The health care delivery system in the Us is broken more ways to Sunday... too many people uninsured, too much burden on employers, not enough preventive medicine, too much spent on unnecessary tests to avoid malpractice claims no computerized medical records... as well as the problems Cohn points out... so chalk up another one for McCain being out of touch with what concerns voters... that and as much time in Iraq as necessary when he himself said we couldn't stay indefinitely before he said we must... The Democrats should get their nominee in place and start taking some of this nonsense on... it is amazing that he still has any image as a reasonable man...

Hmmm.  

I'm a doctor, and as I've noted several times on this site I've spent years working both in the US and in Australia's universally free, public health system.  I support a move to a system of single payer, universal heath insurance in the US, and I consider McCain's assertions that access isn't a problem both false and politically obtuse.  I also think his approach to cost-containment is simple-minded and doomed to failure.  In fact, I rather doubt McCain has any intention about doing anything whatsoever about health care in America.  He's just blowing smoke.  

With that said, I'm not sure that your response focussed upon medical errors and unnecessary treatment is entirely on target.  Medical errors are a big problem, but you'll have to show me some data before you can convince me that they're a bigger problem in the US than in any other country with a comparably advanced health care system.  For sure, if you give more treatment, almost of necessity you'll give more erroneous treatment.  For a while I worked in an ICU.  We stuck all sorts of needles and tubes into our patients and gave lots of potent medications to thin the blood and support the blood pressure and keep patients sedated and sometimes paralyzed.  Every so often, somebody would screw up and do the wrong thing--I know that I dropped at least one patient's lung putting in a central line--and a small proportion of the time such screw-ups would have fatal consequences.  Contrast that with Namibia, where I worked for a while more recently.  In the public heath system in Namibia, covering the vast bulk of that nation's 2 million people, there are exactly four ICU beds.  As a result, vanishingly few Namibians die as a result of ICU-related medical errors.  Instead they die of congestive heart failure, asthma, gallstone pancreatitis and a hundred other conditions that would be fairly easy to manage in a modern ICU.  

Also, how are you defining unnecessary treatment?  The "necessity" of various treatments seems to me a nebulous concept indeed.  Here's an example: Two patients each have an ankle sprain.  By any objective measure, the injuries are of identical severity.  One patient is offered analgesic medication and he declines, and he declines saying he'll be fine without it.  He won't even take a Tylenol.  He goes home on crutches, ices the joint, and in a few days he's back to work and even taking a light jog around the block.  The second patient, on the other hand is in the emergency department writhing in pain.  He refuses so much as to touch his toe to the floor.  The only way to get him to stop crying is to give him a shot of morphine, and the only way to get him home is with a script for oxycodone.  A week later he's still not bearing weight on the ankle and his family doctor makes a referral to a physical therapist.  After two months of PT and going off and on and off opiates with several visits to the doctor with blood tests and an MRI scan of the joint to rule out some serious underlying pathology such as a bone infection or malignancy, patient 2 is finally back to some semblance of normality.  Now, I ask you, was patient 2's several thousand dollars worth of treatment necessary or not?  There are some advanced health care systems where at least some of that treatment would have been omitted.  There are a lot of places where he wouldn't have been able to get an MR scan.   And it's a dead certainty--in retrospect--that the MRI scan did him not a bit of good.  But does that mean it was "unnecessary?"  A sizable minority of people who present with persistent ankle pain will have something seriously wrong underlying it, and I know a lot of us would be pretty steamed if we had a late diagnosis of limb-threatening osteomyelitis or life-threatening cancer when there was a completely non-invasive test (MRI) that could have diagnosed it earlier.  

Thank you aeromonas.  Such a pleasure to read something from someone who knows what he is talking about.

Wait....so if we quote him saying that US healthcare is great, will the RNC sue us? Will the Associated Press write an article calling us all liars? Are they working on a story righht now about how Virginia Centrist, evil liar commenter on TNR, is lying about John McCain, the greatest man who ever lived?

Excellent post, aeromonas.  I was going to ask the same questions, although with less sophistication as I have very little knowledge of the health industry.  But when people throw out raw numbers like that, I immediately get suspicious.  40,000 people die due to avoidable medical error?  Where did that number come from?  How does it compare to other countries?  What is the percentage of error vs. overall treatment?

One more thing:

What an out of touch prick. This is a real issue where we can nail him for being a rich bastard. While the top level care in the US is unquesionably better than other countries, that's only available for the top level citizenry.

A friend recently told me: "The election will come down to this: Who will learn first? Will Barack Obama learn how to connect with culturally conservative white voters? Or will John McCain learn how to talk about the economy?"

I'm betting on Obama. You can't teach an old man new tricks.

"Just that quality here *isn't* great and that suggesting as much is really misleading."

Not only that, but suggesting as much demonstrates a lack of compassion.

As I clicked on the TalkBack link, I was actually thinking, "Jeez, man, raw numbers can be made to say anything - I wonder what aeromonas would have to say about them?"  Now I know.  Thanks for the insight.