During the GOP rebuttal following the State of the Union, Virginia Governor Bob McDonnell said “most Americans do not want to turn over the best medical care system in the world to the federal government,” a theme Republicans have repeated many times.
Is US health care the best in the world? No, it isn’t.
US vs. the World
A cross-country analysis conducted by the Commonwealth Fund compared the US’s health care program to those of eight other countries, looking at tangibles such as life expectancy, infant mortality and the amount spent on health care by the respective governments.
Of the nine countries surveyed, the US had the lowest life expectancy rate and the highest infant mortality rate. Moreover, the US spent almost twice as much on health care per capita as the other countries while the government spent less than half that spent by the foreign governments for health care.
| US | Australia | Canada | France | Germany | Japan | Norway | Sweden | UK | |
| Life expectancy | 78.1 | 81.4 | 80.7 | 81.0 | 79.8 | 82.6 | 80.0 | 81.0 | 79.1 |
| Infant mortality | 6.7 | 4.2 | 5.0 | 4.0 | 3.8 | 2.6 | 3.0 | 2.5 | 4.8 |
| Per capita health spending | 7,290 | 3,137 | 3,895 | 3,601 | 3,588 | 2,581 | 5,910 | 3,323 | 2,992 |
| % paid by government | 45.4 | 67.7 | 69.8 | 79.0 | 76.9 | 81.3 | 83.6 | 81.7 | 81.7 |
US is the only industrialized nation without public health care
Of the 38 industrialized nations, the US is the only one that does not offer public health care, with 71 nations offering some form of public care, including:
- Mexico
- China
- India
- United Arab Emirates
- Saudi Arabia
- Israel
- Pakistan
- Russia
Quality of care in other countries
Those who oppose a public option cite poor quality of care — long waiting lists, etc. — in countries that offer it as a reason for not adopting a similar system in the US. A colleague of mine who lived in London for a couple of years described her experience with the UK’s National Health Service:
“The doctors were always very capable, facilities were excellent, and the wait time was no more than I would have waited in the US for a routine appointment — about two weeks. The UK’s system offers good coverage and if you want extras, such as a shorter wait time to see a physician for a non-emergency or a private hospital room, you can purchase supplemental private insurance. But I didn’t find it necessary.”
She added: “Sixty-two percent of Americans who file bankruptcy do so because of medical bills. Of those 62 percent, 78 percent had health insurance. In England there’s peace of mind knowing you won’t be in financial jeopardy if you become seriously ill. You can’t be dropped because of pre-existing conditions or because you couldn’t afford the cost of premiums.”
Your ratings on health cares systems are very misleading. The US has lower life expectancy figures than the other countries shown for two major reasons – automobile accidents and homicides. Neither of those issues will be changed by nationalizing health care. Infant mortality is higher in the US because the US records every live birth as an infant. Other nations leave out babies born below certain weights. That means our mortality rates will be higher by definintion. Finally, our infant mortality is negatively influenced by women using drugs while pregnant. In conclusion, your measures tell nothing about the effectiveness of our health care system.But I am sure that fairness and accuracy have nothing to do with your efforts.
Jim,
Those are good points. But even conceding that the US provides excellent health care, how does that help the 46 million Americans who don’t have insurance and, therefore, can’t pay for it?
Phil,
With all due respect you just changed the entire point of your original op ed with this answer. Are you saying that our healthcare system is inferior (as your original writing suggest) or are you saying that we should simply provide free healtcare to 46 million people (many of that number being illegal aliens) on the backs of those of us who pay our share? Can you help me explain to my daughter why her healthcare will become inferior to what it is now so that illegal aliens can get free?
Jim, with all due respect, every countries life expectancy rates would go down if you didn’t count automobile accidents and homicides. Can you please provide a citation about which countries do and don’t count live births? Thanks!
The fact that the US spends double per capita and doesn’t get results as good as other countries says a lot. We are the only industrialized nation that allows 45,000 people to die every single year from a lack of insurance. That’s 15 9/11s every year. 46 million are uninsured, 25 million are under-insured and those that are insured often go bankrupt or get dropped from their insurance plans when they actually get sick.
Do you want to know why we pay so much more than just look at today’s headline.
“2009 turned out to be a very good year for the CEO of the private health insurance company WellPoint. Angela Braly’s compensation package soared by 51 percent last year. She earned $13.1 million, up from $8.7 million in 2008. At least three other WellPoint executives received compensation increases of as much as 75 percent.”
Those profits are outrageous and that would never happen in a single payer system like a Medicare-for-all. Medicare is a popular system that has less overhead costs because there aren’t CEO bonuses and private jets etc.
When you adjust Life Expectancy statistics by deaths from homicides and car accidents, to get down to what is more about health, U.S. Life Expectancy shoots up, in some estimates, to the top.
Moreover, when talking about healthcare and life expectancy, we ought to separate other factors that affect health and life expectancy but are not functions of healthcare:
1. U.S. takes in large numbers of immigrants from the 3rd world, whose life expectancy is lower because of poor childhood nutrition and medical care.
2. Eating and exercise habits. U.S. lifestyle is more sedentary.
As to the supposed fact that we spend much more per capita on health care, expenditures expressed in currency per capita are meaningless when countries with government run healthcare use price controls and rationing. The question that should be asked is whether U.S. healthcare industry is less productive than healthcare industries in other countries. That is, if to achieve exactly the same end result (the same improvement in health from the same starting point), it takes more real resources – human labor, energy, amortization of equipment and facilities. Do you have any facts to show that to be true?
Boris,
I just researched the most accepted comparative studies that have been done. It is true that I didn’t dissect those studies and question their assumptions. But as I told Jim above, even if the quality of care for those who can afford it is excellent, how can we justify 46 million people not being able to afford it?
Boris, the US has rationing and there’s no longer line than no health care at all. Why should Americans be forced to pay more for drugs than any other nation. If Walmart can negotiate good prices why can’t the government do it for things Americans need? We subsidize the drug industry as it is by giving them government research for free. The VA negotitates 40% off of drug costs because of its buying power.
The care in the US is good, but only if you can affors it and our system has driven the prices up to a point where most people can’t afford the care they need because we allow corporations to make unlimited amounts of profit by denying care and adding extra costs for CEO pay, bonuses, private jets and all the other goodies the fat cats get.
My post was primarily about the issue of quality of care and real costs (resources consumed to produce the delivered care, which is not the same thing as the price directly paid by the end consumer or the prices paid by the insurance companies.) And my points were that
a) At least based on often cited metrics of life expectancy, when they are properly adjusted (for all countries) for factors that have nothing to do with medical care, the claim that U.S. care is not the top drawer doesn’t hold.
b) If there is some aspect of health care delivery in other countries that lower the resource consumption, such as using pharmacists and nurses in many routine care scenarios instead of doctors (for example in the U.K. a chemist can dispense prescriptions without a doctor and a lot more is over-the-counter to begin with), having lower barriers to new drug introduction (there is no FDA in Europe) we should be taking note. As it happens, the corrective actions that would come from such learning imply less, not more government involvement in medical care.
c) Once supply curves (productivity) are equalized per point (b), what drives the price paid for services is demand. We have a pathological disconnect between a consumer and the cost, due to the structure of Medicare, employer subsidies for providing insurance and other laws that disassociate consumers from the incremental price of incremental care.
To say that insurance companies’ profits, let alone compensation of their CEOs drive healthcare costs has no basis in fact. Examine the healthcare dollar breakdown chart http://www.staysmartstayhealthy.com/healthcare_costs to see that insurance in total are only 3 cents of that dollar. And this is not the profit, it’s the cost of processing claims (which would exist in a government run public option) plus a not so big profit.
Drugs cost more in the U.S. because other countries impose price controls. Impose price controls here (let’s not go through the pretense of calling it “negotiated prices”) and what do we suppose is going to happen to profits, investment and consequently drug development itself? More about the misconceptions about profits below.
“[O]ur system has driven the prices up to a point where most people can’t afford the care they need” is an outright falsehood, as even the total number of uninsured do not add up to “most”.
To be factual about the 47 million uninsured (10 million of whom are not U.S. citizens and thus have particular barriers to being insured):
a) The absolute number has grown in recent years, but in proportion to the population growth, the relative percentage hasn’t changed much
b) A large proportion of the 47 million uninsured are uninsured voluntarily. 38% of the 47 million have more than sufficient incomes ($50K+) to buy coverage. See http://www.census.gov/prod/2007pubs/p60-233.pdf At the other end of the spectrum are 14 million of the uninsured who are eligible for Medicaid, but chose not to enroll.
c) Being uninsured doesn’t mean not getting medical care, as for better or worse by law emergency rooms can not turn anyone away, or even redirect to urgent care units, despite the fact that emergency rooms are overused for non-emergency purposes (among patients in the 20’s the hospitalization rate resulting from an emergency room visit is only 5%.)
d) However, it does mean delaying diagnosis and treatment of deadly progressive conditions, leading to well researched higher mortality rates (estimated 25% higher) among the uninsured. The studies controlled the best they could for tractable factors – health condition to begin with, socio-economic status, etc. What it could not possibly control for is the behavioral differences behind large numbers of people making a choice not to buy insurance. So it doesn’t actually show that not having insurance causes higher mortality. It may be just as easily showing that risk-taking, one of the manifestations of which is not being insured, causes higher mortality.
e) Once the non-U.S. citizens, 50K+ earners who can afford insurance and real low earners eligible for Medicaid are taken out of the total, 11 to 12 million remain that “fall through the cracks”. Yet the “reform” bill didn’t target just that group.
To talk about market price rationing of care in the same way as government rationing is intellectually dishonest as the meaning of the word is very different in each context. Just as when someone says, “the changes in my industry forced me do get more training” we know that “to force” used in that context is a very different concept from “the robber forced me to give him my wallet.”, and an honest person wouldn’t dream of calling the police to defend a person from “the force of change”.
Is a profit the problem with healthcare costs? Presumably we are talking about doctors and drug company profits (given that per above insurance company profits are a non factor; hospitals are mostly non-for-profit). This sort of thinking comes out of an entirely fallacious intuition about profits. To start with, if profits are so bad, let the anti-profit advocates be the first ones to give up their profit. Those who are gainfully employed should ask for a pay reduction down to a level that will be just sufficient to sustain the body and mind to perform the work, because guess what: economically everything above that is your Profit! And then want to we suppose drives investment into industries but the possibility of making a profit. Take away profits and what you are left with is government technocrats deciding winners and losers, a task proven impossible many times over.
What is problem, and it does show up in extra profits, is protectionism, such as doctor licensing, insurance regulation, that causes supply restrictions by effectively protecting established, particularly well-heeled players from competition.
In summary, there is just so much misinformation, misunderstanding and misinterpretation of data flying around, that debating particulars of various solution ideas is proving impossible until all that noise is reduced substantially.
Dear Phil,
Thank you for sharing data about this important issue. The absence of a public option and government support to help families during our lifetimes enjoy a healthy life is embarrassing and tragic. Isn’t it remarkable that Medicare is offered to people to help with their end of life care….and no comparable offering available to help people care for their children from infancy on? I appreciate your being a voice to reach out to our citizens to take some of the political rhetoric out of the debate. Warm regards, Janet
Dear Phil,
Thank you for sharing data about this important issue. The absence of a public option with government support to help families obtain the care they need to have a healthy life is embarrassing and tragic. If find it remarkable that Medicare is offered to people to help with their end of life care….yet no comparable offering is available to help people care for their children from infancy and throughout their lives. Other Western nations are so far ahead of the U.S. in healthcare policies. I appreciate your being a voice of reason reaching out beyond partisan politics. Warm regards, Janet
Thanks, Janet. I’m not saying we can afford to provide cradle to grave coverage. But let’s get rid of misleading rhetoric about the US having the greatest health care in the world.
Wow Phil! This is a great study, but does this mean you support a public health care option? Maybe I missed something.
Delores
Delores,
It doesn’t necessarily mean I support a public option, but I’m tired of phoney rhetoric that suggests the US has the best health care in the world. The facts say it’s not true.
Quality of healthcare & paying for healthcare are 2 different things. The public option is kinda strange. “Forcing” people to buy insurance sounds strange. Single Payer makes the most sense for paying for healthare. You pay into it from day one & it’s there as you need it when you get older. You don’t lose what you earned when you get laid off. You don’t have people weaseling out of paying you back your money.
Real story…last year a friend of mine, a tri-athlete who competes worldwide, went to have ankle/foot surgery in Austria where her surgery cost less than 50% of what it would have cost in the US where she would have paid over $26,000 just for the surgery, not counting the post-operative expenses. She went to an Austrian hospital that specialized in sports injuries and post-operative care. She is now in training to compete again and can’t stop singing praises of the hospitals in Austria. Also, I understand that India also offers medical procedures at way way below what the same procedure costs here. The U.S. does not have the best health care in the world; it has the most expensive health care in the world (no data to back that statement up, but I think that assumption is correct). Best and most expensive are not always the same thing.
Thankyou for the excellent article.