Myth: The U.S. has the best health care system in the world.
Fact: The U.S. has among the worst health statistics of all rich nations.
Summary
The U.S. does not have the best health care system in the
world - it has the best emergency care system in the world. Advanced
U.S. medical technology has not translated into better health statistics
for its citizens; indeed, the U.S. ranks near the bottom in list after
list of international comparisons. Part of the problem is that there is
more profit in a pound of cure than an ounce of prevention. Another part
of the problem is that America has the highest level of poverty and income
inequality among all rich nations, and poverty affects one's health much
more than the limited ministrations of a formal health care system.
Argument
Let's review the health care statistics first, and analyze them
afterwards. All statistics here are for the year 1991; they have generally become
worse for the U.S. since then.
Health Care Expenditures (percent of GDP) (1)
United States 13.4%
Canada 10.0
Finland 9.1
Sweden 8.6
Germany 8.4
Netherlands 8.4
Norway 7.6
Japan 6.8
United Kingdom 6.6
Denmark 6.5
Doctors' incomes: (2)
United States $132,300
Germany 91,244
Denmark 50,585
Finland 42,943
Norway 35,356
Sweden 25,768
Percent of population covered by public health care:
ALL NATIONS (except below) 100%
France, Austria 99
Switzerland, Spain, Belgium 98
Germany 92
Netherlands 77
United States 40
Average paid maternity leave (as of 1991; this changed with Clinton's
signing of the 1993 Family and Medical Leave Act):
Sweden 32 weeks
France 28
United Kingdom 18
Norway 18
Denmark 18
Japan 14
Germany 14
Netherlands 12
United States 0
Life Expectancy (years):
Men Women
Japan 76.2 82.5
France 72.9 81.3
Switzerland 74.1 81.3
Netherlands 73.7 80.5
Sweden 74.2 80.4
Canada 73.4 80.3
Norway 73.1 79.7
Germany 72.6 79.2
Finland 70.7 78.8
United States 71.6 78.6
United Kingdom 72.7 78.2
Denmark 72.2 77.9
Infant Mortality Rate (per 1,000 live births):
United States 10.4
United Kingdom 9.4
Germany 8.5
Denmark 8.1
Canada 7.9
Norway 7.9
Netherlands 7.8
Switzerland 6.8
Finland 5.9
Sweden 5.9
Japan 5.0
Death rate of 1-to-4 year olds (per community of 200,000 per year):
United States 101.5
Japan 92.2
Norway 90.2
Denmark 85.1
France 84.9
United Kingdom 82.2
Canada 82.1
Netherlands 80.3
Germany 77.6
Switzerland 72.5
Sweden 64.7
Finland 53.3
Death rate of 15-to-24 year olds (per community of 200,000 per year):
United States 203
Switzerland 175
Canada 161
France 156
Finland 154
Norway 128
Germany 122
Denmark 120
United Kingdom 114
Sweden 109
Japan 96
Netherlands 90
Note: the murder rate for the above age group is 48.8 per 200,000. Even
subtracting this entirely still puts the U.S. near the top of the list.
Premature Death (years of life lost before the age of 64 per 100 people):
United States 5.8 years
Denmark 4.9
Finland 4.8
Canada 4.5
Germany 4.5
United Kingdom 4.4
Norway 4.3
Switzerland 4.1
Netherlands 4.0
Sweden 3.8
Japan 3.3
Percent of people with normal body mass:
Men Women
Germany 53% 37
Finland 51 37
United Kingdom 46 38
Canada 52 29
Switzerland 49 30
France 44 30
Denmark 44 25
United States 47 22
Sweden 44 25
Percent of people who believe their health care system needs fundamental change:
United States 60%
Sweden 58
United Kingdom 52
Japan 47
Netherlands 46
France 42
Canada 38
An explanation of America's poor health care statistics
Sharp readers will notice that the last chart may mean different
things to different people. Conservatives think the U.S. health care system
needs reform because there is too much government involvement in health
care; liberals because there is not enough.
So let's clarify this statistic with a few others. Americans are the
most dissatisfied with the quality and quantity of their health care. Of
the 10 largest industrialized nations, the U.S. ranked dead last in health
care satisfaction, with an approval rating of only 11 percent. (3) There's
no putting a positive spin on this statistic; any president with such a
low approval rating would be impeached!
Most of this dissatisfaction stems from the high expense and unavailability
of U.S. health care. During the 1993 debate on health care reform, polls
consistently showed that two-thirds of all Americans supported the idea
of universal coverage. (4) Polls also showed that Americans didn't want
to pay the higher taxes to achieve this goal, which many pundits took to
be an amusing example of public inconsistency. Actually, the public was
entirely consistent. Other nations manage to cover everybody, and at lower
cost.
Nor is America's international reputation in health care as high as
many Americans boast it to be. "Ask anyone you know from a foreign
country... which country is the envy of the world when it comes to health
care," Rush Limbaugh wrote in See, I Told You So. But according
to a Gallup poll published by the Toronto Star, only 2 percent of
all Canadians believe that the U.S. has a better health care system than
their own. (5)
The fact is that America does not have the finest health care
system in the world; it has the finest emergency care system in
the world. Highly trained American doctors can summon Star Wars-type technology
in saving patients who have become seriously injured or critically ill.
But as far as preventative medicine goes, the U.S. is still in the Stone
Age. It should be no surprise that in America's health care business,
entrepreneurs will take a pound of cure over an ounce of prevention every
time.
But in reality, what affects the health of Americans lies more outside
the formal health care system than within it. In Europe during the last
century, life expectancy nearly doubled after nations purified their drinking
water and created sanitation systems. In America during this century, the
highest cancer rates are found in neighborhoods around the chemical industry.
(6) A healthy diet and exercise provide better health than most medicines
in most circumstances. Other nations have realized that factors outside
the hospital are more important than factors inside it, and have used this
bit of wisdom to lower their health care costs.
Perhaps the greatest reason why Europeans are healthier than Americans
is because they have reduced poverty, especially child poverty. The link
between poverty and poorer health has long been proven. One survey reviewed
more than 30 other studies on the relationship between class and health,
and found that "class influences one's chances of staying alive. Almost
without exception, the evidence shows that classes differ on mortality
rates." (7) The American Journal of Epidemiology states that "a
vast body of evidence has shown consistently that those in the lower classes
have higher mortality, morbidity and disability rates" and these "are
in part due to inadequate medical care services as well as to the impact
of a toxic and hazardous physical environment." (8)
And in an even more important finding, studies from Harvard and Berkeley
have proven that income inequality -- not just absolute poverty
-- is equally important. (9) States with the highest levels of income inequality
also have the highest mortality and morbidity rates. The reason why relative
poverty matters is because prices and opportunities are relative too -
the U.S. may have the best medical technology in the world, but at $10,000
a procedure, who can afford it?
Many reasons contribute to the worse health of the poor. Political
scientist Jeffrey Reiman writes: "Less money means less nutritious
food, less heat in winter, less fresh air in summer, less distance from
sick people, less knowledge about illness or medicine, fewer doctor visits,
fewer dental visits, less preventative care, and above all else, less first-quality
medical attention when all these other deprivations take their toll and
a poor person finds himself seriously ill." (10) And this is not to
mention that the poor work and live in more polluted, hazardous and strenuous
environments.
These deprivations are especially hard on infants in their critical
development years. The U.S. has tried to combat this problem by offering
universal prenatal and postnatal health care, much like Europe does. But
the U.S. is fighting against a head wind because it has levels of poverty
that Europe does not. Again, a person's health is affected by more factors
outside the formal health care system than within it. It's not enough to
give a few programs to a person in poverty; what's needed is removing that
person from poverty completely.
"When I look back on my years in office," says C. Everett
Koop, Reagan's former Surgeon General, "the things I banged my head
against were all poverty." (11)
If America is to improve its health statistics, it must not only pass
universal health care, but reduce poverty as well.
Return to Overview
Endnotes:
1. Organization for Economic Cooperation and Development, Paris,
France, OECD Health Data, 1993; OECD Health Systems: Facts and Trends,
1993.
2. Remaining statistic charts listed in Where We Stand, by Michael
Wolff, Peter Rutten, Albert Bayers III, and the World Rank Research Team
(New York: Bantam Books, 1992)
3. Health Affairs, vol. 9, no. 2, cited by Steven Randall, Jim
Naureckas and Jeff Cohen in The Way Things Aren't: Rush Limbaugh's Reign
of Error (New York: W.W. Norton & Company, 1995), p. 65.
4. Jeff Cohen and Norman Solomon, Through the Media Looking Glass:
Decoding Bias and Blather in the News (Monroe: Common Courage Press,
1995), p. 81.
5. The Way Things Aren't, p. 66.
6. This was the finding of a county-by-county national survey conducted
by the National Cancer Institute in 1975. Cited in "N.J.'s Chemical
Belt Takes Its Toll: $4 Billion Industry Tied to Nation's Highest Cancer
Rate," Washington Post, February 8, 1976, p. A1.
7. Aaron Antonovsky, "Class and a Chance for Life," in Inequality
and Justice, Lee Rainwater, ed., (Chicago: Aldine Publishing Company,
1974), p. 177.
8. S. Leonard Syme and Lisa Berkman, "Social Class, Susceptibility
and Sickness," American Journal of Epidemiology 104, no. 1
(July 1976), pp. 1,4.
9. Berkeley study: George A. Kaplan and others, "Inequality in
income and mortality in the United States: analysis of mortality and potential
pathways," British Medical Journal, Vol. 312 (April 20, 1996),
pp. 999-1003. Harvard study: Bruce P. Kennedy and others, "Income
distribution and mortality: cross sectional ecological study of the Robin
Hood index in the United States," British Medical Journal,
Vol. 312 (April 20, 1996), pp. 1004-1007.
10. Jeffrey Reiman, The Rich Get Richer And the Poor Get Prison
(New York: MacMillan Publishing Company, 1990), p. 75.
11. Quoted in Stephanie Coontz, The Way We Never Were: American
Families and the Nostalgia Trap (New York: HarperCollins, 1992), p.
270.