Is the U.S. headed toward third-world healthcare?

The United States is in denial. It is no longer consistently the best, biggest and brightest light in the world, yet its leaders exhort that cheer nevertheless.

"We have the best healthcare in the world!" How many times has that been claimed by a politician, policymaker or someone else in a leadership role? House Speaker John Boehner made such a declaration just a few months ago, NBC News reports, in response to President Barack Obama's attempt to fix flaws in the federal health insurance exchange, the most jury-rigged way to access healthcare services in the world.

Instead, as the Commonwealth Fund just reported again, the U.S. has the most expensive system of healthcare delivery in the world by a large margin, more than 50 percent costlier than the number two nation, Norway.

Meanwhile, the U.S. ranks dead last in access to services, preventable deaths and healthy living.

Such dire news should command an enormous amount of media attention, but that annual Commonwealth Fund study is all but ignored by everyone except a few policy wonks.

More servings of denial? The New York Times reported over the weekend an epidemic of nonalcoholic fatty liver disease, the result of Americans eating huge portions of unhealthy food. Joel E. Lavine, the chief of pediatric gastroenterology, hepatology and nutrition at NewYork-Presbyterian Morgan Stanley Children's Hospital, equated it to stuffing geese to create foie gras. One patient interviewed had one of the worst cases ever seen--at the age of 13. Gavin Owenby was told to exercise and cut down his sugar intake. But despite experiencing crippling abdominal pains, he said "it's hard."

Gavin lives in a small town in rural Georgia where the availability of cheap junk food will almost certainly continue unabated. The median household income of this town is $26,615--which would make many eligible for health insurance if Georgia had decided to expand Medicaid eligibility or the federal government had filled the income gaps regarding subsidies for purchasing insurance on the exchange. Gavin, molded at a formidable age to engage in unhealthy behaviors, is on his own to make a change. More likely is a future $200,000 liver transplant that will only treat his condition rather than cure it.

Another recent article on the New Yorker magazine website noted that life expectancy in the U.S. had dropped in 1990 from 20th place among the 34 countries that comprise the Organization for Economic Cooperation and Development to 27th place in 2010.

Yet most Americans do not read the New York Times or the New Yorker. Perhaps a tiny percentage of the population read both publications, and I imagine those who do would be looked on with some skepticism and suspicion by everyone else if they admitted such a thing.

That's among the reasons it's a lot easier to say we have the best healthcare system in the world. What un-American party pooper would question a claim like that?

I'd like to think that hospitals, in plotting out their community missions, would play a more active role in educating the American people about the distribution of dollars, the gaps in system-wide performance, care delivered and life expectancy.

To their credit, some hospitals do offer a form of healthy lifestyle encouragement to their patients. However, such programs are completely disconnected from the hard facts of daily life in the U.S.--it's much easier to pick up a bag of chips than get on a treadmill, much easier to label access to healthcare as a socialist plot than to make it accessible, much easier to ridicule the First Lady's vegetable garden than to make it affordable for everyone to buy vegetables.

Moreover, evidence continues to mount that hospital finances are more geared toward preserving the status quo than making the radical changes required to bring healthcare costs and outcomes in line with the rest of the world. This is borne out in the cynical dealmaking between the California Hospital Association and the state's largest labor union, which aborted ballot initiatives that would have capped hospital charges at 25 percent above costs and limited hospital executive pay. Even though both initiatives likely would have been defeated in court, had they passed, it would have communicated to hospitals a desire from their constituents to change their business practices. But Californians will now never get a chance to voice that.

Meanwhile, in doing some recent numbers crunching on hospital pay, I discovered that more than a quarter of the non-profit hospital CEOs in the Tri-State area--New York, New Jersey and Connecticut--are paid more than $1 million a year in base pay and bonuses. The most highly compensated of the entire lot, Steven Safyer, M.D. of Montefiore Medical Center in the Bronx, serves the single poorest Congressional district in the United States.

Talk about a disconnect.

If one out of four CEOs at the not-for-profit hospitals in one of the most populous regions in the U.S. rely on seven-figure paychecks, it becomes difficult to convince them they should cut the price of their care or improve the health of their patients to the point that they stop gracing their doors.

Eventually, though, the cost of care and the poor outcomes will become such a burden that even the most uninformed among us will loudly demand a change. But if that outcry does not occur until the performance of the U.S. healthcare system is in a league with a third-world country, it may be too late to make a difference. - Ron (@FierceHealth)

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