It’s an election year so one could expect hyperbole in campaign rhetoric, but we need to hold elected officials accountable when they mislead the public about health care. Nurses know the truth. It serves no one well to place a mask over problems and pretend they don’t exist. Issues don’t get resolved when the people who write our laws act as if all is well. Some of our legislators live in an imaginary world where it is acceptable to relentlessly declare that the United States has “the best health care system in the world.” What metrics are they using?
The “best health care system in the world” should have the greatest longevity. We don’t. Our life expectancy is shorter in the U.S. than it is in Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, or the United Kingdom. The “best health care system in the world” should have the lowest infant mortality rate. We don’t. In fact, we have the highest infant mortality rate of the high-income countries. We also rank poorly on birth outcomes and our children are less likely to survive to their 5th
birthday than those other countries. We don’t have the fewest injuries and homicides. We don’t have the lowest rate of adolescent pregnancy & STDs. We don’t have the lowest rate of drug-related mortality, obesity and diabetes, heart disease, chronic lung disease or disability. We lead the high-income countries in some of those indicators.
We don’t have the healthiest population. We don’t have the greatest access to health care. Unlike the rest of the world, we treat health care as a privilege and not as a right and we tie it to employment. Although the Affordable Care Act reduced the number of uninsured, there are still about 33 million people, or about 10% of the population without health insurance. We don’t have the fairest system. The disparities in treatment, morbidity and survival for people of color, for women, for the LGBTQ community, for the poor, for undocumented immigrants, for the elderly, and for children, is well-documented.
The “best health care system in the world” should have the most economically-efficient system. We don’t. The U.S. spends more money on health care than any other country in the world. We spend a larger portion of our GDP on health care than any other nation. But Americans die sooner and suffer more illness. The outcomes do not match the expense. The “best health care system in the world” would also be the safest, but medical error is the third leading cause of death in this country. It is not getting better. Our disease management system is not financially sustainable and does not serve our population. So our elected officials need to work on fixing it instead of perpetuating the illusion that it is “the best health care system in the world.”
The insiders who have the information are the nurses. The 24/7/365 presence in health care is the nurses. The experts they need to listen to are the nurses. The backbone of the entire system needs to be heard. If we are truly to ever have “the best health care system in the world” we need to address nursing’s issues.
Nurses need adequate staffing, better education that actually prepares nurses for practice in the real world, on-the-job apprenticeships before giving new nurses patient responsibilities, safety from workplace violence, reduction in the culture of blame and punitive regulatory schemes that fail to hold organizations responsible for adverse events, an end to the anti-union measures that weaken our collective voices, an end to the focus on “patient satisfaction” that actually endangers patients, an end to the single-minded efforts directed at profit to the detriment of patient and staff safety, and technology that is actually designed for provider ease of use. Most importantly, we need to be heard. As long as nurses are invisible or silent, we will never have “the best health care system in the world” and politicians need to stop saying we do.
For more detailed information, see:
Johns Hopkins Medicine, Study Suggests Medical Errors Now Third Leading Cause of Death in the U.S.
National Academies Press, U.S. Health in International Perspective: Shorter Lives, Poorer Health
The World Bank, Health Expenditure, total (% of GDP)