Over the last half-century, medical science has dramatically improved throughout the world. Although costs have risen in all western countries as new technologies have been widely adopted, costs in the United States have risen much more than they have in any other country. Despite using fewer resources (eg, numbers of physicians and nurses, hospital beds) than do peer countries, per-capita spending on health care in the United States is double that in similar countries. The major driving force behind this difference is that we in the United States pay much more for the same products and services. There is no evidence that this increased spending gives better outcomes. Neither the general public nor doctors are happy with our current health care system. Subsequent articles will discuss the components of our system and how they are failing and how they can be improved.
Looking at US health care in 2019, to paraphrase Charles Dickens, we live in the best of times and we live in the worst of times. Science has made extraordinary advances. I remember as a child growing up in Montreal having all the public swimming pools closed because of polio epidemics. As a resident at the Massachusetts General Hospital in the late 1960s and early 1970s I cared for patients with myocardial infarctions by putting them to bed for several weeks with a lidocaine drip to prevent premature ventricular contractions. We routinely did staging laparotomies to guide therapy of Hodgkin disease. Over the ensuing 5 decades, diagnostic and therapeutic technology has dramatically improved. Polio is on the verge of extinction thanks to vaccines. Prompt angioplasty lets patients suffering an acute myocardial infarction go home the next day. Computed tomography scans have replaced laparotomies. Over the same time, something important has been lost. Health care has more and more become an industry in which the needs of patients take a back seat to corporate profits. Some months ago, when I booted my computer, MS News asked me to take a survey. There was only one question: “How do you view the current US health care system?” The results of this admittedly unscientific survey were revealing. Of the more than 500,000 responses tabulated when I looked, 3% looked at the US health care system very positively, 27% positively, 48% negatively, and 22% very negatively. Nor is only the general public disenchanted with our current health care system. Burnout has become epidemic among physicians. A Mayo Clinic article quoted a 54% rate of burnout among physicians, almost double that in other occupations.1
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-Edward P. Hoffer, MD, FACC, FACP, FACMI
This article originally appeared in the June 2019 issue of The American Journal of Medicine.
