From the director ... back to the future: a unique view of health reform.

Opponents of President Obama's health reforms are not above misrepresenting the quality of health care in other countries. In my experience, critics of progressive efforts to reform health care are also quick to tout American medical care as "the best in the world." They raise fears that the proposed reforms will make our health care "second rate." Unfortunately, findings from studies comparing health outcomes like longevity and patient experiences in the U.S., U.K. and Europe tell us that our health care is already second rate.

What I have found even more frustrating than such politically motivated distortion of the truth is the willingness of learned policy makers, pundits and even friends to accept at face value unfounded assertions of U.S. health care superiority. To be fair, there clearly has been growing public recognition of a U.S. crisis in affordability and polling data suggests that a growing majority of Americans support universal access. However, I remain concerned that public opinion can still be too easily swayed. Opponents of reform have already confused the national debate by implying that the President's plans, which would require a role for government in prioritizing research and technology development, will result in denial of care to sick people.

In a recent essay, "Medical Progress--Unintended Consequences" Daniel Callahan PhD, president emeritus of The Hastings Center, a well regarded bioethical think tank, describes American culture as having a long and unique romance with medical research and new technology. Few new medical technologies are ever assessed for their comparative effectiveness, safety and cost. But that does not seem to deter their enthusiastic adoption by doctors and patients alike.

A British oncologist was asked by the authors of a 1984 book on rationing of medical care why chemotherapy of unproven benefit was used in the U.S. at rates far in excess those in the U.K. His response: "Americans confuse activity with progress."

The various "wars" on disease over the last decades have been fought with huge investments in research and new technology, some of which have managed to prolong survival, but have mostly failed to produce curative victories. As a result there are growing numbers of people now living with unremitting chronic disease that years ago would likely have been fatal.

Most experts agree that our health care system generally does a poor job of taking care of such patients. To complicate matters further, many have multiple chronic conditions requiring multiple treatment regimens. To address this serious and growing problem, Callahan suggests redirecting significant research funding away from its current focus on cures towards finding ways to more effectively co-ordinate medical care and better integrate social and family support for people living with chronic disease.

Callahan's essay offers a unique perspective on the current national reform debate. He concludes by calling on policy makers to reexamine how we as Americans value and define medical progress. "Serious progress would mean turning back the clock: learning to take care of ourselves, to tolerate some degree of discomfort, to accept the reality of aging and death (not to mention the near-death experience of erectile dysfunction) and to see our personal doctor as someone as likely to talk with us as to have us scanned. That cluster of backward-looking ideas is what I think of a common sense, affordable progress."

His advice merits serious consideration by us all.

Arthur A. Levin, MPH, Center for Medical Consumers [c] 2009

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