turn increase the likelihood
of premature birth and consequently put babies at risk. From 2000 to 2005, the number
of preterm births increased 9%, and in 2005, about one-third of infant deaths were
directly due to a gestation period of less than 37 weeks.
If deaths at the beginning of life are one critical measure of a nation's health, the
number of years we get before the end of our life is another. Life expectancy in the
U.S. has steadily increased since the early 1900s, from 46 years for men and 48 years
for women to 75 years for men and 80 years for women in 2004. Improvements in sanitation,
innovations in vaccines and antibiotics, and control of infectious diseases account for
much of the gain. But again, not everyone has equal access to these extra years.
Source: TIME magazine of Dec. 1, 2008, pp. 44-47
1. vaccinations - Impfungen
2. pneumonia - Lungenentzündung
3. entrenched - verwurzelt
4. mandated - angeordnet, verpflichtend
5. prenatal care - Schwangerschaftsfürsorge
6. birthing - Gebären, Geburt
1. What is to be understood by 'America's after-the-fact-health-care philosophy'?
2. What are the basics of preventive health care which half of American adults did not
receive in 2005?
3. Why is it that on the one hand Americans are the world's leader of spending money on health,
but on the other hand Americans' state of health is one of the world's poorest?
4. What should be done first if insurance coverage were to be expanded?
5. Why is it that a relatively high percentage rate of infant mortality occurs among American babies?
6. Which group of Americans are the most vulnerable what infant deaths are concerned?
7. Compare the German health system with the American as to preventive care and the number of
On above graphic:
1. What factor contributes to the amount of exercise Americans get?
2. What people suffer most from overweight and obesity?