Given that the US spends $2.4 trillion per year on health care, far more on a per capita basis than any other country, it’s hard to believe that we fare so poorly when it comes to “preventable deaths,” a smorgasbord  of illnesses that shouldn’t—but do—kill us before our time.

But that’s the disheartening conclusion of a study by the Commonwealth Fund which recently appeared in Health Affairs.

The study looked first at death rates compiled by the World Health Organization regarding diabetes, epilepsy, influenza, pneumonia, stroke and ulcers during 1997-1998. It showed that Uncle Sam ranked 15th out of 19 industrialized countries in death rates from such “preventable” conditions.

A repeat analysis for the years 2002-2003 revealed that we had dropped to dead last, even though US health care costs rose nearly 30% in the intervening years.

According to the scientists leading the analysis, nearly 100,000 lives could have been spared if our health system performed as well those in Australia, France or Japan.

The scientists defined “preventable deaths” as those secondary to illnesses or injuries that need not happen or for which we have therapies proven to extend life through a certain age. Measles is an example, at least in developed countries. So are fatal cases of epilepsy, skin cancer, and certain surgical complications.

“These are conditions where early care and the right care should be able to prevent an early death,” Cathy Schoen, a Commonwealth Fund executive told the Washington Post. “We shouldn’t see people dying of diabetes before age 50.”

Or, as Mark Pearson, who chairs the health division at the Organization for Economic Cooperation and Development Pearson concluded succinctly, “the US doesn’t take primary care very seriously.”

Preventive services for patients with Type II diabetes do reduce future health-care costs, but even in the long term, the initial expenses are not completely recovered according to a study published in Health Affairs earlier this month. 

To reach these conclusions, Michael O’Grady and colleagues compiled data from several clinical trials that used an aggressive but doable program to manage all phases of the disease.

They found that federally-insured patients enrolled in such a program would cost over $1,000 per person per year, and that even after 25 years, only ¾ of those costs would be returned via reduced spending on dialysis, amputations and coronary heart disease.

The only group in whom preventive services actually reduced long-term costs were those in their mid-20s at study onset.

“There’s no free lunch here,” concluded O’Grady in an interview with the Washington Post.

President Obama, House Speaker Nancy Pelosi and others claim that health reform will save money, in part by preventing the costs of future diseases by increasing access to preventive services.

Pelosi and Senator Tom Harkin frequently criticize the Congressional Budget Office for adopting a long-enough time horizon in estimating the cost impact of such programs.

The new study supports their position. Most savings accrued well after the 10-year horizon typically used by CBO. The study authors propose a 25-year time horizon for calculating the impact of such programs.

CBO Director Douglas Elmendorf seemed open to the suggestion, indicating the study was “exactly the sort of research that we use in building our cost estimates. We will consider these findings in future estimates we do in this area.”

Earlier this month, the CBO concluded that the costs of widespread cancer screening and cholesterol management programs were going to far outweigh any savings, even in the long term.

In a survey of chronically ill adults in 8 affluent countries, US patients were the most likely to forego care due to high costs and rate their care as inefficient and error prone.

This according to Cathy Schoen and her team, who surveyed 7,500 adults chosen at random in France, Germany, Netherlands, Canada, Australia, New Zealand and the US. The study was published in Health Affairs.

Participants had at least one chronic illness such as arthritis, diabetes or heart disease. They had rated their health as fair or poor, or reported that they had recently sustained a major illness, undergone major surgery or required hospitalization.

Overall, US patients viewed their health system more negatively than any other country. One-third said it ought to be rebuilt from the ground up and only one-fifth said it worked well. Dutch patients viewed their system most positively, followed by the British, French and Canadians.

54% of Americans reported at least one cost-related access problem in the previous year, such as skipping medication doses, not filling prescriptions and not seeing a physician during an illness. This was highest among the 8 countries.

Only 7% of Dutch participants reported that costs were a barrier to accessing medical services.

41% of Americans indicated they incurred at least $1,000 in out-of-pocket medical expenses in the last year. That happened to just 5% of French and 4% of British respondents.

One third of US respondents reported experiencing a medical error, receiving an incorrect medication or dosage, delays receiving test results or receiving incorrect test results. That was higher than any other country.

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Just as some reached for bullhorns to pronounce a crisis in the US health care system because of the worsening shortage of general internists, along comes a new option for people who want primary care—the retail clinic.

Retail clinics are low budget, low profile affairs staffed primarily by nurse practitioners and housed in places like Wal-Mart and CVS. They are to be distinguished from urgent care centers which are larger in size, freestanding, staffed by physicians and others, and equipped to manage a slightly higher level of care (e.g. suturing lacerations).

Can retail clinics help avert the crisis mentioned above? Yes and no.

No, because a study published in Health Affairs this week finds that 90% of visits to retail clinics are for simple things like sinusitis, blood pressure checks and immunizations. These problems constitute only 13% of visits to general internists, 30% of visits to pediatricians and 12% of visits to emergency rooms. The study shows that retail clinics cannot match the spectrum of services offered by primary care physicians.

Yes, because 60% of visitors to retail clinics do not even have a primary care provider. One third of them are uninsured altogether. These people can now get at least some inexpensive primary care services at a convenient time and place, whereas in the past they either got nothing or found themselves waiting forever to be seen in an emergency room.