The Myth of the Quality of American Health Care

By Melanie R. Margolis

"Americans enjoy the best health care in the world," reads the 2000 GOP Platform adopted by Republican National Convention delegates on July 31, 2000. Perhaps it is one of the best kept secrets around, but the preceding quote, which is a commonly held belief in the U.S., rings astoundingly untrue. Yes, excellent medical care is available in the U.S., and ground-breaking medical research is conducted here. Most Americans, however, are not aware of the low U.S. rankings in studies comparing various countries' health care.

A commentary published in the July 26, 2000 issue of the Journal of the American Medical Association notes that in a comparison of 13 countries based on 16 health indicators, the U.S. ranked on average 12th. The countries included in the study were, in order from the top-ranked (best health care) to the lowest-ranked, as follows: Japan, Sweden, Canada, France, Australia, Spain, Finland, the Netherlands, the United Kingdom, Denmark, Belgium, the U.S., and Germany. Of the 13 countries compared, only Germany ranked lower overall than the U.S. In fact, the U.S. ranked dead last for three indicators. These were low-birth-weight percentages, neonatal mortality and infant mortality overall, and years of potential life lost. The U.S. ranked 11th for life expectancy for females at one year and 12th for life expectancy for males at one year. These rankings do not paint a picture of a country that has the world's best health care.

On June 21, 2000, the World Health Organization released the World Health Report Health Systems: Improving Performance, which is accessible at http://www.who.int/whr/ (World Health Report). The World Health Report ranked the U.S. 37th out of 191 countries. According to the World Health Report, the objective of a health care system is to be both good and fair. Thus, a health care system should strive to achieve the highest possible average level of health with the fewest disparities among individuals and groups. Americans must face the fact the U.S. health system is not good and fair as so defined. (See The Health Care Fairness Act of 1999 at HealthPolicy/991118HCFAct.html for a discussion of the lower health status of minority populations in the U.S.)

According to the World Health Report, of the 191 countries in the study, the U.S. spent the highest percentage (13.7%) of its Gross Domestic Product on health care but still managed only to achieve an overall ranking of 37. The World Health Report also found that private (non-governmental) health expenses as a percentage of total health expenses in most industrialized countries average only 25% because most have universal health coverage. In the U.S., however, private (non-governmental) health expenditure runs 55.9%.

How can anyone say that a country with health care/status that ranks 37th of 191 and 12th of 13 truly has the best health care in the world? The U.S. may actually have the best health care in the world for some Americans -- for those with the resources to pay for their health care, for those with access to primary care physicians and specialists. But for every American receiving this elusive best health care in the world, many more Americans receive woefully inadequate care. After all, over 40 million Americans lack health insurance. Numerous factors (from the structure of the U.S. health system to the American lifestyle) contribute to the low rankings of the U.S. compared to other industrialized (and some non-industrialized) countries. It is clear, however, that to say Americans are experiencing the best health care in the world is to buy into a myth.

08/07/00