Alan Stolier, MD/




” Those Americans who die or go broke because they happened to get sick represent a fundamental moral decision our country has made. All the other developed countries on earth have made a different moral decision. All the other countries like us — that is, wealthy, technologically advanced, industrialized democracies — guarantee medical care to anyone who gets sick.” And so begins the book by T. R. Reid, The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care.  T. R. Reed is a longtime columnist for the Washington Post as well as former chief of its Tokyo and London Bureaus. Over the next few weeks, we will follow T. R. Reid as he sets out on a global tour of “doctor’s offices, hospitals, and health ministries to see how other democracies organize healthcare systems that are universal, affordable and effective.”


There is a great diversity of what American citizens think about our healthcare system. It is likely that physicians and other healthcare professionals similarly represent a cross-section of American thought on this topic as well. Indeed, the gulf dividing us may be too wide to bridge, at least at this moment in history. Yet the divide will be bridged, though maybe not today or even tomorrow. Tsung-Mei Cheng, a health research analyst at Princeton has formulated the Universal Laws of Health Care Systems which lends clarity:

  1. “No matter how good the health care is in a particular country, people will complain about it.”
  2. “No matter how much money is spent on health care, the doctors and hospitals will argue that it is not enough.”
  3. “The last reform always failed.”

At one time, politicians would boast that the United States had the finest health care system on the planet. According to Reid, this was last said in the State of the Union Address in 2002. If said today, the President would likely be “hooted out of the room”. I think most of us recognize that our health care system is expensive and generally unjust. The World Health Organization ranks the U.S. as 37th when rating quality and fairness. We’re just behind Dominica and just ahead of Slovenia. “The one area where the United States unquestionably leads is spending.” We spend approximately $9403 per person (compared to Japan at $3400). Almost 18% of our Gross Domestic Product (GDP) is spent on health care. That ranks highest in the industrialized world!

Percentage of GDP spent on healthcare (From World Health Organization)                                                                                                                                                                                                         

USA 17.9
France 11.5
Switzerland 11.7
Germany 11.3
Canada 10.4
Sweden 11.9
UK 9.1
Japan 10.2
Mexico 6.3
Taiwan 6.2

One of the other benchmarks used to measure healthcare systems is “avoidable mortality-that is how well a country does at curing diseases that are curable. In a 2008 study by the Commonwealth Fund, deaths before age 75 from conditions that are at least modifiable with effective medical care, concluded that the U.S. finished worse among 19 wealthy countries. For some diseases, the U.S. tops the world. America’s five-year survival for women diagnosed with breast cancer was the best of 9 countries studied!

Possibly the best benchmark of effective health care is what’s termed “life expectancy at age 60” (predicts how many more years a 60-year-old can expect to live). This is a better estimate of survival within the adult life than life expectancy at birth, particularly for low- and middle-income countries. Life expectancy at birth is greatly influenced by high infant mortality and therefore says little about survival. In a 2006 Commonwealth Fund study, the U.S. was tied for last in survival after 60! The following is a link showing life after 60 for many countries. http://www.helpage.org/global-agewatch/population-ageing-data/life-expectancy-at-60/.  To be sure, there are countries such as Uruguay, Honduras, Ecuador and Jamaica which finish below us.  Yet all countries of western Europe finish above us (except for Denmark and Belgium with whom we are tied.

It’s clear by any measure that the citizens of the United States pay a lot for their health care. There’s nothing wrong with paying more to maintain health. However, although “Americans are shelling out the big bucks”, are we getting what we pay for? “Anybody who dares to say that other countries do something better than we do is likely to be labeled unpatriotic or anti-American”.

It makes little sense to try and develop an entirely new healthcare system without looking to see what others have done and done successfully.  “We have borrowed numerous foreign innovations that have become staples of American life: public broadcasting, text messaging, pizza, sushi, yoga, The Office and even American Idol”. Dwight Eisenhower, our 34th President, developed the Interstate System as a direct result of his wartime experience with the German Autobahn. In summary, there is no sense in reinventing the wheel, particularly in healthcare where other countries have been more successful than we have in climbing that mountain.

So, in the next few weeks, we will publish a brief overview of healthcare systems around the world. All the countries discussed rank higher than the U.S. in care, cost and in the longevity of their citizens. Hopefully, this will be helpful in forming your own opinions about where if anywhere America should go in addressing our expensive and inefficient system. Furthermore, it may stimulate you to investigate each healthcare system in more detail.


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