America’s Strange Health Care Debate

I cannot  recall any other major policy debate in America in my adult lifetime in which there has been so much passion and “certitude” and so little discussion of the facts. Sound bites in news programs, newspaper editorials, political speeches on the floor of the Congress, and even our many healthcare “forums” here in Vermont on the subject have for the most part been occasions for people to vent angry opinions about our present system of healthcare delivery, and to characterize opposing views.
We could we could instead, however, be having a national debate on this important issue based upon easily obtainable, reliable data.
The relative costs and performance outcomes of the many different healthcare delivery systems in over 200 countries and territories are known, tracked, carefully gathered, and published annually by the World Health Organization (WHO) in Geneva. This year’s edition is entitled “World Health Statistics 2009”, and  you have almost certainly never seen or even heard of it, though you have probably listened to hours of speeches, debates and discussions about healthcare costs and waste and delays, in the U.S. and Canada and Europe, and on and on.
WHO’s annual health statistics report is compiled from data submitted by 193 member countries. All statistics in the report are cleared by the member states and are presented as the Organization’s official figures, though they should ….”still be regarded as best estimates made by WHO rather than the official view of member states.” There is, in other words, a lot of money, sensitivity and emotion involved in healthcare statistics, as you may have noticed. The full 2009 Report may be accessed at
So, relative healthcare costs. The United States as a government, according to the 2009 World Health Report, expends $3,076 US on healthcare per capita per year, which puts it third in the world behind Luxembourg ($4,992) and Denmark ($3,239) and then followed (top ten)by:

    1. Netherlands ($2,785)
    2. Austria ($2,737)
    3. France ($2,727)
    4. Germany ($2, 664)
    5. Iceland ($2,628)
    6. Canada ($2,587)
    7. Sweden ($2,583)

These, however, are only government healthcare expenditures, and all of the other countries listed here have essentially national, not free-market healthcare systems.
The Report also tracks total national healthcare expenditure as a percentage of gross domestic product, public and private. Here then are those relative figures, for the top ten countries:

    1. United States (15.8%)
    2. France (11%)
    3. Denmark (10.8%)
    4. Switzerland (10.8%)
    5. Germany (10.6%)
    6. Austria (10.2%)
    7. Canada (10.0%)
    8. Sweden (9.2%)
    9. Spain (8.4%)
    10. Japan (8.1%)

The United States relative to its GDP expends, counting both government and private funds,spends 43% more on health care than does the next highest country, which is France.
Compared with Canada (aren’t we always comparing our HC system to Canada’s?) the US expends, in public and private funds together, 63% more on healthcare. So with the highest healthcare costs in the world, what are we in the United States getting in the way of results, i.e., HEALTH?
One standard measure of the effectiveness of our healthcare system might be life expectancy at birth, in years. According to WHO, the nation with the highest life expectancy is Japan, at 83 years, followed by Italy, Australia and Switzerland, at 82 years. You may expect to live to be 81 if you live in Canada, Israel, Netherlands, Norway, Singapore, France, Sweden, New Zealand and Andorra. People in Austria, Belgium and Cypress live to the age of 80, on average. Costa Ricans and people in Finland live on average to be 79. Citizens of the U.S., along with those of Chile, Denmark and Cuba die on average at age 78.
The infant mortality rate calculates the number of deaths at birth, per 1000 births, for both sexes. The U.S. is tied at six deaths per thousand with the countries of Thailand, Slovakia, Lithuania and Hungary. Among the countries with FEWER than six deaths per 1000 live births are Slovenia, Singapore, San Marino, South Korea, Lithuania, Estonia, Cuba, Cyprus and Andorra.
It is worth noting, in respect of the infant mortality numbers just cited, that the WHO annual report also tracks the percentage of births attended by skilled health personnel. While the number for attended U.S. births is high, at 99%, there are 46 countries that have 100% of births attended. These include Albania, Barbados, Bosnia, Brunei, Canada (oops!) Chile, Croatia, Cuba (again) , Cyprus and the Czech Republic, along with Kazakhstan, Kuwait, Poland, Quatar , Moldova, Malaysia, and Libya. Also Turkmenistan, United Arab Emirates and Uzbekistan.
Maternal mortality rates per 100,000 live births are also rated. The United States loses 11 mothers per 100,000 live births. Countries which lose fewer than that include Canada, Croatia, Czech Republic, Hungary, Israel, Kuwait, Latvia, Malta, Poland, Slovakia and Macedonia. In all, a total of 31 countries suffer fewer than 11 maternal deaths per 100,000 live births.
The point here is not to denigrate the “American Healthcare System.” It is among the finest in the world…..AMONG the finest in the world. It is indisputably the most expensive in the world….. by far. A little realism and a dash of humility would probably help us to improve it further.
But I begin to question whether those in the Congress who are currently resisting reform, and  those insurance and drug company lobbyists who are using their obscene profits to loudly oppose reform, really want to change any aspects of the system. It is serving them quite well as it is.
Stephen Green is retired from the United Nations. He lives in Vermont.