When I was in medical school in Toledo, Ohio, my wife worked in a hospital medical laboratory. Many of her coworkers were the spouses of well paid, union auto workers. My wife used to tell me that her coworkers and their husbands would boast about how much they looked forward to walkouts and strikes. During a strike, the autoworkers got 90 percent of their regular pay and benefits from their union. They looked at strikes as extended vacations.
When I was growing up, my Dad always wanted to own a Cadillac. He never did buy one. He bought Buicks instead because the Cadillac was always just a little beyond his wallet. But to my Dad, a Cadillac represented the pinnacle of automotive prestige. Perhaps because of that, in 1985 when I was a bit older and established in my career, I bought my wife a brand new Cadillac. It turned out to be the worst car I have ever owned. I can’t tell you how many times it left my wife stranded along the roadside or how many hours it spent in the shop. Yes, I know the 80’s were particularly bad years for American automobiles, but let’s just say Cadillac lost a customer forever.
My Dad, a World War II veteran, also used to instill in me that America was the richest and most powerful nation in the world. America was simply the best at just about everything. So it is no surprise as I started to travel the world in my adult life that I took some of those notions with me. The only problem was, my perceptions about America didn’t always jive with what I was actually seeing in other industrialized nations. Whether it was infrastructure like highways, airports and railroads or quality of life indicators like cleanliness, access to healthcare, education, or industrial design, I started seeing cracks in the armor of my American belief system.
During my keynotes at medical conferences these days, my colleagues often chide me when I make statements that while America remains a leader in diagnostics, therapeutics and advanced procedures, we are just about the worst of the worst in our use of information technology in medicine. They get even angrier when I suggest that American medicine is perhaps on a course not all that dissimilar from what happened to General Motors. In essence, we have the most expensive healthcare in the world yet we get failing grades in so many important parameters. Have we become that Cadillac I bought in the 80’s? Overpriced and unreliable?
A couple of reports I came across today on the Internet (this one, and this one) are certainly cause for concern. Compared to six other industrialized nations (Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom) American healthcare is dead last in patient safety, efficacy, access, equity, and population health. Also as outlined in an article published online today in the journal Health Affairs, a 2009 Commonwealth Fund International Health Policy Survey finds that only 46 percent of U.S. doctors use electronic medical records, compared to 99 percent of doctors in the Netherlands and 97 percent of doctors in New Zealand and Norway. And frankly from what I have observed, even that 46 percent number is optimistic. The genuine EMR usage in ambulatory and primary care settings in America is actually much lower. Yes, the ARRA HITECH funding is a good kick start toward getting us on a par with other nations, but we have so far to go and perhaps so little time to remain competitive by almost any measure.
It’s not too late to pull American Medicine out of the fire. I see plenty of initiatives that give me cause for hope. But believe me when I say that the equivalent of Kia and Hyundai are nipping at the heels of American healthcare. Will it take a bankruptcy to get our attention?
Bill Crounse, MD Senior Director, Worldwide Health Microsoft