American medicine is the best in the world.
MOST Americans take this statement as an article of faith—so long as they are in good health. Even when they have a bout of illness they feel, for the most part, that they are getting excellent care. But growing numbers of patients, the consumers of American medicine, are asking questions that range from mildly nagging to openly angry.
When the doctor was first called, why did he refuse to make a house call? Did he take too long in making the right diagnosis? Did he prescribe too many drugs before he knew what the real trouble was? Did he pick the right surgeon to operate? Were all those lab tests necessary? Did the surgeon charge too much? Why does a hospital room cost $60 a day, more than the fanciest resort hotel room? Why doesn't insurance cover more of those bills?
Ingenious and Amazing
These questions are asked each year by many of the 130 million Americans who pay 500 million visits to the doctor. For them, the doctors write a billion prescriptions for a total drug bill of some $3.5 billion. Each year, 27 million Americans go into a general hospital, where they spend an average of 8.2 days and get a bill of $530, about half of which is covered by insurance. The total cost of U.S. medical care is now $53 billion a year—5.9% of the gross national product, or 7.5% of all personal income. These figures are far higher than those for other Western countries with at least equivalent quality of care.
Is the U.S. citizen getting a fair shake for his money? For an estimated 25% of the population, the answer is yes. For another 50%, medical care can be described as passable, but it is certainly not as good as it could and should be. For 25%, care is either inexcusably bad, given in humiliating circumstances, or nonexistent. The breakdown is not simply by social stratum: the rich do not necessarily get the best care, nor the poor the worst. Says Dr. William H. Stewart, Surgeon General of the U.S. Public Health Service: "If even one American doesn't have access to a reasonable level of care, there's something wrong. And when millions don't, there's obviously something wrong."
As befits a huge industry, U.S. medicine has an impressive plant, and many of its facilities are indeed outstanding. In research and medical technology, the U.S. amazes and leads the world. A newborn baby with a defective heart can probably get the best care at Manhattan's Lenox Hill Hospital, which operates an elaborate unit exclusively for pediatric cardiology. For surgery on such a baby's heart, U.S. surgeons are preeminent. So are the surgeons who operate on older patients' arteries. For trouble in the brain's arteries, researchers at Columbia-Presbyterian Medical Center have helped to develop a magnetic probe that will swim through the arterial labyrinth and tell the neurologist what he needs to know. At Harvard, surgeons practice knifeless surgery with a proton gun that destroys overactive tissue deep inside the skull. At Massachusetts Eye and Ear Infirmary, ophthalmic surgeons turn patients upside down to let gravity help them in repositioning a detached retina.
Unhappily, such examples of American medical ingenuity do not make American medicine the world's best. They are available to only a few. The U.S. ranks 13th (behind several West European