More Bad Grades for U.S. Healthcare

A new report from the Commonwealth Fund shows some serious slippage and a few improvements

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Anyone who's had to use our healthcare system lately will not be surprised to learn that a performance scorecard released this week found several areas in need of improvement. Access to care is one example. In that category, the Commonwealth Fund report gave the United States a score of 58 out of 100 in 2008, nearly 10 points lower than in 2006, when the first national scorecard was released. That's in part because last year, 42 percent of adults—some 75 million people—were either uninsured or underinsured, the report found, compared with 35 percent in 2003.

Overall, the country scored a 65, down slightly from 67 in 2006, based on indicators in five areas: healthcare outcomes, quality, access, efficiency, and equity.

Other failings the report highlighted: Only half of all adults receive recommended preventive care and screenings. And the United States ranks last among industrialized countries at preventing premature deaths from preventable causes like heart disease and diabetes, which I wrote about earlier this year.

But the study also showed that when we put our minds to addressing problems, scores improve. The national emphasis in recent years on hospital safety has contributed to a 19 percent improvement in hospitals' ratios of actual deaths to the number that would be expected based on the severity of patients' conditions and other factors. Hospitals also have made strides at making sure that patients with heart attack, heart failure, and pneumonia get the recommended care. "What gets attention gets improved," Cathy Schoen, senior vice president at the Commonwealth Fund, said at a briefing announcing the scorecard results. However, she noted, "To date we have focused too narrowly."

The upcoming presidential election presents an opportunity for change, as the report points out. But will it happen? On Tuesday, I attended an event sponsored by Rutgers Business School's pharmaceutical management program at which the top healthcare advisers to both campaigns discussed the candidates' plans for healthcare reform. Obama adviser David Cutler, a Harvard University economist, described Obama's plan to achieve near universal coverage by creating health insurance exchanges that can't turn sick people away or charge them more. McCain adviser Gail Wilensky, an economist and senior fellow at Project HOPE, presented McCain's plan to remove the favorable tax treatment on employer-sponsored insurance and provide tax credits to make coverage more affordable. (For more details, check out the story I wrote this spring about the candidates' proposals.)

At the outset, moderator Susan Dentzer, editor-in-chief of the journal Health Affairs (and a former U.S. News writer) promised that anyone hoping to get splattered by a little mud that day would be disappointed. She was right. But the discussion was so darned dispassionate that it was hard to make the connection between the candidates' lofty proposals and the reality that people are literally dying because they can't get the healthcare they need. As I rode down in the elevator with two attendees, one of them said to the other, "I wanted to be inspired. But instead it was a lot of rhetoric, no good answers, and it was boring." Candidates, take note.