Multiple studies have shown that health care in America is inconsistent, generally uncoordinated, almost entirely unmeasured, and far too often unsafe.
The death rate can vary by 60 percent for breast cancer surgery between two adjacent hospitals. The death rate can vary by more than 600 percent for heart surgery.
The number of crisis-level hospital admissions for kids with severe cases of asthma can vary by a factor of 10.
The famous Rand studies showed that even though patients with chronic conditions spend over 75% of the health care dollars in America, the American health care infrastructure gets care right for chronic-care patients barely half the time.
Diabetics, alone, consume roughly 32% of the total cost of Medicare, and the American health care infrastructure gets diabetic care consistently right about 8% of the time.
Roughly 2% of the patients admitted to California hospitals have sepsis or get sepsis while hospitalized. For California seniors who die in hospitals, sepsis causes 23% of the deaths. It's the number-one cause of death in California hospitals for patients of all ages. Many other states face similar sepsis death rates, and there is no organized program anywhere in America to bring the number of those deaths down.
No one who looks carefully at the available data on either safety or outcomes will say that American health care is doing the job we need it to do.
Asthma is the fastest-growing condition for kids in America. Asthma is the largest single care expense for young kids. Asthma is the number one cause of death for kids.
The American infrastructure of care gets care right for asthma barely 46 percent of the time.
So what should be done?
We should stop simply hoping that care will get better. We should stop passively and very ineffectively wishing that kids with asthma, or adults with congestive heart failure or diabetes were somehow getting better and more consistent care.
We need to address the issues of care improvement in America with a combination of courage, data and competence.
It can be done. "Health Care Will Not Reform Itself" tells how it can be done. We need to face the facts, understand the shortcomings, and count the heads of people needing various kinds of health care in America to see where we can add the most value in care improvement. And then we need to do what needs to be done to make care better for those patients.
We need to stop doing magical thinking -- hoping that a new tool or a new study will somehow point the way to better care -- and we need to stop hoping that caregivers will somehow notice the new tool or approach and decide for one reason or another to use it.
Wishful thinking and random attempts at care improvement have both obviously been inadequate strategies. We need to recognize the fact that barely 46% of the kids with asthma get right care, and we need to make their care right.
We need to have the integrity to clearly articulate the major problems of American health care, and we need the capability and the commitment to fix those problems.
That is tomorrow's post.
For today, we need to recognize that we spend more money in America on health care than any other country by a factor of two or three -- and we are not getting the consistent, high-quality care we should be getting for all the money we are spending.
Let's recognize that patients deserve to know when their likelihood of five-year survival from esophageal cancer is four times higher if they pick the right care team.
Let's stop pretending that getting chronic care right barely half the time is an acceptable place for American health care to be. And let's do something about it.
We need universal coverage for all Americans, and we need that universal coverage to be set up in a way that directly improves care.
More on that topic tomorrow.
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