Health Care in America

To the Editor: The Commentary by Slack and Slack,¹ published in the August 2011 issue of Mayo Clinic Proceedings, deserves widespread attention. I have waited for years for someone to point out the fallacy of comparing large (in land mass and population), multiethnic countries such as the United States with small, homogeneous nations when considering the outcomes of medical care.

I appreciated the authors’ use of the phrase, mortal ity “amenable to health care.” Many public figures talk about illness, disease, and death as if these conditions could somehow be expunged from the world, rather than recognizing them as ineluctable parts of the human experience.

One of the 2008 US presidential primary candidates, a person of intelligence and experience, spoke in Minneapolis, MN, about the great cost savings that might come from preventive care and the elimination of chronic disease. In my experience, chronic disease is often the result of successful treatment of acute disease (few people survived a heart attack in my youth), and prevention of one disease opens the door to another. Preventive care may be a good thing to do, but, after the obvious advice (early to bed, early to rise,) has been given, it is unlikely to save money or be inexpensive.

During that same 2008 presidential campaign, Cohen et al² cautioned the candidates that preventive care interventions added to health care costs and, unless focused on population segments at highest risk of the diseases to be prevented, were just as likely to squander resources as treatments directed toward existing conditions. Given the World Health Organization’s recent announcement that chronic ailments, especially diabetes, are increasingly prevalent worldwide,³ there appear to be many opportunities either to benefit humankind through optimal health care or to waste immense resources through well-meaning but misdirected efforts. It is likely that the best solutions will differ from country to country, and identification of those solutions is not so simple as making extrapolations from successful programs in small, homogeneous nations to the rest of the world.

Because it is safe to say that the demand for treatment of existing illness is unlikely to recede, finding funds for preventive care will not be easy. Focusing on mortality and morbidity that are truly amenable to health care and studying the disparities within our own “United Countries” would help ensure that any actions taken within the United States are prudently conceived.