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.
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.
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.
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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.