Kidney Disease Article Hits Home
Thank you so much for your wonderful article about polycystic kidney disease (PKD; Clinician Reviews. 2011;21[8]:21-26). As the authors mentioned, this terrible disease affects one in 400 people, yet not that many providers know about it.
I have lost seven members of my family to PKD, and I was diagnosed with it 25 years ago. So far, my blood pressure is still within normal limits and I am not in need of treatment. However, knowing that I have a genetic disease that eventually will lead me to dialysis or the need for a kidney transplant has changed my life completely. All I pray for is that neither of my two children inherit this terrible gene.
Aura Veliz, RN, MSN, WHCNP, Los Angeles
In Health Care, the US Doesn’t Compare
I’m writing in response to Sharon Falke’s guest editorial “The Green, Green Grass of Home” (Clinician Reviews. 2011;21[8]:cover, 1, 4-5). I read it over lunch in the hospital cafeteria the other day and was dumbfounded. Initially, she lays out serious problems with the United States’ “‘for-profit’ health care system,” and I was getting interested. But reading further, she writes, “But despite its inefficiencies, our health system serves the populace well.... All one need do is compare our system to those in some underdeveloped countries to see the contrast.” I am in complete agreement with Ms. Falke’s premise: Our health system is better than those of the third-world countries that she discusses. But how does that make us “one of the premier systems in the world,” as she says at the end of her article?
America is (was?) an industrialized first-world country, so why would she compare our health system to those of third-world countries? On the face of it (the lowest rung in research analysis), this is a poor comparison—apples to oranges. Our health care system generally is better than those in third-world countries. However, in order to make an editorial worth the paper it’s written on, the comparison needs to be with other first-world countries’ health care systems.
In every poll recently taken, Americans overwhelmingly favor some form of universal health care coverage. Is Ms. Falke aware that insurance premiums doubled in the past 10 years? Is she aware that our for-profit health care insurance system excludes some 52 million Americans (17% of the population) from accessing affordable, essential health and medical care with the limited exception of county hospital emergency rooms?
Every industrialized country has fairer access to health care and lower costs for health care than the US. Most of the world’s wealthy countries have longer life expectancies than we do. The world’s richest country, the US, ranks 47th, just ahead of Cyprus and a little behind Bosnia and Herzegovina, in terms of longevity. In fact, the average American can expect a shorter life than people in relatively poor countries like Jordan.
Another method, the DALE (Disability-Adjusted Life Expectancy) rating, measures how many years the average citizen can expect to live before encountering the disabling diseases of old age. The top 10 countries for healthy living in terms of DALE, in descending order, are: Japan, Australia, France, Sweden, Spain, Italy, Greece, Switzerland, Monaco, and Andorra. The US ranks 24th in the world for healthy life expectancy. That puts us below almost all other developed nations. Basically, you die earlier and spend more time disabled if you’re an American rather than a member of most other advanced countries.
There have been many studies done, and these produce different rankings. Still, there is a group of developed countries that are providing quality health care, distributing it more fairly and equitably, and doing all that for much less money than we spend. Health care costs consume a greater percentage of Gross National Product in the US than in any other country.
Ms. Falke seems to think that most Americans have ready access to primary and emergent health care and are able to obtain it at a reasonable cost. Does she know that the greatest number of bankruptcies in this country is due to the inability of citizens to pay their health care bills? That applies to those who are insured as well as uninsured or underinsured. She may be right that we have a great provider education system (although everyone knows how broke clinicians are at the end of their programs—hundreds of thousands of dollars in debt).
She ends by saying that health care in the US “will continue to be one of the premier systems in the world.” For whom? Not the people who can’t afford it or those who go bankrupt from their health care (“sick care”) bills. I don’t think the grass is greener for health care in the US. The US Congress has excellent health insurance benefits, paid for by you and me, the taxpayer. Why don’t we all have it?
Deborah Sohr, NP, San Francisco