Who has the best health care?

One of the key tactics in the battle of health care reform has been to make certain claims and accusations about the merits or deficiencies of various health delivery systems in the U.S. and abroad. Proponents of the constantly morphing behemoth making its way through the convolutions of the American legislative process are quick to cite the advantages of the European, Cuban and Canadian versions and tout examples of satisfied participants as proof that those systems work since, if they didn't, how could anyone have a good story to tell about their experiences with them?

The opponents have sadly chosen to just be reactionary and claim there is nothing so bad about the current American system that it requires such draconian transformations, and simultaneously denying horror stories from our own shores, while relating the ills of those other nations' health services.

As is often the case, the truth is not strongly on either side.

It's shameful that we always fall for the punditry that extremists of any ilk use to inflame us into following their viewpoints and rejecting any others without so much as hearing them. Here in the land of trying to find tolerance for everything and avoiding stereotypes at all costs, we are still easily tricked into divisive regional, racial, cultural and ideological prejudices that are then used to support that "theirs could never be as good as ours" or "vulgar America needs to aspire to the cultural superiority and enlightenment of other nations" in order to manipulate our emotions before our common sense has a chance to kick in.

Here's a bold statement: You can get excellent health care anywhere in the world that has a system for delivering health care. It's true. You can get great care in England, or Canada, or Australia, or Germany, China or Cuba; heck, even in the United States in a V. A. hospital. There may be better odds of it in some than others, but then that's still pretty subjective to each person's view of great care.

What's more, it's pretty much a certainty that anyone in any of those places that is really in need of medical attention will get it regardless of their ability to pay. None of them are able to do it without lines, or limitations of some sort, and they do generally tend to treat the sickest first, meaning that the rest are not going to get what they want as fast as they want unless they grease a few palms.

No matter how free a system is, there will always be those with affluence that can move ahead in the line or be plucked out of it entirely to get preferential treatment, but due to the inherent ethics of health care workers, this is far less prevalent than in any related industry. One of the issues that have been discussed in the wake of the Haitian earthquakes is whether American citizens who are victims there should get preferential treatment by American aid workers on the ground there.

It's a strictly academic debate, because the reality is that the type of people that are there doing that job are not the type that are going to care what anyone tells them about whom to help first. They are going to focus on who has the greatest immediate need. It is in their training; it is in their character, and it is endemic to the profession as a whole. Profiteers and bigots exist, but they are pushed to the fringes and ostracized wherever they are recognized.

The reason you can get great care anywhere is because that's what care-givers do. They do the best they can for everyone that comes into their care regardless of the resources at their disposal. Obviously, there are factors such as moral judgments; racial, sexual and cultural bigotry; greed, burn-out and elitism that affect the individual health care worker's quality of care, but those are so secondary to the primary imperative of those who choose this work that the desire to ease suffering is the great equalizer, not only between individuals, but between nations and their health care systems.

This is not at all to say that the American system or any other in the world does not need improvement or that access issues can be comparatively better in other nations than in the U. S. There is a definite need for reform, but the reform should not only be made based in the reality that the issue is getting the infirm and the healers together, but that once that is done the care will be delivered as compassionately, efficiently and as fairly as can be done, wherever in the world it happens. Anecdotes of good care anywhere are irrelevant because they are the rule, not the exception.