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Coming home for health care
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By Monica Chen : The Herald-Sun
mchen@heraldsun.com
Aug 30, 2007 :
10:46 pm ET
DURHAM -- While skyrocketing health care costs have prompted many Americans to yearn for the socialized medical care of some foreign countries, Cathy Wright, a 53-year-old American resident of France, chose to come to the U.S. for her care.
Wright, who lives in Paris, recently had a hip replacement surgery at Duke University Medical Center for osteoarthritis, a "wear and tear" condition in which the cartilage atrophies and leads to bone and muscle damage.
After hip surgery and bungled recovery in France two years ago, Wright went searching for alternatives and eventually settled on Duke orthopaedic surgeon Scott Kelley.
At Kelley's clinic on 3609 Southwest Durham Drive, equipped with new X-ray machines, computer imaging programs and a gym for physical therapy, Kelley performed a German procedure that minimized muscle damage on Wright.
Two weeks after the surgery, Wright was able to fly back to Paris solo.
In retrospect, Wright said of her first hip replacement, the bungled one, "I'm stubborn and I didn't listen to people who said the only place to do it is in America."
"The French health care system is very good. But for this kind of procedure, America is probably best," she said.
In the nation's ongoing debate over health care, most experts, doctors and patients can agree on the following: The U.S. does high-tech, specialized procedures very well.
After that, the waters get murky.
As Kelley sat in a theater this summer watching "Sicko," he became frustrated with the film's message.
The documentary by controversial director Michael Moore pointed out deficiencies in the U.S. system and the benefits of the French system. In the film, Moore spoke to French citizens, feigning shock that they don't pay anything to receive treatment under that country's universal health care system.
A branch of social security that guarantees treatment to all legal residents, the French system was named the "best health system in the world" by the World Health Organization in 2000.
Even Wright admits it was her French doctors who made the mistake of not mandating physical therapy in her case. The health care system there was not to blame.
"It had nothing to do with insurance. They just believed, as far as I can tell, that no therapy was needed," Wright wrote from France in an e-mail. "There is practically nothing that is not covered by social medicine over here."
Meanwhile in the U.S., 16 percent of Americans in 2005 were uninsured, according to the BlueCross BlueShield Association.
About 2.2 million more people joined the ranks of the uninsured in 2006, according to recent data released by the U.S. Census Bureau.
Kelley said he agrees that the U.S. system has problems, but offers a few caveats.
"My fear is they're going to throw the baby out with the bath water, that they're not going to preserve the elements that are working," Kelley said.
Tertiary care -- or third level of care, the level received by a patient referred from a specialist to a subspecialist --in the U.S. is excellent, Kelley said. What's not working is the high cost of diabetes treatments, cancer screenings and other forms of basic care in this country.
"People shouldn't pay outrageous prices for diabetes medications," he said.
According to BlueCross, the U.S. leads the world in health care spending as a percentage of gross domestic product -- at 16.5 percent.
But spending does not translate into quality care for all citizens. The U.S. ranked 37th out of 191 countries in the same WHO survey that praised the French system.
"The French system for basic care is probably a lot more accessible," said Wright, recounting the experiences of a friend whose wife is diabetic. "That kind of basic care for people to live a normal, healthy life is really lacking in America."
Jonathan Oberlander, an associate professor of social medicine and health policy administration at UNC Chapel Hill, supports universal health coverage that is a combination of public and private plans.
The U.S. does high-tech procedures very well, he said, "But more is not always better. Patients [who] live in high-intensity areas [with more access to special care] do not have better outcomes."
"If you're well-insured, then you have access to some of the best doctors and the latest medical technology in the world. But if not ...," Oberlander said.
According to the Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill, about 76,000 Durham County residents under 65 did not have health insurance in 2005.
The institute ranked Durham 44th among the state's 100 counties in health insurance coverage for children under 18 and 31st among adults under 65.
Wake County had the lowest percentage of uninsured residents in the state among both children and adults and Orange County had the second best state percentage among adults.
The Triangle features a concentration of high-quality care that can be seen in the gleaming new facilities and equipment of the Duke Health System, UNC Healthcare and WakeMed Health & Hospitals, among others.
But Kevin Schulman, a Duke medical professor who also teaches business administration, said he believes the problem with U.S. health care is not one of access to insurance, but of cost.
"Cost is the driver behind the access issue," Schulman said. "If we had 100 percent coverage right now, we'd lock in the world's most expensive health care system."
So what's the solution? More service innovation is key, Schulman said. Open up regulations so that cheaper and more convenient services, such as nurse care at pharmacies, can grab a share of the market.
"Most of the time when you're sick, you don't need the whole breadth of services provided by the Duke emergency room," Schulman said.
As the health care debate has snowballed into the forefront of the public discourse, presidential candidates have begun to propose changes to the current system.
John Edwards, the Democratic candidate from North Carolina, is proposing a universal health care plan to make insurance more affordable and require employers to cover their employees.
Other presidential candidates have followed suit, each proposing alternatives to the current system. Sen. Barack Obama of Illinois, another Democratic frontrunner, has proposed a comprehensive system.
When asked which candidate's plan was the best, Oberlander couldn't say, but added, "If I woke up tomorrow and either one of those were adopted, I'd be happy."
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