John A. Marcille

I think it started a couple of years ago when I'd heard for the hundredth time that the U.S. has the best health care in the world, just after reading about a study showing that we lagged some other developed nations in some significant area. I put the idea on my tickler list, and finally assigned the story to Martin Sipkoff, a frequent contributor to Managed Care.

And it is a powerful story. Martin assembled the numbers, and if you ever had any doubt, you will no longer doubt that we have problems. In infant mortality, life expectancy, even patient satisfaction — we are not No. 1. In fact, we are No. 1 on few if any scales. Does this mean that we don't have some great thoracic surgeons here, some fabulous cancer clinics? Sure we do. It isn't a question of what we can do, it's what we do. Technology and training are not the issue.

Head on over to Google and do a search for "best health care in the world" and you'll get thousands of hits, most talking about America. At best this is wishful or hopeful thinking. Not one person interviewed for this story, including several HMO medical directors, said we are the best. They mostly have profound concerns about our system.

Personally, I think that if we hadn't moved to managed care 10 to 15 years ago, we'd rank lower today. The story doesn't dwell on it, but the solution is political and social will. Medical technology and training are not the problem. I see laudable movement toward improvement of error-prevention systems, but questionable progress toward universal insurance, which, most of our experts indicate, is needed. That would still leave questions about coordination of care, but it would be something.