I have stated that the equity issue in the U.S. is one primary reason that the U.S. has a lack-luster performance record when compared to other countries, but I’ve also warned that cross-country comparisons are not the only standard. These two reports from the Institutes of Medicine, above, offer a good review of the literature, and I believe offer a compelling argument for the less than ideal care that we receive. These reports do not use cross-country comparisons, but generally, look at the care one should receive and the care we do receive. They label the errors as overuse, underuse, and misuse (and they acknowledge that the quality is lacking). First, what should be said, and I don’t believe that I have emphasized this enough – the U.S. (and the world to maybe a lesser extent) has made remarkable strides in health technologies, pharmaceuticals, diagnostics, and therapeutics. Our doctors can do amazing things. Their training is exceptional and all of these advances have pretty much exploded since the end of WWII. These reports point out that no single doctor can keep all of the complexities in their head. Further, as we increase the life expectancy we have a population living with more and more chronic conditions and comorbidities (meaning they have heart issues, diabetes, and a cancer history) further complicating the doctor’s job. The problem is not with our knowledge base (we can always learn more, but our learning curve is steep), but with our ability to organize this knowledge and to administer the knowledge in a safe and efficient manner. The problem is with the delivery system. We have inadequate systems and databases for tracking patients, for preventing errors (computers can catch negative drug interactions for example), for storing medical information, and for clinical communication. Basically, we have had an amazing explosion of medical advances and a woefully out-dated system that cannot keep up. It’s like giving a new teenage driver a 500 hp sports car. Accidents are unavoidable. Errors are bound to happen. We need a new delivery system. We need better health information technology, drug delivery systems, medical databases, and safeguards that limit doctor errors. Why don’t we have these things? Our system is too complex and too decentralized to integrate. We have too many players and a very limited capacity to organize them.