Again, to put the problem in perspective, that means that the risk a patient has of dying as a consequence of simply being admitted to a hospital in the United States is:

• Twice that of dying from lung disease
• Three and a half times that of dying from diabetes
• Five and a half times that of dying from an automobile accident
• Almost seven times that of dying from a firearm

But even that's not the whole story.

In the era of HMOs, most patients are not hospitalized. Rather they are treated on an outpatient basis. According to the Journal of the American Medical Association, between 4% and 18% of outpatients experience adverse effects following their visit! JAMA estimates that these result in:

• 116 million extra physician visits
• 77 million extra written prescriptions
• 17 million emergency room visits
• 8 million extra short-term hospitalizations
• 3 million extra long-term hospitalizations
• 199,000 additional deaths

These additional deaths, taken together with the deadly adverse effects of in-hospital stays and prescription drugs, mean that overall the U.S. health care system is the direct cause of 426,000 needless deaths each year! That's more than the combined total from strokes, kidney disease, diabetes and chronic lung disease! Only cancer and heart disease claim more victims.

The cost of these needless deaths and hospitalizations is staggering. It comes to fully $77 billion annually!

But there's a more fundamental reason for being alarmed about the failings of America's health care system than just its more obvious deficiencies. The simple fact is that it is not meeting its most basic requirement: keeping Americans healthy.