DR. DONALD BERWICK: It is, I guess, politically
correct, widely believed, that to say that American
health care is the best in the world. It's not. There's
a much more complicated story there. For some kinds of
care my colleague Brent James calls it rescue care.
Yes, we're the best in the world. If you need very
complex cardiac surgery or very advanced chemotherapy
for your cancer or some audacious intervention with
organ transplantation, you're pretty lucky to be in
America.

You'll get it faster and you'll probably get it better
than in at least most other countries. Rescue care
we're great. But most health care isn't that. Most
health care is getting people with diabetes through
their illness over years or controlling the pain of
someone with arthritis or just answering a question for
someone who is worried or preventing them from getting
into trouble in the first place. And on those scores:
Chronic disease care, community-based care, primary
care, preventive care. No no, we're no where near the
best. And it's reflected in our outcomes.

We're something like the... We're not the best health
care system in the world in infant mortality rates.
We're like number 23. There is an index that is used in
rating health care systems, which is the rate of
mortality that could have been prevented by health
care. There are at least a dozen countries with lower
rates of preventable mortalities than the United States
and not one of those countries spends 60 percent of
what we do on health care.