The US Has The Greatest Health Care in the World

Via Steve Chapman at Reason:

[President Obama] says though the United States spends more per person on medical care than any other nation, "the quality of our care is often lower, and we aren't any healthier. In fact, citizens in some countries that spend substantially less than we do are actually living longer than we do."

That's one of the favorite rationales for a government-led overhaul. But it gives about as realistic a picture of American medicine as an episode of Scrubs.

It's true that the United States spends more on health care than anyone else, and it's true that we rank below a lot of other advanced countries in life expectancy. The juxtaposition of the two facts, however, doesn't prove we are wasting our money or doing the wrong things.

It only proves that lots of things affect mortality besides medical treatment. Heath Ledger didn't die at age 28 because the American health care system failed him.

One big reason our life expectancy lags is that Americans have an unusual tendency to perish in homicides or accidents. We are 12 times more likely than the Japanese to be murdered and nearly twice as likely to be killed in auto wrecks.

In their 2006 book, The Business of Health, economists Robert L. Ohsfeldt and John E. Schneider set out to determine where the U.S. would rank in life span among developed nations if homicides and accidents are factored out. Their answer? First place.

That discovery indicates our health care system is doing a poor job of preventing shootouts and drunk driving but a good job of healing the sick. All those universal-care systems in Canada and Europe may sound like Health Heaven, but they fall short of our model when it comes to combating life-threatening diseases.


  1. Xmas:

    err...Heath Ledger died from a bad combination of too many prescription drugs. That is, kinda, a failure of the American Health Care System. It was a human failing of doctors and the patient not talking or, perhaps, drug seeking behavior on the patient's part, not something that you can condemn the whole system for.

    Maybe Steve Chapman should have gone with River Phoenix or Chris Farley...

  2. Ian Random:

    Wait, Slate says Scrubs is "most accurate portrayal of the medical profession on TV."

  3. Dan:

    "All those universal-care systems in Canada and Europe may sound like Health Heaven, but they fall short of our model when it comes to combating life-threatening diseases."

    My extensive reading on the subject as well as my years of working in the healthcare industry suggests that you are correct - the U.S. has the best healthcare system in the world when it comes to combating life-threatening diseases like cancer. If I'm diagnosed with cancer, I'll be glad I live here.

    What you're overlooking is the failure of the U.S. healthcare system to catch problems early in many patients, problems that in the long run can lead to heart disease and cancer. The U.S. does a lousy job at primary care, and as a result, many patients don't get treatment until they're extremely ill, at which point the excellent healthcare you cite takes over, but at a price.

    For the poor, or for those without insurance, a visit to the emergency room is often the first time they're treated for costly diseases like diabetes, which, if caught early, can be mitigated, and can even be prevented in the first place through promoting better eating and exercise habits.

    We need to do a better job of making sure people have time with their doctors to discuss their lifestyles and get early diagnosis of small problems before they grow larger. So let's not be sanguine. Even those who oppose Obama's plan can admit that in certain ways, our system is far from perfect, and even that we can learn something from the Canadian and European systems.

  4. thebastidge:

    "What you’re overlooking is the failure of the U.S. healthcare system to catch problems early in many patients, problems that in the long run can lead to heart disease and cancer. The U.S. does a lousy job at primary care, and as a result, many patients don’t get treatment until they’re extremely ill, at which point the excellent healthcare you cite takes over, but at a price.

    ...we can learn something from the Canadian and European systems."

    I've yet to see anything that suggests that their system is actually better than ours at early detection. Sure, people are more likely to go to the doctor before things are life-threatening, but by the same token, both doctor and patient are less alert and take such visits much less seriously.

    The problem with people not seeking regular preventive maintenance healthcare is a cultural problem, not a problem of access. People don't maintain their cars, don't get enough exercise, let their house fall into disrepair which costs more than maintenance etc. It's a problem of psychological feedback mechanisms, expectations, and training (or in other words, culture).

    It's not that we lack the means, but rather because many of us lack the habit, the discipline, and the awareness of the responsibility. I don't want government inflicting discipline on me, do you?

    Plenty of capability exists in our system to get early diagnosis, and early treatment. Going to a socialist model will not increase our capacity. A yearly or particularly, a five-year checkup is not beyond the financial means of ordinary people. It would be even more afforable if we were paying directly for our health care, and not losing to inefficiencies and agency problems with payment intermediaries.

  5. H Weiss:

    Also included in our mortality statistics are preemie babies. A baby born at 23 weeks (or even earlier) in America is counted as a live birth and every effort is made to save its life, sometimes unsuccessfully. A baby born premature in most other countries is counted as a miscarriage.

  6. Rob:

    The follow on argument is that it doesn't matter if we have the best healthcare quality when it's too expensive to afford.

    I agree that prices are high and the CEO of whole foods had a nice arycle in the WSJ on how to fix the system to lower prices. Unfortunately the people who argue that our system is broken will completely ignore the ideas to address the current system. They are hellbent on adding another economic faux pas into the system (govt subsidezed insurance).

    Their logic is frankly irrational "The system is broken. Don't address why it broken, just make the system bigger!"

  7. Les:

    Careful there, saying stuff like, "But our health care is fine, we just have a lot of shootouts and car-accidents ruining our life-expectancy average." You may think you're saying, "Health care is fine, leave it alone," but you know someone in politics is going to hear, "We need to ban guns and have mandatory mass-transit."

  8. Dan:

    In response to Les:

    If one could wave a magic wand and make all the guns and ammunition in this country disappear permanently, it would probably have a small, but measurable, impact on healthcare spending. I'm sure billions are spent every year fixing up bullet wounds from gang wars, hunting accidents, etc.

    Not that I think banning guns makes sense from a practical standpoint of course, nor do I think the government should do so. I dislike guns intensely, but I'm not in favor of taking them away from their owners. Making guns less accessible to criminals and harder for small children to accidentally shoot each other with would be good steps.

  9. Curt:

    H Weiss -- Do you have any good references for that assertion on infant mortality? I've seen it over and over again on the internet (so it must be true...), but I'd like to see some pretty definitive source for it.

  10. Jonathan:

    Dan, that has to be one of the best examinations of the US health care system I've read during this whole 'debate' on healthcare. Finally, a reasoned look at what we have and what works and what we need to improve upon and what we could learn from other systems. I'm very interested to hear what you believe would be the best way to go about improving the ability of our system to catch problems early and to make care more accessible while still retaining our excellent care in other areas.

  11. Scott:

    Curt, OECD doesn't host this anywhere freely available on their website, but if you sign up for the free 7 day trial and download their Health Data database under the Health Status - Mortality - Maternal and infant Mortality, if you click on the little ? button at the top you can navigate to a page that says this.

    Infant mortality

    The number of deaths of children aged under one year of age that occurred in a given year, expressed per 1000 live births.

    Note: Some of the international variation in infant and neonatal mortality rates may be due to variations among countries in registering practices of premature infants (whether they are reported as live births or not). In several countries, such as in the United States, Canada and the Nordic countries, very premature babies (with relatively low odds of survival) are registered as live births, which increases mortality rates compared with other countries that do not register them as live births.

  12. Dan:

    Thanks, Jonathan.

    I'm flattered that you found my comments useful. I'm not sure I'm qualified to offer specific presciptions for fixing the system, as my career in healthcare has been in the journalism and public affairs areas, not in formulating policy. As I said, from my extensive reading and from seeing things happen in my industry, I've come up with a philosophy, but I can't pretend to have a lot of great ideas that haven't already been thought up elsewhere.

    One specific cost-cutting policy that would be easy to adopt immediately (and is being debated in Congress) would be to make available in the U.S. generic versions of expensive bioliogic drugs. So-called "biosimilars" are already available in Europe, at prices 20% to 30% cheaper than the innovator biologics. Some of these biologic drugs can cost $100,000 a year or more, and it seems illogical that after being on the market for more than 20 years (in some cases), these drugs still have no generic competition here in the U.S. Unfortunately, big pharma has pretty much convinced Congress to support less than competitive biogenerics legislation that will allow companies to keep their monopolies for many years more. Thankfully, President Obama doesn't buy into this, and here's hoping he'll find a compromise solution.

    For more perspective that reflects where I'm coming from, I'd suggest reading the recent cover story on healthcare in The Atlantic, which examines how the system we have now doesn't provide proper economic incentives for patients and healthcare institutions to try and save money. The article is called, "How American Health Care Killed My Father," by David Goldhill. A lot of the thoughts I put down on my blog posting came out of reading that article. Here's a link, though I think you have to be a subscriber to read the full piece:

  13. dwall:

    Lets just raise the price on drugs and technology advances we create and sell to other countries. Until they are copied, where else they going to get them? Enough with flexible pricing for other countries.