01/12/2014 09:01 am ET Updated Dec 06, 2017

America's French Laundry Health Care Problem: Your Sunday Conversation

Thomas Northcut via Getty Images

It's often argued that nothing needs to be fixed with the American health care system, because it is the best in the world. The argument I lay alongside that is that the best tasting menu -- at least according to Anthony Bourdain, a man with whom I wouldn't recommend you trifle -- is at French Laundry in Yountville, Calif.

And yes, there are definitely things I wouldn't "fix" about either. But no one needs French Laundry in order to live, although if millions of Americans suddenly developed the emergent need to have Thomas Keller's black trumpet mushroom pain perdu in order to stay alive, it would become rational to advocate that normal human Americans receive easy and affordable access to it.

Of course, the truth is that the American health care system is not as good as all that. Here's Sarah Kliff, riffing on a chart from a recent Journal of the American Medical Association study titled, "The Anatomy of American Health Care":

The bubbles with numbers greater than one mean the United States is losing more life to a particular condition than the average member country in the Organization for Economic Cooperation and Development. A bubble with a number less than one means Americans are losing fewer years of life, although you don't see many of those, because, in every category measured in 2008, the United States did worse than average.

anatomy of american health care

Americans lose three times as many years of life to infectious diseases as the average OECD country and lose twice as many years to metabolic diseases. There are some categories in which America used to lose fewer years of life than other countries back a few decades ago. But, ever since the 1980s, that hasn't happened.

Nevertheless, the way some of us experience the American health care system can leave us with the impression that it is, truly, great. I sure felt that way not long ago, when I ended up having to spend the night at my local hospital when a nasty bacterial infection in my respiratory system aggravated a so-called "pre-existing condition." The care I received was first rate, the room private and clean, the service swift, and at times, it really felt like there was a team of people at my beck and call. It wasn't the sort of health care that our beloved American oligarchs get, to be sure. But it still seemed like I was Lord Grantham up in that piece, and more to the point, it felt like a bargain for someone like me.

And that, right there, is where the "best health care in the world" illusion comes into play. Privilege determines so much about your health care outcomes, and not just the precise amount of access and the exact level of health care quality. And when you consider the sort of people who sit on TV and nod along with a person insisting that American health care is the greatest in the world without even a crack in their credulous mask, you can see how this myth has become an accepted truth. If privilege tells the story of American health care, that's the way it's going to be depicted.

So let's take a look at some timely, alternative stories. Adrianna McIntyre cites a recent study in Health Affairs that gives a snapshot of how just being poor, in and of itself, can drive the need for medical care. The study's authors took a look at "temporal trends in the incidence of" the low blood-sugar levels traditionally associated with conditions like diabetes, and found that low-income individuals -- people for whom things like SNAP and Social Security are major factors in their overall resources, from month to month -- can enter health danger zones just because of what day of the month it is. Per the study's abstract:

One in seven US households cannot reliably afford food. Food budgets are more frequently exhausted at the end of a month than at other points in time. We postulated that this monthly pattern influenced health outcomes, such as risk for hypoglycemia among people with diabetes. Using administrative data on inpatient admissions in California for 2000-08, we found that admissions for hypoglycemia were more common in the low-income than the high-income population (270 versus 200 admissions per 100,000). Risk for hypoglycemia admission increased 27 percent in the last week of the month compared to the first week in the low-income population, but we observed no similar temporal variation in the high-income population. These findings suggest that exhaustion of food budgets might be an important driver of health inequities.

Another recent study conducted by the Center on Society and Health at Virginia Commonwealth University and the Robert Wood Johnson Foundation found that the quality of one's education plays a huge role in health care outcomes as well:

While overall life expectancy has increased throughout the industrialized world, Americans without a high school education are being left behind. In fact, life expectancy is now decreasing for whites with fewer than 12 years of education - especially white women. Additionally, lower rates of education tend to translate into much higher rates of disease and disability, and place greater strains on mental health.

Overall, people with less education face a serious health disadvantage. They are:

--Living shorter lives. In the U.S., 25 year-olds without a high school diploma can expect to die 9 years sooner than college graduates.

--Living with greater illness. By 2011, the prevalence of diabetes had reached 15 percent for adults without a high school education, compared with 7 percent for college graduates.

It gives one pause, to start having these sorts of conversations about health care. These days, we're only pretty used to having one sort of conversation -- and that's about Obamacare, and how soon it will mean an affluent politician (or group thereof) might lose their seat in Congress and have to go work (I'm using the term "work" very loosely) for a private equity company or K Street outfit. And remember, if Obamacare works (probably using the term loosely there, too), it only really mainly deals with access and some amount of cost control.

For many Americans -- most, even -- the quality of health care will remain well outside the illusory "best in the world" bubble, owing to economic dislocation, education and other factors. At some point, we need to have those sorts of conversations as well.


Also this week ...

WILL THIS STORY BE IGNORED?: If I recall correctly, the whole Deepwater Horizon disaster made a lot of news, right? Well, we'll see if 300,000 West Virginians without drinking water because of a chemical spill, courtesy of Gary Southern and the idiots at Freedom Industries (the name of this year's BP) merit any mention today. I am guessing no. Here's more from Aaron Bady of The New Inquiry.

SUNDAY SHOW MEME WATCH: Watch for the emerging conventional wisdom: "Chris Christie is sooooo lucky! Scandals are great for politicians!"

You'll hear a lot of people Sunday badly bastardize the old "whatever doesn't kill you makes you stronger" adage, and insist that New Jersey Gov. Chris Christie (so long as he is not lying) is going to become a "better" or "more presidential" person for having undergone this stupid bridge-closure scandal. The questions you'll want to keep in mind are: 1) "Really? You mean to say that Christie wouldn't be a million times better off if this had never happened?" and 2) "What about all the politicians who don't get involved in scandals? Shouldn't we respect them more? Are they suckers?"

You'll also hear what Christie is going through called "adversity." Come on now, son! Adversity is what you experience when you take on a challenge in the hopes that you'll be better for the experience. It's the rough roadblocks that life throws in your way as you're trying to live it. Adversity provides you with character building lessons, that you hand down to other people so that they have an easier time in their lives. This bridge closure nonsense isn't "adversity." It was completely avoidable. It wasn't a well-intentioned plan that went sideways. It wasn't a mess that was made because some process turned out to be too complicated, or someone missed a phone call or misread a memo. Some people intentionally did something that they knew was wrong and they delighted in the misery they were meting out to innocent parties. To call this "adversity" is to insult anyone who actually had triumphed over adversity.

WHO WANTS OUR NUCLEAR WASTE?: I don't typically write about or read much in the way of energy policy, but a reader, Steve, sends along a piece that really hits a sweet spot with me. Folks in Carlsbad, N.M., are pulling a reverse "not in my backyard." America's nuclear waste? They want it. They're hoping policymakers will take yes for an answer. It's all in this longish read from Forbes' Christopher Helman. In general, nuclear waste disposal is one of the most fascinating and difficult problems we face. The need for safe disposal is unavoidable, the risks of half-assing it are dire, and unlike a lot of other policies, where we talk about "the future" in terms of what's happening 20 years down the road, you measure the "out years" in nuclear waste disposal in terms of eons.

If you've got a story you want to share on Sunday, feel free to drop me a line!

"WHY WOMEN AREN'T WELCOME ON THE INTERNET": I get my share of hate and derangement in my inbox, but it is a vastly different world for women who ply their trade as writers on these here webs. Amanda Hess, writing for Pacific Standard, describes her own harrowing experiences, in one of this week's must-read pieces. Hess writes:

The examples are too numerous to recount, but like any good journalist, I keep a running file documenting the most deranged cases. There was the local cable viewer who hunted down my email address after a television appearance to tell me I was "the ugliest woman he had ever seen." And the group of visitors to a "men's rights" site who pored over photographs of me and a prominent feminist activist, then discussed how they'd "spend the night with" us. ("Put em both in a gimp mask and tied to each other 69 so the bitches can't talk or move and go round the world, any old port in a storm, any old hole," one decided.) And the anonymous commenter who weighed in on one of my articles: "Amanda, I'll fucking rape you. How does that feel?"

Also check out Conor Friedersdorf's companion piece, in which he describes the eye-opening experience of getting to walk in a female writer's shoes.

STOP WORRYING ABOUT "POLARIZATION" AND START WORRYING ABOUT "PARTISAN WARFARE": University of Texas professor Sean Theriault lends his expertise to the Monkey Cage, in an effort to untangle these two concepts from the way they're popularly described by pundits. He puts it well: "The difference between my senators is that when John Cornyn shows up for a meeting with fellow senators, he brings a pad of paper and pencil and tries to figure out how to solve problems. Ted Cruz, on the other hand, brings a battle plan.

ECONOMIC INEQUALITY STORIES: Ben Irwin rounds up "20 Things The Poor Really Do Every Day."

FOR THE PURPOSE OF NERDING OUT: The incomparable IO9 offers up the "The Ultimate Guide to 2014's Science Fiction and Fantasy TV."

[You'll find more Sunday Reads and more on my Rebel Mouse page. What stories mattered to you this week? Drop me a line and let us know what you are reading.]



Health Care Reform Efforts Throughout History