NRL News
Page 7
April 2009
Volume 36
Issue 5

Inaccurate Grounds for Calling U.S. Health Care Inferior

Critics of the U.S. health care system frequently maintain that other countries have superior health care we should use as models for U.S. reform. They argue that many countries spend far less on health care than the United States yet seem to enjoy better health outcomes.

However, these claims fall apart upon careful examination. Compared to the rest of the world, the U.S. has top-tier survival rates, choice of providers, and very short wait times. It turns out that the statistics critics cite either are incomplete or compare apples to oranges.

WHO Rankings. Critics frequently quote the World Health Report 2000, prepared by the World Health Organization (WHO), in whose performance rankings of 191 nations’ health care systems the U.S. disappointingly ranked 37th. You’d assume these WHO rankings would reflect how likely you were to survive an illness or injury, or to live better and longer with a chronic condition. However, the WHO rankings give great weight to whether the evaluated health care system meets the organization’s ideological preferences.

The U.S. is penalized for things like allowing Health Savings accounts, not having a government-run health care system, and having an insufficiently progressive income tax system (i.e., escalating rates on increasing levels of earnings).The low U.S. grades on these overcome its advantage on the statistics that directly measure health outcomes, where WHO rates our country number one.

Life Expectancy. Another frequently cited statistic is that according to the Organization for Economic Co-operation and Development, the U.S. ranks 18th among 30 world democracies in life expectancy. However, health care is not the only factor in life expectancy. If you correct for two causes of death not directly related to health care—homicides and automobile accidents—the U.S. actually rises to the top of the list for life expectancy.

Infant Mortality. The UN ranks the U.S. 163rd out of 195 countries in comparing infant mortality rates. However, in measuring these rates, the U.S. includes all deaths after “live birth” and defines births as live if newborns show any sign of life, regardless of prematurity. By contrast, Austria and Germany include only deaths of infants who weigh at least one pound at birth. In Belgium and France, the deaths of infants born after less than 26 weeks of pregnancy are not included. Moreover, many other countries do not reliably register babies who die soon after birth.

Specific Diseases. When you compare the outcomes for specific diseases, the U.S. clearly outperforms the rest of the world. According to the U.S. National Cancer Institute and the International Agency for Research on Cancer, five-year survival rates for all of the five most common types of cancer are better in the U.S. than in European countries.

Medical Innovation. Moreover, the U.S. drives the bulk of worldwide research and innovation related to health care. A study by Michael Tanner concludes, “Eighteen of the last 25 winners of the Nobel Prize in Medicine are either U.S. citizens or individuals working here. U.S. companies have developed half of all new major medicines introduced worldwide over the past 20 years. In fact, Americans played a key role in 80 percent of the most important medical advances of the past 30 years. ... [A]dvanced medical technology is far more available in the United States than in nearly any other country.”

Even under the WHO rankings, the U.S. is rated first in “responsiveness to patients’ needs in choice of provider, dignity, autonomy, timely care, and confidentiality.” Despite genuine problems of distribution and utilization of preventive care, overall, in comparison with other countries U.S. health care is faster, more effective, and more advanced.