Diatribune

copyright © 2007 Betsy L. Angert. BeThink.org

Americans are proud of their place in history. Those residing in this nation [for the most part] are prosperous. Even citizens of lesser means have more than those in other countries. We, the people often speak of the quality that is America. Our educational institutions are excellent. Health care here is said to be the best in the world. Goods and services could not be better. That is why we often hear “Buy American.” In the United Sates, we take care of our people, physically, intellectually, and emotionally. Americans are financially fat and happy. This country is great! We are known throughout the globe as a, no, the one and only superpower.

However, this label may be indicative of a nation that sits on its laurels and has for far too long. In educating our children America lags further and further behind.

U.S. falls in education rank compared to other countries
By Elaine Wu
U-Wire
Story posted: 10-04-2005 07:07

The United States is falling when it comes to international education rankings, as recent studies show that other nations in the developed world have more effective education systems. In a 2003 study conducted by UNICEF that took the averages from five different international education studies, the researchers ranked the United States No. 18 out of 24 nations in terms of the relative effectiveness of its educational system.

In health care, while we excel at much, we are nowhere near the best. Indeed, the health care we provide is barely average. If we consider the cost, the total dollars spent to heal a hurting the public, or prevent serious illness, this nation ranks poorly. The United States does not offer the best of medical care. Indeed, our system leaves much to be desired.

The Commonwealth Fund, a private foundation working toward high a performance Health System, created a National Scorecard on U.S. Health System Performance. This was first-ever in-depth study of health care. Researchers monitored health care outcomes, quality, access, efficiency, and equity and placed the findings in one report.

The results indicate that America's health system falls far short of what is attainable, especially given the resources the nation invests. Across 37 indicators of performance, the U.S. achieves an overall score of 66 out of a possible 100 when comparing actual national performance to achievable benchmarks. Scores on efficiency are particularly low.

Executive Summary
Once upon a time, it was taken as an article of faith among most Americans that the U.S. health care system was simply the best in the world. Yet growing evidence indicates the system falls short given the high level of resources committed to health care. Although national health spending is significantly higher than the average rate of other industrialized countries, the U.S. is the only industrialized country that fails to guarantee universal health insurance and coverage is deteriorating, leaving millions without affordable access to preventive and essential health care. Quality of care is highly variable and delivered by a system that is too often poorly coordinated, driving up costs, and putting patients at risk. With rising costs straining family, business, and public budgets, access deteriorating and variable quality, improving health care performance is a matter of national urgency.

The Commonwealth Fund Commission on a High Performance Health System has developed a National Scorecard on U.S. Health System Performance (see the table below for scores on 37 key indicators). The Scorecard assesses how well the U.S. health system is performing as a whole relative to what is achievable. It provides benchmarks for the nation and a mechanism for monitoring change over time across core health care system goals of health outcomes, quality, access, efficiency, and equity.

The table summarizes U.S. average rates on 37 indicators, their benchmark comparison rates typically those achieved by the top 10 percent of countries, states, health plans, hospitals, or other providers and the U.S. average score, calculated as the ratio between U.S. performance and benchmark rate. In just a few instances, the benchmarks represent targets, rather than achieved top performance. The sources of the benchmarks are shown in the table.

Some major findings include:
Long, Healthy, and Productive Lives: Total Average Score 69
The U.S. is one-third worse than the best country on mortality from conditions "amenable to health care" that is, deaths that could have been prevented with timely and effective care. Its infant mortality rate is 7.0 deaths per 1,000 live births, compared with 2.7 in the top three countries. The U.S. average adult disability rate is one-fourth worse than the best five U.S. states, as is the rate of children missing 11 or more days of school because of illness or injury.

Quality: Total Average Score 71
Despite documented benefits of timely preventive care, barely half of adults (49%) received preventive and screening tests according to guidelines for their age and sex.

The current gap between national average rates of diabetes and blood pressure control and rates achieved by the top 10 percent of health plans translates into an estimated 20,000 to 40,000 preventable deaths and $1 billion to $2 billion in avoidable medical costs.

Only half of patients with congestive heart failure receive written discharge instructions regarding care following their hospitalization.

Nursing home hospital admission and readmission rates in the bottom 10 percent of states are two times higher than in the top 10 percent of states.

Access: Total Average Score 67
In 2003, one-third (35%) of adults under 65 (61 million) were either underinsured or were uninsured at some time during the year.

One-third (34%) of all adults under 65 have problems paying their medical bills or have medical debt they are paying off over time. And premiums are increasingly stretching median household incomes.

Efficiency: Total Average Score 51
National preventable hospital admissions for patients with diabetes, congestive heart failure, and asthma (ambulatory care sensitive conditions) were twice the level achieved by the top states.

Hospital 30-day readmission rates for Medicare patients ranged from 14 percent to 22 percent across regions. Bringing readmission rates down to the levels achieved by the top performing regions would save Medicare $1.9 billion annually.

Annual Medicare costs of care average $32,000 for patients with congestive heart failure, diabetes, and chronic lung disease, with a twofold spread in costs across geographic regions.

As a share of total health expenditures, U.S. insurance administrative costs were more than three times the rates of countries with the most integrated insurance systems.

The U.S. lags well behind other nations in use of electronic medical records: 17 percent of U.S doctors compared with 80 percent in the top three countries.

Equity: Total Average Score: 71
On multiple indicators across quality of care and access to care, there is a wide gap between low-income or uninsured populations and those with higher incomes and insurance. On average, low-income and uninsured rates would need to improve by one-third to close the gap.

On average, it would require a 20 percent decrease in Hispanic risk rates to reach benchmark white rates on key indicators of quality, access, and efficiency. Hispanics are at particularly high risk of being uninsured, lacking a regular source of primary care, and not receiving essential preventive care.

Overall, it would require a 24 percent or greater improvement in African American mortality, quality, access, and efficiency indicators to approach benchmark white rates. Blacks are much more likely to die at birth or from chronic conditions such as heart disease and diabetes. Blacks also have significantly lower rates of cancer survival.

American also no longer has the goods. Manufacturing in the United States is down. What we do produce is not always appreciated. People may say buy American; yet, often they speak of built-in obsolescence when discussing America machinery. Thus . . .

U.S. manufacturing jobs fading away fast
By Barbara Hagenbaugh,
USA Today

Rochester, N.Y. - Charles Seitz remembers when Rochester was a bustling manufacturing town. Now, all the 58-year-old unemployed engineer sees is a landscape of empty buildings.

"There's nothing made here anymore," the former Eastman Kodak employee says, his eyes welling with tears as he talks about his struggle to find a new job. "Wealth is really created by making things. I still adhere to that."

It's a situation that's been playing out across the country for decades but has received increased attention in recent years.

Fifty years ago, a third of U.S. employees worked in factories, making everything from clothing to lipstick to cars. Today, a little more than one-tenth of the nation's 131 million workers are employed by manufacturing firms. Four-fifths are in services.

The decline in manufacturing jobs has swiftly accelerated since the beginning of 2000. Since then, more than 1.9 million factory jobs have been cut about 10% of the sector's workforce. During the same period, the number of jobs outside manufacturing has risen close to 2%.

Many of the factory jobs are being cut as companies respond to a sharp rise in global competition. Unable to rise prices and often forced to cut them companies must find any way they can to reduce costs and hang onto profits.

Jobs are increasingly being moved abroad as companies take advantage of lower labor costs and position themselves to sell products to a growing and promising market abroad. Economy.com, an economic consulting firm in West Chester, Pa., estimates 1.3 million manufacturing jobs have been moved abroad since the beginning of 1992 the bulk coming in the last three years. Most of those jobs have gone to Mexico and East Asia.

If there are fewer industrial jobs in America, in what sectors do we excel. Surely, you may say, this country is technologically savvy.

I invite you to take this survey. Test Your High Speed Internet IQ. Consider where the United Sates ranks in the world of cyberspace. Then, if you are able, stand tall and proud, as you say, 'I am an American.'

Please Peruse the Sources, Resources, and References. Familiarize Yourself with our Homeland . . .