A dysfunctional system.

Byline: The Register-Guard

"If a politician declares that the United States has the best health care system in the world today, he or she looks clueless rather than patriotic or authoritative."

- Dr. Ezekiel Emanuel, director, Clinical Bioethics Department, National Institutes of Health, writing in the May 16 Journal of the American Medical Association.

Just how clueless defenders of the U.S. health care system have become was made clear in a report released recently by the Commonwealth Fund. And also in an essay on health care reform by former Gov. John Kitzhaber that appeared opposite this page on May 21. And also in a column by Nicholas Kristof of The New York Times that appeared opposite this page on May 22.

It's hard to pick up a newspaper or news magazine in 2007 that doesn't have a story illustrating some aspect of the increasingly unfair, inefficient and overpriced U.S. health care system.

The New York-based Commonwealth Fund did a comprehensive analysis of health care systems in the United States, Germany, Britain, Australia, New Zealand and Canada.

Guess where the U.S. system ranks on measures of comparative quality of care? Last. Access? Last. Efficiency? Last. Fairness? Last. And most important, outcomes for patients? Last.

One place the U.S. health care system finished ahead of all other nations was cost. Americans pay the most for the privilege of receiving less. Per capita health spending in the United States in 2004 was $6,102, twice that of Germany, which spent $3,005. Canada spent $3,165, New Zealand $2,083 and Australia $2,876, while Britain spent $2,546 per per- son.

Here's what Americans receive as a result of spending, on average, more than 16 percent of the nation's gross domestic product on health care (nearly $2 trillion a year):

More than 46 million Americans have no health insurance. (The United States was the only nation in the Commonwealth study that does not provide universal health care.)

The U.S. infant mortality rate is higher than that of most developed nations.

Average U.S. life expectancy is 78, which ranks 45th in the world, behind Bosnia and Jordan.

The U.S. health care system has the lowest percentage of doctors using electronic medical records or receiving electronic updates on recommended treatments.

The lack of a comprehensive electronic medical record system is particularly embarrassing in a nation that takes justifiable pride in its advanced medical technology. The U.S. Department of Health and Human Services reports that a majority of U.S. health care providers still rely on written records, which contributes to avoidable medical errors and a level of inefficiency that is a hidden part of every patient's medical bills.

The problems plaguing the U.S. health care system can't be solved with incremental reform. Kitzhaber, a former emergency room physician, is absolutely right when he says real health care reform requires a top-to-bottom rethinking of the system.

It isn't just an insurance problem, a tax code problem or a drug price problem. Real reform must address costs, realistically define - and appropriately apportion - benefits, and revamp the health care delivery system so that financial incentives are aligned with outcomes.

Such fundamental restructuring faces powerful opposition from industries that have a huge financial stake in the status quo. Those industries have been able to count on political allies and on the insured public's fear of change to limit the scope of previous reform efforts.

Kitzhaber believes that Oregonians may be ready to tackle the bigger problems posed by comprehensive reform. His statewide effort to engage stakeholders in the debate has produced Senate Bill 27, the Oregon Better Health Act, which is now before the Oregon Legislature.

Kitzhaber is quick to point out that SB 27 doesn't attempt to answer every question posed by such a complex restructuring scheme. The bill lays the foundation for a process that ultimately will require a waiver from Congress to implement.

But Kitzhaber is among just a few fighters in the health care reform battle right now who are aiming high enough to hit the right target: a 21st century health care system that's compassionate, affordable, responsible and universal.