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Editorials
Thursday, July 6, 2000U.S. health system
merits higher rankingHOW can the United States, which spends a higher proportion of its gross domestic product on health care than any other country, stand 37th out of 191 in a ranking of health systems worldwide? That is the ranking assigned in a recent World Health Organization report. France ranked first.The issue: A study by the World Health Organization ranks the U.S. health-care system 37th out of 191 countries.
As two American physicians, Michael Arnold Glueck and Robert J. Cihak, tell it, the explanation is that the WHO analysis used dubious standards that resulted in serious distortions. Glueck, of Newport Beach, Calif., has written extensively on medical reform issues. Cihak, of Aberdeen, Wash., is president-elect of the Association of American Physicians and Surgeons.
Writing for Scripps Howard News Service, Glueck and Cihak explain that the WHO study compares each country's system to what its experts estimate to be the upper limit of what can be done with the resources available in that country.
Who ranks the health-care systems by performance on five measures. Among them is overall population health as determined by the number of years of good health that an average baby born in 1999 can expect in his or her lifetime. The study does not count as a positive value the years a person lives after becoming disabled or sick.
"So a country like the United States, which has done so much to extend the lives of cancer survivors, AIDS victims, and people with brain injuries or Alzheimers Disease, actually gets marked down for the effort," the authors complain. "The implication of WHO's scoring method is that people with disabilities and chronic disease should be euthanized, as they really don't count."
The doctors say that WHO considers it more important that health-care financing be "fair" than that it be adequate.
"It doesn't matter how much a country spends on health care or how it is used as long as the 'financial burden is shared' fairly," they explain.
The United States still has to find a way to provide adequate health care for the estimated 44 million Americans without health insurance. This is a glaring gap that must be filled.
Still, most Americans have access to health care that is matched by few if any other countries. That 37th ranking can't be taken seriously.
Chechen attacks dash
Russian hopes of peaceTHE declaration last week by the commander of Russia's forces in Chechnya that the rebellion was all but over was welcome news to a country weary of the devastating conflict. However, subsequent Chechen attacks that killed 33 Russian soldiers have effectively ended any expectations that the war's end is near. A negotiated settlement remains the method most likely to bring peace to the region.
Nearly 2,000 Russian soldiers had been killed and 6,000 wounded when Col. Gen. Gennadi Troshev suspended major combat operations, including air and military strikes, after meeting with an official whom President Vladimir Putin chose earlier to administer Chechnya. "We came to the common conclusion that the war, as such, is over on the territory of Chechnya," the general said.
The Kremlin quickly reversed Troshev's order and resumed attacks on Chechen forces. Proving on Sunday that the rebellion was far from over, five Chechen trucks loaded with munitions were blown up in towns and cities ostensibly under Russian control. Most of the casualties occurred when one of the trucks smashed into a dormitory housing a Russian militia that had just ended its tour of duty and was set to return home to the Ural Mountains region.
The explosions were reminiscent of a series of bombings in apartment houses and other buildings in Moscow and other Russian cities last September that killed more than 300 people and were blamed on Chechen terrorists.
Russian officials attributed the latest suicide bombing casualties to negligence in employing security measures. But the bombings represent a new stage in the war that has taken on all the characteristics of a lengthy standoff.
Russia celebrated the capture of the Chechen capital of Grozny in February, and most of the rebels fled to the mountains. Since then, the militants have infiltrated major towns and drawn support from residents, who have been embittered by indiscriminate Russian attacks.
While the rebel forces have been unable to go toe to toe with the heavily equipped Russian military, they have effectively mounted a guerrilla war.
Putin, whose hawkish stance on Chechnya propelled him to the presidency, has kept a low profile in recent days and has said little about the bombings. However, he paid a surprise visit to the North Caucasus region yesterday to meet local officials on his way back to Moscow from a meeting with leaders of Central Asian states and China in Tajikistan -- and blamed poor discipline for the heavy losses.
The prognosis of a long, costly war should prompt Putin to make a greater effort to find a way to achieve peace.
Published by Liberty Newspapers Limited PartnershipRupert E. Phillips, CEO
John M. Flanagan, Editor & Publisher
David Shapiro, Managing Editor
Diane Yukihiro Chang, Senior Editor & Editorial Page Editor
Frank Bridgewater & Michael Rovner, Assistant Managing Editors
A.A. Smyser, Contributing Editor
