We could drown in statistics. Sometimes we look to them for quick answers to questions, or shoot them off to make a point in an arguement like a slam dunk. They have power as objective measures. A Texas politician (Pete Sessions) once asserted that "Americans have some of the greatest health care in the world." Without parsing his words it sounds like he's saying that, collectively, we have the best. Similar statements are trumpeted in rallying cries whenever a progressive attempt at health care reform is made. Many of us accept such impassioned assertions. Without objective numbers it's like judging the best blueberry pie in a bake-off at the county fair, which isn't the best way to start a debate about a topic as critical as healthcare.
A great place to find statistics about the world is in the Central Intelligence Agency's World Fact Book, which is available online. The agency collects mundane bits of data about each of the planet's nations, crunches them into neat numbers and shares them with the public. I was surprised to find that in measures of health, the United States is not at the top of most lists. For example, we have a child mortality rate of 7.07 per 1000, which ranks us at 34, just below Cuba, which seems to do better at keeping infants alive than we can. In terms of life expectancy, we rank 50 (the country with the best longevity is Monaco, the elite playground of the world's wealthiest.) Thinking that maybe the CIA got the numbers wrong, I looked at statistics kept by the World Health Organization; they are similar. Of course, an analysis of the numbers would need to be done to indicate their statistical significance so these simple rankings don't mean much in themselves. They only give a starting point for understanding where we are in relation to the rest of the world.
Perhaps measures of our health system's greatness are hidden in the statistics; we have 2.672 physicians and 3.1 hospital beds per 1000 Americans, which is more than our Canadian neighbors' socialized system. They have a paltry 1.9132 physicians, though a few more beds in hospitals. According to ranking by World Health Indicators, that puts us in the world's number 52 spot. We spend a lot more, too. According to WHO statistics, we expend 14.6% of our gross domestic product to maintaining our health, whereas the Canadians use only 9.6% of theirs, and the United Kingdom uses 7.7%. In fact, one rank in which the United States is number one is for our expenditures on healthcare. Whether or not there is significance in the figures is yet to be determined, but it might be the unidentified statistic to which opponents to health care reform refer.
During the great health care debates in which Americans considered the possibility of improved access to health care by extending low cost coverage to more of their brethren, the example of the British and Canadian systems was raised. The specter of a socialized medical system was roundly beaten down by those who feared that governmental meddling would only make us sicker at a much greater expense. Systems like that take away patients' freedom of choice and would bankrupt the nation. A quick run down of the gross numbers has to make one wonder how we could spend any more than we already do. As a country, we are not the worst in terms of our health, but we are probably doing something wrong when, within our cohort of developed economies, we rank last in positive outcomes. Maybe Americans choose to be unhealthy?
Within those numbers might be an answer to what we are doing wrong. While we spend the most on healthcare, at a rate which continues to outpace inflation, our health outcomes haven't improved. Someday I want put those raw figures into a statistics program to see if there is any meaning in them. I suspect that one significant difference is that accessibility to healthcare is mediated by a profit-based system of insurance companies. Our scheme allocates most access to care to those covered within an employer's health plan; some are less generous than others. Congress members have better access to care than a greeter at a big box store who's insurance has a high co-pay and deductible or a recently unemployed truck driver forced to choose between paying for a $10,000 COBRA or a mortgage and groceries. So much for freedom of choice; but let's not pretend that it's the best in the world.
About Pamela Lazorko
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