The United States healthcare system in 2008 gets an overall grade of 65 out of 100, according to a study relased late last week by the Commonwealth Fund’s Commission on a High Performance Health System. The U.S. ranked last among 19 nations surveyed in the number of deaths that may have been avoided with the proper care in 2002-2003, falling from 15th place in 1997-98.

I wince when I type sentences like that. Anyone familiar with my work knows that I’ve gone out of my way on more than one occasion to NOT say that healthcare in other countries is somehow “better” than that available in the U.S.  I note U.S. strengths in high-end care and technology and its leading role in medical research. I know overseas surgeons who have told me that, all other things being equal, they consider their peers in the United States to be the most advanced.

The problem is that all other things are not equal. The United States lags behind, badly, in the commission’s 37 different indicators of healthy lives, quality, access, efficiency and equity, compared to other countries.

Here’s some coverage of the study by major media:

• While the U.S. Spends Heavily on Health Care, a Study Faults the Quality (New York Times)
• U.S. health system scores a D in new report card (CBS Marketwatch)
• U.S. Health Care Still Ill, Survey Finds (HealthDay, Washington Post)

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Sometimes, you can’t go it alone and get satisfaction. Individual consumers with complaints, however valid, are rarely a match for the sort of colossal indifference that a big corporation or government entity can routinely bring to bear on a problem.

And most medical tourists and travelers go it alone. I know I did, in 2004. I did my research. I talked to other people who had been overseas for healthcare. I vetted my doctor. And I went, and I had a great experience.

But what if something had gone wrong — if I had been unhappy with my treatment or had complications? I like and trust my doctors; I know they would have done everything they could to “make it right.” But I have no way of knowing what would have happened, really.

Earlier this week, the Washington Post ran a story about a patient, Betty Meisel of Portland, Oregon, who went to Thailand in 2005 for plastic surgery and had things go wrong. The hospital, perhaps the best-known destination for international patients, claimed three years later to have not received the email she says she sent back then regarding her terrible surgical outcomes. When contacted by a reporter in April, the hospital did write to Meisel and issued a refund.

Which didn’t make everything OK, of course, though it was something.

Years ago, stories like Betty’s were more the rule than the exception, when reporters wrote about medical tourism. This was not because the medical facilities and doctors overseas were bad, but because reporters didn’t know enough to place a single bad outcome in context. The “news value” would be the oddness of someone going overseas for surgery, and the media treated bad surgical outcomes almost with a “what else would you expect?” kind of demeanor. The media learned, over time, and stopped reporting the small percentage of bad results as the norm. Bumrungrad International, in fact, has a reported complication rate that any U.S. hospital would be proud to match.

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