PsychMD said:
The article may have been freely accessible the day it was published, but now it seems to require a paid subscription to acces (not just a simple registration to the site). I would have liked reading it, but, too bad it's not free anymore...
Yes, I noticed that. Here it is...
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Die in Britain, survive in the US
Which is better American or British medical care? If a defender of the National Health Service wants to win the argument against a free market alternative, he declares, You wouldnt want healthcare like they have in America, would you?
That is the knock-out blow. Everyone knows the American system is horrible. You arrive in hospital, desperately ill, and they ask to see your credit card. If you havent got one, they boot you out. It is, surely, a heartless, callous, unthinkable system. American healthcare is unbridled capitalism, red in the blood of the untreated poor.
For goodness sake, the American system is so bad that even Americans plenty of them anyway, if not all want to give it up. They want something more like the Canadian system or our own National Health Service. That is what Hillary Clinton wanted and there are still plenty of people like her around. Tony Judt, in a recent edition of the New York Review of Books, was damning about American medical care and glowing about European healthcare. Think of all the money that is wasted in America invoicing patients and administering lots of separate, independent hospitals.
At the same time, we cant help being aware that back here in Britain the NHS is not exactly perfect. The waiting lists have come down, according to the government. They have probably come down somewhat in reality, too. But they still exist and, come to that, there is the worryingly high incidence of hospital infections. So is British healthcare better than American? Or the other way round? And how do you judge?
Lets try the simple way first. Suppose you come down with one of the big killer illnesses like cancer. Where do you want to be London or New York? In Lincoln, Nebraska or Lincoln, Lincolnshire? Forget the money we will come back to that where do you have the best chance of staying alive?
The answer is clear. If you are a woman with breast cancer in Britain, you have (or at least a few years ago you had, since all medical statistics are a few years old) a 46 per cent chance of dying from it. In America, your chances of dying are far lower only 25 per cent. Britain has one of the worst survival rates in the advanced world and America has the best.
If you are a man and you are diagnosed as having cancer of the prostate in Britain, you are more likely to die of it than not. You have a 57 per cent chance of departing this life. But in America you are likely to live. Your chances of dying from the disease are only 19 per cent. Once again, Britain is at the bottom of the class and America at the top.
How about colon cancer? In Britain, 40 per cent survive for five years after diagnosis. In America, 60 per cent do. With cancer of the oesophagus, survival rates are low all round the world. In Britain, a mere 7 per cent of patients live for five years after diagnosis. In America, the survival rate is still low, but much better at 12 per cent.
The more one looks at the figures for survival, the more obvious it is that if you have a medical problem your chances are dramatically better in America than in Britain. That is why those who are rich enough often go to America, leaving behind even private British healthcare. One reason is wonderfully simple. In America, you are more likely to be treated. And going back a stage further, you are more likely to get the diagnostic tests which lead to treatment.
Fewer than one third of British patients who have had a heart attack are given beta-blocker drugs, whereas in America 75 per cent of patients are given them. In America, you are far more likely to have your heart condition diagnosed with an angiogram a somewhat invasive but definitive test. You are far more likely to have your artery widened with life-saving angioplasty. In Britain not very long ago, a mere 1 per cent of heart attack victims had angioplasty. In America you are much more likely to have heart by-pass surgery. In 1996 British surgeons performed 412 heart by-passes for every million people in the population, less than a fifth of the 2,255 by-passes per million performed in the United States. America has many more lithotripsy units for treating kidney stones 1.5 per million of population compared with 0.2 in Britain.
It is true that in America they overdo the diagnostic tests. In one hospital they did a CT head scan on absolutely everybody who came in complaining of a headache. Even some of the doctors began to think this might be over the top when they realised that only in 2 per cent of cases was anything found. But in Britain the problem is the other way round. Having any diagnostic test beyond an X-ray tends to be regarded as a rare, extravagant event, only to be done in cases of obvious, if not desperate, need.
Peggy, an American radiologist, came to Britain to meet her English boyfriends family. A pall fell over the visit when the boyfriends father found blood in his urine. He went to the local NHS hospital. Peggy knew that blood in the urine could mean something worryingly serious or could be utterly minor. A few tests could make things clear: a CT scan or cystoscopy for example. That would be routine in the US. But no such tests were done by the NHS hospital in Welwyn Garden City where the father was a patient.