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State of the Nation’s Health Care 2008

Oral Remarks
David C. Dale, MD, FACP
The American College of Physicians

Thank you for coming to hear this report from America’s internists on the State of the Nation’s Health Care.

I’m David Dale – President of the American College of Physicians – and I’m pleased to be here today representing 125,000 internal medicine physicians and medical students.

At home in Seattle, I am Professor of Medicine and former Dean of the School of Medicine at the University of Washington. I teach students and doctors in training, do medical research and have practiced internal medicine for more than 40 years.

Today, the American College of Physicians is describing an agenda to create a health care system for the United States that is second to none.

Americans have every reason to be proud of our democratic system of government, our economy, our creativity and our commitment to individual liberties.

But… and I’m not pleased to say this… when it comes to health care, too many of us simply are not getting the health care we need and deserve–and many Americans don’t have access to even basic health care services.

In 2008, the State of the Nation’s Health Care can best be described as follows: We spend more on health care than any other industrialized country… and we get too little in return.

Just a month ago … on January 1st… the American College of Physicians released a report entitled Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries in the Annals of Internal Medicine, our flagship publication.

This paper:

  • describes the symptoms---the findings ---the evidence… of a failing health care system;
  • diagnoses the causes; and
  • provides a prescription for improvement—a prescription for a better future.

First, the symptoms: Despite many strong points, overall the U.S. health care fails to provide accessible and high-quality health care. In fact, compared to 12 other industrialized countries, the U.S.:

  • Spends more but gets less – the U.S. has the world’s highest per capita expenditures for health care and spends, by far, the most on administration of the system; and
  • Spends a greater share of its gross domestic (GDP) on health care than any other country.

But the U. S.

  • Is last in access and equity—the U.S. has 47 million uninsured persons – the most-the highest percentage- for any industrialized country.
  • Is last in providing patients in helping people to maintain healthy lives.
  • Is last in preventable mortality, infant mortality and proportion of adults with limitation on activities – the U.S. infant mortality rate is 7.0 deaths per 1,000 live births, compared with 2.7 in the top three industrialized countries.


  • Is second- to-last in overall quality – based on measures of whether the care that patients receive is safe, whether the right treatment is given for the condition, and whether the care is well-coordinated and patient-centered.

The numbers are disturbing enough, but behind each of the numbers are patients—millions of them—who are not getting the care they need.

The numbers tell us that 47 million people in the United States lack health insurance. Let me put a human face on what it means to be uninsured in the United States.

I work in an urban teaching hospital, the University of Washington Medical Center. Every day, through our emergency department and clinics, we admit patients with advanced illnesses and preventable problems who have no health insurance. So often, good primary care could have prevented the problem, saved the person from the burdens of illness, and saved the cost of an expensive hospitalization.

Allow me to give you another example of what the shortage of good primary care means to patients, particularly Medicare patients.

A colleague who practices in Anchorage, Alaska—Dr. Richard Neubauer – recently left his general internal medicine practice after 27 years. He told me that he was lucky to find a young physician to take his practice, because other general internists there have not been able to find anyone to take their place when they retired or left Alaska. Much to Dr. Neubauer’s disappointment, the new doctor declined to acceptance of over 150 of his Medicare patients and placed severe limits on seeing any more. This is not an isolated situation. Dr. Neubauer tells me that there are growing numbers of people in Anchorage looking for a primary care doctor and waiting to get an appointment. I believe this same scenario is occurring in many communities throughout our nation.

Yet Washington, this Washington, keeps issuing reports that say that there is no primary care access problem. I say, tell that to the elderly patients who no longer have a doctor.

Next, the diagnosis: What can we learn from the 12 other countries we studied that all do better? Well, the high-performing countries:

  • Have universal coverage… that is, they provide coverage to everyone
  • Provide strong support to primary care
  • Have effective physician payment systems aligned with quality
  • Encourage lower administrative costs
  • Support research on effectiveness and quality – including studies of which treatments work best for a particular condition compared to other treatments
  • .

Finally, the solution; adopt the best of what works in other countries to create a uniquely American health care system that is second to none. What would such a system look like?

This is how the American College of Physicians describes it.

Most importantly, we, all of us, could have more accessible, higher quality, more equitable and efficient care, care that is as good as or better than anywhere in the world second to none.

Americans, by our nature, do not like to be second or be in last place, especially when we know we have the resources to do better. Instead of accepting a health care system that ranks well below other nations, voters should insist that our politicians pledge to support policies that will create a better health care system. In many areas, we are the best in the world, why not in health care?

In this 2008 election year, why settle for anything less than the best?

Now, I am pleased to introduce Bob Doherty, the senior vice president of ACP’s division of government affairs and public policy. He will describe how ACP will be challenging the Presidential candidates, members of Congress, and President Bush to adopt ACP’s recommendations for a high performing health care system.

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