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Context of 'October 5, 2009: Polls: Americans Foregoing Medical Procedures, Skimping on Meds Due to Health Care Costs'

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In an op-ed, the New York Times calls the idea that the US has “the best health care system in the world,” as recently stated by President Bush, or provides “the best medical care in the world,” as recently stated by former New York City Mayor Rudolph Giulani, a “delusion.” “That may be true at many top medical centers,” the Times writes. “But the disturbing truth is that this country lags well behind other advanced nations in delivering timely and effective care.” The Times notes that in 2000, the World Health Organization (WHO) ranked the health care systems of 191 nations. France and Italy were first and second; the US came in 37th. The Times notes a more recent study by “the highly regarded Commonwealth Fund,” which “has pioneered in comparing the United States with other advanced nations through surveys of patients and doctors and analysis of other data”; the latest Commonwealth Fund study put the US last among six highly developed nations (see May 15, 2007). “Other comparative studies also put the United States in a relatively bad light,” the Times notes.
Lack of Universal Coverage - Unlike every other major industrialized nation, the US does not provide universal health coverage. In the US, some 45 million people have no health insurance whatsoever, and millions more suffer with poor coverage. The Times writes, “Although the president has blithely said that these people can always get treatment in an emergency room, many studies have shown that people without insurance postpone treatment until a minor illness becomes worse, harming their own health and imposing greater costs.”
Lack of Access - While citizens of foreign nations often face longer waits before they can see specialists or undergo elective surgery than do Americans in comparable situations, “[t]he real barriers here are the costs facing low-income people without insurance or with skimpy coverage.” However, “even Americans with above-average incomes find it more difficult than their counterparts abroad to get care on nights or weekends without going to an emergency room, and many report having to wait six days or more for an appointment with their own doctors.”
Unfair Disparities - The dichotomy between the care provided to economically well-off Americans and their more economically challenged fellows is worse than in any other industrialized nation. “Americans with below-average incomes are much less likely than their counterparts in other industrialized nations to see a doctor when sick, to fill prescriptions, or to get needed tests and follow-up care.”
Unhealthy Living - The US ranks last among 23 nations in its infant mortality rate—more American children die in infancy than in 22 other countries. “But the problem is much broader,” the Times continues. “We rank near the bottom in healthy life expectancy at age 60, and 15th among 19 countries in deaths from a wide range of illnesses that would not have been fatal if treated with timely and effective care. The good news is that we have done a better job than other industrialized nations in reducing smoking. The bad news is that our obesity epidemic is the worst in the world.”
Varying Quality - The Commonwealth Fund study notes that the US ranks first in providing the correct care for a given condition, and does very well in providing preventative care to its citizens. But it does much worse in coordinating the care of chronically ill patients, in protecting the safety of patients, and in meeting the needs and preferences of patients. Overall, the quality of health care in the US is the lowest among the six nations profiled by the study.
Varying Survival Rates - US citizens live longer than their foreign counterparts with breast cancer, and second-longest with cervical cancer and childhood leukemia. But US citizens rank last or next-to-last in life expectancy for patients with kidney transplants, liver transplants, colorectal cancer, circulatory diseases, respiratory diseases, diabetes, bronchitis, asthma, and emphysema.
Poor Patient Satisfaction - Only 40 percent of Americans are satisfied with the nation’s health care system. Of 17 countries surveyed, the US comes in 14th. The US ranks first in negative public perceptions, with a third of Americans calling for a system-wide revamp of American health care.
Poor Use of Information Technology - American health care providers are years behind their foreign counterparts in their use of information technology, electronic medical records, electronic prescriptions, and more. “This makes it harder to coordinate care, spot errors, and adhere to standard clinical guidelines,” the Times writes.
Conclusion - “With health care emerging as a major issue in the presidential campaign and in Congress, it will be important to get beyond empty boasts that this country has ‘the best health care system in the world’ and turn instead to fixing its very real defects,” the Times concludes. “The main goal should be to reduce the huge number of uninsured, who are a major reason for our poor standing globally.… The world’s most powerful economy should be able to provide a health care system that really is the best.” [New York Times, 8/12/2007]

Entity Tags: Commonwealth Fund, Rudolph (“Rudy”) Giuliani, World Health Organization, George W. Bush, New York Times

Timeline Tags: US Health Care

Researchers for Harvard Medical School and the Cambridge Health Alliance release a report that shows approximately 45,000 Americans a year—122 a day or one every 12 minutes—die as a result of a lack of health insurance and a subsequent inability to receive medical care. The study’s co-author, Harvard medicine professor Dr. David Himmelstein, tells a reporter, “We’re losing more Americans every day because of inaction… than drunk driving and homicide combined.” Lead author Dr. Andrew Wilper, a medical professor at the University of Washington, says: “The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors, and baseline health. We doctors have many new ways to prevent deaths from hypertension, diabetes, and heart disease—but only if patients can get into our offices and afford their medications.” The study also shows that Americans aged 64 and below have a 40 percent higher risk of death than those who have coverage. The study is published in the online edition of the American Journal of Public Health, and released by Physicians for a National Health Program, which favors government-backed or “single-payer” health insurance. In 1993, a similar study showed those lacking insurance had a 25 percent higher risk of death. In 2002, the Institute of Medicine estimated that around 18,000 Americans a year died because they lacked coverage. Himmelstein says the sharp rise in risk is due to the swelling ranks of the uninsured. Around 46.3 million people in the United States lacked coverage in 2008, according to the US Census Bureau, an increase over the 45.7 million figure from 2007. Another factor is the dwindling resources where the uninsured can receive care. Public hospitals across the country are either denying uninsured people any care at all, or restricting the care they offer. Co-author Dr. Steffie Woolhandler says the findings show that without proper care, uninsured people are more likely to die from complications associated with preventable diseases such as diabetes and heart disease. The National Center for Policy Analysis, a conservative think tank, calls the study flawed; a spokesman for the Center says: “I think you can’t trust the results. Having said that, we ought to do something for the uninsured.” Woolhandler says the study followed similar protocols to those used by earlier government and private studies. “For any doctor… it’s completely a no-brainer that people who can’t get health care are going to die more from the kinds of things that health care is supposed to prevent,” she says. “Historically, every other developed nation has achieved universal health care through some form of nonprofit national health insurance. Our failure to do so means that all Americans pay higher health care costs, and 45,000 pay with their lives.” [Reuters, 9/17/2009; Harvard Science, 9/17/2009; CBS News, 9/17/2009]

Entity Tags: David Himmelstein, American Journal of Public Health, Cambridge Health Alliance, Steffie Woolhandler, National Center for Policy Analysis, Andrew Wilper, Harvard Medical School, Institute of Medicine, Physicians for a National Health Program

Timeline Tags: US Health Care

A poll by the nonpartisan Consumers Union finds that many Americans are having so much difficulty affording their medical care that they routinely put off doctors’ visits, forego medical tests, forego medical procedures, skip filling prescriptions, and take expired medications to save money and limit expenses. According to the poll, 51 percent of Americans have “faced difficult health care choices in the past year,” and 25 percent cannot afford their medical bills or their medications. Another poll, by Ipsos and McClatchy News, finds that 53 percent of Americans favor a public health insurance plan “to make sure all Americans have access to quality health care,” and 42 percent believe that sufficient changes could occur without a public plan. The Consumers Union poll finds that 28 percent of Americans have either endured cutbacks in their medical coverage or lost their coverage entirely in 2008 alone, with the trend widespread among differing income groups. Around 66 percent of respondents who make below $50,000 a year say they have cut back on their health care due to costs. [Consumers Union, 10/5/2009; McClatchy News, 10/7/2009]

Entity Tags: Ipsos, McClatchy News, Consumers Union

Timeline Tags: US Health Care

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