Medical Tuesday Blog

Is US Medical Care Inefficient?

May 16

Written by: Del Meyer
05/16/2019 9:08 PM 

Viewpoint: JAMA | September 11, 2018

Victor R. Fuchs, PhD1

JAMA. 2018;320(10):971-972. doi:10.1001/jama.2018.10779

Is US medical care inefficient? Many health policy experts maintain it is, whereas others prefer a verdict available to juries in Scotland— “not proven.” The correct answer is that no industry is either efficient or inefficient in abstract terms. Efficiency describes the relation between the input(s) and output(s) of a product (e.g. an engine), an organ (e.g. the heart), or an industry. Each industry has a unique set of inputs and outputs and set of technologic, economic, and sociopolitical constraints.

It may be possible, however, to compare the efficiency of US medical care with the efficiency of medical care in other countries if the inputs, outputs, and constraints are sufficiently similar; if they differ, it is possible to adjust for those differences. For example, per capita spending for medical care in the United States is approximately double the spending in the United Kingdom, but life expectancy at birth is almost 3 years lower in the United States than in the United Kingdom. Some of the difference is probably attributable to a poverty rate of 17% in the United States compared with only 10% in the United Kingdom. Using a slightly different metric, the poverty rate in the United States exceeds the poverty rate of 10 other high-income countries at 6.6 percentage points higher than the mean of the other 10.1

Edward R. Annis (March 27, 1913 – September 14, 2009) was a Florida surgeon who served as president of the American Medical Association and as president of the World Medical Association. He was one of the most foremost critics of the United States Medicare program. After completing his surgical residency at Cook County Graduate School of Surgery, he moved to Florida, practicing medicine in Tallahassee. In 1953, he became chief of surgery at Mercy Hospital in Miami.

Annis demonstrated talent as a public speaker while in high school and college and became a member of the AMA’s speaker’s bureau in December 1959. As such, he traveled throughout the United States making speeches on the AMA’s behalf. From January 1961 to June 1962, Annis made a series of speeches against the King Anderson bill, which would authorize the use of Social Security taxes to pay for health care benefits for retirees. He debated Democratic Senator Hubert Humphrey and the president of the U.A.W. on television. After President Kennedy gave a speech on May 20, 1962, at Madison Square Gardens describing the bill’s benefits, Annis was refused equal time in which to counter the President’s arguments. The President explained the bill’s intent. “… and added: “they (the doctors) do not comprehend what we are trying to do.” …. “we do not cover doctor’s bills here”…”we do not affect the freedom of choice; you can go to any doctor you want.” [2]

The AMA then rented the Gardens and prime time television so that Annis and Leonard Larson, then the president of the AMA, could argue against passage.[3] The AMA’s efforts resulted in the King-Anderson Bill dying in committee in 1962 and 1963. . .

Buoyed by his popularity from the anti-Medicare campaign, Annis successfully ran for the AMA presidency in June 1962, taking office in June 1963. While AMA president, he intensified the AMA’s resistance to Medicare. Annis’ term expired in June 1964.

Dr. Annis predicted that the cost-plus financing of Medicare would doom it to bankruptcy and trigger destruction of the doctor-patient relationship. “This bill would put the government smack into your hospital, defining services, setting standards, establishing committees, calling for reports, deciding who gets in and who gets out, what they get and what they do not get, even getting into the teaching of medicine.” “And it will serve as a forerunner of a different system of medicine for all Americans.” (socialized medicine)[4] He predicted that “socialized medicine” would have consequences for American healthcare including loss of physician autonomy to bureaucratic control and the imposition of government regulation into the patient-physician relationship. He authored the partly autobiographical, Code Blue: Health Care In Crisis (ISBN 089526515X) in which he reprises his analysis of Medicare’s effects, laying most of what he felt is wrong with American health care at the feet of what he viewed as socialist changes without mention of its benefits.

Read the entire biography at

Editor: When Dr. Annis was asked why the United States had a shorter life expectancy than other countries, Annis eloquently pointed out that the Swedes in this country lived as long as Swedes in Sweden; the Blacks in this country lived longer than the Blacks in Africa. We’re at the same crossroads today. Where are our eloquent spokesmen?

If you know of such a person, please refer candidates to

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