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It should come as no surprise that the United States ranked 37th
in a survey of national health systems by the World Health
Organization. This dismal rating comes even though Americans spend
more per capita on health care than the people of any other nation.
A controversy over a lung cancer test provides a window on why
lavish US spending does not necessarily produce better health for
more people.
Lung cancer is the leading cause of cancer deaths, killing
157,000 Americans a year, and the five-year survival rate for those
who get the disease is 14 percent, about where it was 30 years ago.
It would seem obvious that early detection would produce many more
cures, a belief shared by Dr. Claudia L. Henschke of New York, who
has developed a test for that purpose. The controversy over her
work was reported in The New York Times last week.
Smokers and former smokers, those most vulnerable to lung
cancer, are lining up to take the test wherever it is offered, even
though they have to pay the full $295 cost out of pocket. Most
insurers will not cover what they consider an experimental
procedure. Henschke wants to give the test to 100,000 people to
find out whether it actually reduces deaths.
Other physicians are more cautious, remembering their experience
with a cruder, but similar, testing regimen 30 years ago. They
identified more cases of lung cancer, but could not bring about
more cures. In addition, widespread early testing would encourage
more biopsies and surgical procedures. Those costs, far higher than
the test itself, would have to be borne by private or government
health-benefits programs.
Lung cancer is a devastating disease, and Americans have great
faith in the ability of new technology to save lives. While the
medical community is still debating how to proceed with the test,
the likelihood is that it will eventually be offered to many people
and that the costs will be covered by private or government
programs.
However, expenses like these are one reason US health costs are
so high, and why many businesses and individuals find
health-insurance premiums beyond their reach. Forty-four million
Americans are uninsured, thus denying themselves routine check-ups
and other tests that unambiguously save lives.
The World Health Organization, in its report, did not mention
the lung cancer tests. But it does contain at least one bit of
indirect criticism of the US system. ``A set of publicly funded
interventions in the United States cost about $21.4 billion per
year, for an estimated saving of 592,000 years of life (considering
only premature deaths prevented),'' it says. ``Reallocating those
funds to the most cost-effective interventions could save an
additional 638,000 life years if all potential beneficiaries were
reached.''
The United States, being the wealthiest nation on earth, does
not have to reallocate anything to improve health care for its
citizens. It needs to make sure that every citizen is allowed to
participate fairly in the system.
WHO faults the US system for inequity of payment, ranking it
54th in the world. Even when Americans are covered by health
insurance, many have gaps in coverage or have to pay much of their
medical costs out of pocket. If the lung cancer test ever becomes
an accepted procedure, those with litle or no insurance will be the
ones least likely to benefit from it. No wonder that despite its
lavish spending, WHO ranks the United States 24th in the longevity
of its citizens.
Americans are ``early adopters'' of medical technology, in the
words of WHO, as shown by the popularity of the lung-cancer test
wherever it is given. The WHO report ought to be a reminder that
this overreliance on high technology to the detriment of universal
coverage is not the best approach to improving health. Rather, this
country needs to learn what others have long accepted - the
healthiest societies are those that make sure all their members
have fair and ample access to the tools of medical science.
