Or any other source, outside of real hard data, that is? Iask this because, in my capacity as a benefits consultant, I oftenhear employees say that they know we have the most expensive systemin the world (although few know to what degree), but they feel thatis a fair trade off because we have the BEST health care system inthe world.

Read: U.S. still lags behind other countries inhealth care

Well, let me disavow you of that notion. Every metric measurableshows that we have a mediocre system, at best. The World HealthOrganization ranks the U.S, as 37th in the world, strictly based onoutcomes. That puts us tied with Slovenia, but significantly behindcountries like Costa Rica, Saudi Arabia, Colombia, and the bankruptcountry of Greece.

Part of this, I believe, is because we don’t ask hard questionson the quality of care we receive (and likely wouldn’t get answers,if we did). Does anyone know the readmission rate or infectionrate of the hospital they are about to have a surgical procedurein?

Stephen Dubner, of Freakonomics fame, asked the followingquestion: There are two major cardiology conferences each year,where more than 7,000 of the top cardiologists and thoracicsurgeons go for 1-2 weeks each. What happens to the quality of carein the facilities in which the top doctors are attending theconference?

Before listening to the data, that was pulled from 10 years ofdata from Medicare looking at over 10,000 patients, I tried toimagine, would I want to even go to the hospital knowing mycardiologist, or the top doctor in the department, was away? Thedata really looked at emergency type of heart conditions (likeheart attacks) where “choice” of facility is largelyremoved. And it looks at teaching hospitals vs. non-teachinghospitals.

Conventional wisdom says “Take me to the facility with the topdoctors and keep me away from a teaching hospital. I don’t want anyresidents cutting their teeth on me.”

But the data speaks to what should be a very differentresponse.

If you were brought to a teaching hospital for a heart attack,during one of the two conventions, your mortality rate is about 15percent. Mortality rate at a non-teaching hospital the weekbefore or week after the convention? 25 percent. This is a HUGEswing. This means for every 100 hearth attacks brought in, 10 morepeople die when the top doctors are around.

Let me put this in perspective. If you look at all treatmentsgiven when having a heart attack — like beta blockers, Plavix,stents, angioplasty and aspirin — all these combined reducemortality by 2-3 percent. So you are far better off getting to ateaching hospital where the top cardiologist is at convention thangetting all the standard treatments alone.

And here is another interesting point: The amount of invasivetreatments, such as angioplasty and stents, are utilized in about33 percent fewer cases when the cardiologists are away.

Ok, so wait a second. Did I just say that better care is givenwhen the top doctors are away, and at the same time, less severetreatments are being administered and less dollars are being spent?That sounds pretty counter intuitive. Let me give my take onwhy.

When I think of a “top” cardiologist, an image comes to mind: Hehas lots of gray hair (not sure why my mind imagines a male, but itdoes, nonetheless), and has been doing cardiac surgery for decades.Does this sound about right?

Well, this doctor was trained in medical techniques 30 or 40years ago, and they have likely been sued for malpractice, perhapsmultiple times (which leads to “defensive” medicine), andfrequently they have ownership or at least compensation tied to theprofitability of the facility they practice in.

These traits lead to “more” care, and often inappropriate (orunnecessary) care. Whereas the younger doctors, less jaded bymalpractice and less engaged in profits, and more recently trained,might provide a more idealistic approach to treatment, andreinforcing the “less is more” theory in evidence basedmedicine.

Want to hear more details on this? And the reactions fromthe cardiologists themselves when asked at the actual conferencereferenced here what they think of the study showing care improveswhile they are away? Listen to the wholestory here.

So, I ask you to question EVERYTHING when it relates tocare. Assume nothing. One thing is clear: The more involvedthe patient is in their own care, the better the outcomes (and thelower the costs too).