A healthy system

The statistics are well known, and are the subject of public consternation by politicians and patients alike. The American health care system is the most expensive in the world, yet compared to their peers in other Organization for Economic Cooperation and Development (OECD) nations, Americans have poorer health outcomes including shorter life expectancy and greater prevalence of chronic conditions.

A cursory review of the literature, or a regular glance at the newspaper will reveal a litany of other concerning facts about the healthcare system and the state of health in America. The gap in life expectancy between the richest and the poorest Americans is growing. Rising rates of chronic disease, particularly obesity, may equate to lives that are less healthy, and possibly shorter than those of previous generations. Although the PPACA has increased the rate of health insurance coverage in the United States, one in four privately insured adults report that it is difficult or impossible to afford their premium.

The “Everything Is Terrible And It’s Getting Worse” article is a regular feature in the health sections of newspapers and in the most lauded medical journals. These articles shine a spotlight on the embarrassing failings of our system, detailing relative mediocrity when compared to our industrialized peer nations. Our healthcare system is very expensive. Our burden or chronic disease is growing. We do not have a system that provides significant support to patients trying to make behavioral or lifestyle changes. We largely have a system that rewards the provision of services, rather than health outcomes. These articles are incredibly important, providing a fresh dose of reality to the populace. Particularly important given the fact that a 2008 Harvard School of Public Health Poll showed that 45 percent of Americans still felt as though the American healthcare system was the best in the world.

Flawed as it may be, the system continues providing the health care for a nation, with many working diligently for innovation and improvement. This is the system for which I am currently being trained. When I graduate, this is the system in which I will be working. When I look at the system, I am certain that significant reform is necessary, but I don’t want to succumb to fatalism or discount the passionate efforts of medical providers, community organizations and public health agencies who strive to promote health. There are many providers who do not see the status quo as acceptable and are working for change.

The American healthcare system remains an incubator for innovation, with providers searching and creating novel methods for treating the most serious and deadly diseases. At Duke we’re using the polio virus to treat glioblastoma and transplanting hands. Through my clinical experiences I have seen patients are treated effectively and with great care. Despite the flaws of the system, cancers are cured, blood is returned to ischemic tissue, violent injuries are stabilized. Many providers, at Duke and across the country, provide meaningful, empathic, judicious and evidence-based care for their patients. It is not enough to merely enumerate the ills of healthcare and health in America, the conversation must move forward. New technologies can augment health disparities—this does not mean that innovation should stop, but rather that the underlying contributors to disparities and barriers to access must be addressed.

Through this column, I hope to explore the current state of the American healthcare system, highlighting inefficiencies and inequities along with innovative and effective initiatives to improve health. What can we learn from the experiences of our peer nations, who achieve superior health outcomes? What is the role of the public health system in the context of a shift in disease burden from infectious to chronic disease? How do we shape a better system that provides safer, more equitable and higher value care? I want to share a bit what working within the system feels like, to provide insight into visceral experiences of birth, death, injury and recovery that comprise life in the clinics and on the wards.

Lauren Groskaufmanis is a graduate student in the school of medicine.