Are we getting our money's worth for medical care?

    Guess where the U.S. ranks in life expectancy?  45th, according to recent data, behind Bosnia and Jordan.

    In infant mortality?  We're last among developed countries.

    The Commonwealth Fund, a health-care research group, ranks the U.S. last among major industrialized nations in health care quality, access and efficiency.  We've talked in other weblog entries about how the lack of universal coverage affects even those who have excellent insurance:  for just one example, the average waiting time in US emergency rooms for potential heart attack patients has almost tripled in the past ten years, as ERs  have become clogged with uninsured patients with inadequate primary care and hospital beds are allocated to remunerative elective surgery.

     While many have blamed malpractice litigation for the cost of medical care in the U.S., knowledgeable experts know that malpractice litigation is only a small part of the equation:  they blame the system of remuneration we use to compensate for medical services.  As third-party payors keep ratcheting down the payment for various services, the only way for an ambitious health care provider to increase his or her income is to provide more services.  As a result, experts like Dr. Sandeep Jauhar, a cardiologist on Long Island, argue that physicians succumb to the demands of patients or their families' to turn over every stone-- to find answers or exclude potential problems--even if additional testing or care is neither necessary nor appropriate.  Universal health care systems pay for results--or for "showing up", you could argue.  Our market system pays for activity--whether it is useful or not--and efforts by auditors to assure that the activity is appropriate merely add an additional significant layer of expense to the entire system.