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Why the U.S. Ranks Low on WHO's Health-Care Study

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The New York Times [http://tinyurl.com/yvvqa3] recently declared "the disturbing truth ... that ... the United States is a laggard not a leader in providing good medical care."

As usual, the Times editors get it wrong.

They find evidence in a 2000 World Health Organization (WHO) rating of 191 nations and a Commonwealth Fund study of wealthy nations published last May.

In the WHO [http://tinyurl.com/yrsbb8] rankings, the United States finished 37th, behind nations like Morocco, Cyprus and Costa Rica. Finishing first and second were France and Italy. Michael Moore makes much of this in his movie "Sicko."

The Commonwealth Fund [http://tinyurl.com/23yn5q] looked at Australia, Canada, Germany, New Zealand, the United Kingdom and the United States — and ranked the U.S. last or next to last on all but one criterion.

So the verdict is in. The vaunted U.S. medical system is one of the worst.

But there's less to these studies than meets the eye. They measure something other than quality of medical care. So saying that the U.S. finished behind those other countries is misleading.

First let's acknowledge that the U.S. medical system has serious problems. But the problems stem from departures from free-market principles. The system is riddled with tax manipulation, costly insurance mandates and bureaucratic interference. Most important, six out of seven health-care dollars are spent by third parties, which means that most consumers exercise no cost-consciousness. As Milton Friedman always pointed out, no one spends other people's money as carefully as he spends his own.

Even with all that, it strains credulity to hear that the U.S. ranks far from the top. Sick people come to the United States for treatment. When was the last time you heard of someone leaving this country to get medical care? The last famous case I can remember is Rock Hudson, who went to France in the 1980s to seek treatment for AIDS.

So what's wrong with the WHO and Commonwealth Fund studies? Let me count the ways.

The WHO judged a country's quality of health on life expectancy. But that's a lousy measure of a health-care system. Many things that cause premature death have nothing do with medical care.

We have far more fatal transportation accidents than other countries. That's not a health-care problem.

Similarly, our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada.

When you adjust for these "fatal injury" rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation.

Diet and lack of exercise also bring down average life expectancy.

Another reason the U.S. didn't score high in the WHO rankings is that we are less socialistic than other nations. What has that got to do with the quality of health care? For the authors of the study, it's crucial. The WHO judged countries not on the absolute quality of health care, but on how "fairly" health care of any quality is "distributed." The problem here is obvious. By that criterion, a country with high-quality care overall but "unequal distribution" would rank below a country with lower quality care but equal distribution.

It's when this so-called "fairness," a highly subjective standard, is factored in that the U.S. scores go south.

The U.S. ranking is influenced heavily by the number of people — 45 million — without medical insurance. As I reported in previous columns, our government aggravates that problem by making insurance artificially expensive with, for example, mandates for coverage that many people would not choose and forbidding us to buy policies from companies in another state.

Even with these interventions, the 45 million figure is misleading. Thirty-seven percent of that group live in households making more than $50,000 a year, says the U.S. Census Bureau. Nineteen percent are in households making more than $75,000 a year; 20 percent are not citizens, and 33 percent are eligible for existing government programs but are not enrolled.

For all its problems, the U.S. ranks at the top for quality of care and innovation, including development of life-saving drugs. It "falters" only when the criterion is proximity to socialized medicine.

Next week: the truth about the Commonwealth Fund study.

John Stossel is co-anchor of ABC News' "20/20" and the author of "Myth, Lies, and Downright Stupidity: Get Out the Shovel — Why Everything You Know is Wrong," which is now out in paperback. To find out more about John Stossel and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com.

COPYRIGHT 2007 BY JFS PRODUCTIONS, INC.

DISTRIBUTED BY CREATORS SYNDICATE, INC.



Comments

3 Comments | Post Comment
I am writing a paper on US Healthcare and I came across this article. I have to say the writer is very obtuse, and uninformed. I don't have health insurance, and I do not fall in any of the mentioned/made up groups.
At this time I do not have any income, nor I qualify for existing gov programs such as Medicare/Medicaid. I am a citizen how can't afford to BUY.
So, please, don't mislead your readers about this serious issue.

"Even with these interventions, the 45 million figure is misleading. Thirty-seven percent of that group live in households making more than $50,000 a year, says the U.S. Census Bureau. Nineteen percent are in households making more than $75,000 a year; 20 percent are not citizens, and 33 percent are eligible for existing government programs but are not enrolled"
Comment: #1
Posted by: Verda
Wed Feb 27, 2013 1:03 PM
Mr. Stossel, I am a U.S. Family Physician, and a professor in a U.S. Medical school, and I have to point out that your definition of "healthcare" is too limited. When you speak about things like obesity and lack of exercise, these truly DO go to the heart the health of Americans versus other countries. When We train new physicians, we teach them that our lifestyle is interconnected with, and contributes to our overall health. Homicide and traffic deaths are as legitimate threats to the health of America as hand-washing and access to clean water was a century ago. Environmental stress, and access to health services are measurable predictors of the overall health of the individual and the community. And despite all of the new technology and innovations with which the U.S. leads the world, the biggest advances to our overall health has come from simple things like washing our hands, and having access to clean water. The truth is, we pay a far greater price for our "freedom" than many of us realize.
Comment: #2
Posted by: Kevin Izard, MD
Fri Jul 5, 2013 5:00 PM
With all due respect I think you both completely missed the point Stossel was trying to make (and succeeded in my mind).
Comment: #3
Posted by: YouGuysAre
Thu Dec 5, 2013 9:42 AM
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