DISSATISFACTION WITH U.S. HEALTH
Sharp readers have pointed out that this statistic means
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 allow me to clarify this survey 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.1 There's no putting a positive
spin on this statistic; any president with such a low approval rating would
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.2 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," wrote Rush Limbaugh in See, I Told You So. But according
to a Gallup poll published in the September 13, 1993 edition of
The Toronto Star, only 2 percent of
all Canadians believe that the U.S. has a better health care system than
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 fallen 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
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.4
A healthy diet and exercise provide better health than most medicines in
most circumstances. Other nations have figured this principle out, and
have used it to lower their health care costs.
But 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."5 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."6
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."
7 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.
"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."8
If America is to improve its health statistics, it must
not only pass universal health care, but reduce poverty as well.
Return to Overview
1 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.
2 Jeff Cohen and Norman Solomon, Through
the Media Looking Glass: Decoding Bias and Blather in the News (Monroe:
Common Courage Press, 1995), p. 81
3 The Way Things Aren't, p.
4 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.
5 Aaron Antonovsky, "Class and
a Chance for Life," in Inequality and Justice, Lee Rainwater,
ed., (Chicago: Aldine Publishing Company, 1974), p. 177.
6 S. Leonard Syme and Lisa Berkman,
"Social Class, Susceptibility and Sickness," American Journal
of Epidemiology 104, no. 1 (July 1976), pp. 1,4.
7 Jeffrey Reiman, The Rich Get Richer
And the Poor Get Prison (New York: MacMillan Publishing Company, 1990),
8 Quoted in Stephanie Coontz, The
Way We Never Were: American Families and the Nostalgia Trap (New York:
HarperCollins, 1992), p. 270.