Health Care, Again

I’ve made a point of having a conversation on health care at least once a day with someone who disagrees with the need for health care reform. Below is an email I sent to someone after our conversation ended prematurely. The person this is directed at is in his early 60’s, is very much a member of the Conservative Christian Right, and very eager to tell others that they are wrong without providing proof to back it up.

This is a long email. I did a lot of research and put a lot of thought into it, so I hope that you will read it and give it some thought. This is my work, my understanding, and my conclusions, based upon hard data — not some TV personality’s opinions vomited up for your consumption.

You said: “The US has Best Health Care in the World” and when I said that was incorrect, you told me I was wrong. So I did some research with the following question in mind: How do I quantitatively measure “best” using statistics you’d trust? I know that a lot of people have been lead by certain media outlets to mistrust the World Heath Organization statistics, so… Would you trust the stats compiled in the CIA FACT BOOK? I think you would, so I’ll start there. https://www.cia.gov/library/publications/the-world-factbook/index.html

So, if the US does indeed have the best health care in the world, then we should have the lowest rate of infant mortality and the highest life expectancy, right? The measure of the health of a nation’s citizens is fairly easily determined by infant mortality rates, as there is a correlation between maternal health and the health of infants. Additionally, longevity is an excellent measure of the health of a nation. Healthier people live longer, right? But to be generous, lets say that for a country to be a contender for the “Best Health Care in the World Award” that country should be in the top 10%. So the CIA evaluates 224 countries, which means the US would need to be within the TOP 22 in order to qualify for the upper 90th percentile. Lets see how we rank:

INFANT MORTALITY RATE: 6.26 per 1000 = #180th highest out of 224 countries / 44th lowest out of 224. If the US has the best health care, then we should have one of the lowest infant morality rates, right? Uhm, there 43 countries with fewer infant deaths. Cuba, a communist country with socialized medicine, has fewer deaths per 1000 than we do. Canada is beats the US by 9 slots. The top 10 countries with the lowest infant mortality rates: Singapore, Bermuda, Sweden, Japan, Hong Kong, Macau, Iceland, France, Finland, Anguilla. Germany is 15th, Switzerland is 16th, the UK is 31st and Canada is 35th. The vast majority of these countries have government subsidized health care for all citizens. Source: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html?countryName=United%20States&countryCode=us®ionCode=na&rank=180#top

LIFE EXPECTANCY: 78.11 years = 50th out of 224 countries. If the US has the best health care system then our population should be living longer and healthier than people in other countries. But we’re not. The US, at #50, is in the 77th percentile. Canada is 8th, in the top 5%. UK is 36th, Germany 32nd, Sweden is 10th, France is 9th, Australia is 7th. Macau, Andorra, Japan, Singapore and San Marino are in the top 5. Source: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

I think the only way we can say that we have the best heath care system in the US is if we think “most expensive” = “best”. But I won’t stop there. How else can we quantitatively evaluate the qualitative assertion “The US has Best Health Care in the World” ?

The US as a country is the single largest producer of wealth in the world. Our 2008 GDP was 14.2 trillion. The EU combined was 14.8 trillion. GDP per capita, however, we are #10, with Singapore just ahead of us at #9, and with the UK and Canada at 19 and 21 respectively. Other countries with lower GDP but higher life expectancy and lower infant mortality rates such as Canada, the UK, and Sweden manage to provide health care that exceeds American standards (as measured by our infant mortality and life expectancy rates) at a lower percentage of GDP / per capita. How is it that countries with similar or lower GDP manage to provide health care to their citizens that demonstrably (via infant mortality and life expectancy rates) exceeds our own? Obviously, Government subsidized health care is both more economically efficient and individually effective. Source: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2004rank.html

The reason why Singapore keeps coming up is because, by all accounts, Singapore has the best health care in the world. The Singapore government spent only 1.3 percent of GDP on healthcare in 2002, whereas the combined public and private expenditure on healthcare amounted to a low 4.3 percent of GDP. By contrast, the United States spent 14.6 percent of its GDP on healthcare that year… How does Singapore do it? Yep, Government-subsidized health care. Not only does it make excellent marks on life expectancy and infant mortality, but Singapore subsidizes its citizen’s health without endangering its economy. Source: http://econlog.econlib.org/archives/2008/01/singapores_heal.html

Yes, I know that in the cases of certain catastrophic illnesses, the US has a higher survival or extension of life rate and that in those cases, wealthy people from other countries come here for care. But my understanding is that we have a higher percentage of catastrophic illnesses as a result of poor health maintenance / preventive care, and thus our “supremacy” in this area is born of necessity and opportunistic profitability rather than of efforts at excellence.

Lastly, I know that some people have argued that we can’t afford a health care system because our Defense spending is so high. Well, the CIA Factbook shows that the US is #28 in Defense pending as a percentage of GDP, between Chad and Libya, and almost a full percentage point behind Singapore (#20). Source: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2034rank.html Now, back in the 60’s when most other First World countries were developing national health care systems, the US was caught up in funding the Cold War and that is why only Medicare for the Elderly was passed, because it was thought the country could not afford it. Once the Cold War was over, however, there was very little agreement about how involved the Government should be in the US Economy, and in fact, there were significant cut-backs in “entitlement” spending, the funds of which were then funneled into Defense spending. Even so, according to a Brookings Institute study, the US now spends more money on health care than it does on Defense and Social Security combined. Source: http://www.brookings.edu/projects/opportunity08.aspx Surely, if we are putting that much of our GDP into health care, we can get a better value for our dollars.

Conclusion: Americans have a tendency to believe in our dominance and supremacy in the world, without recognizing that it is an illusion. Stubbornly insisting that “We are the Best!!!” does not make it so. It isn’t unpatriotic to recognize that the US is slipping. But I think it is unpatriotic to blindly accept what the rah-rah “patriotic cheerleaders” have to say about where the US stands in comparison to the rest of the world. We’ve lost our moral high ground with the torture of prisoners and we’re losing our economic vitality to idiots who want a return to the Free Market Robber Baron days. Well, the excesses of the late 1800s and early 1900s lead to the crash in 1929, and the same practices and policies lead to the crash of 2008. And as a result of the abuses of the early 1900’s, the Federal government implemented a social security network (pensions in the 1930s), which it later expanded upon with the Medicare program of 1965 and the WIC program of 1975. In all three cases, a significant number of people argued very heatedly against these “entitlement programs” and yet, without them, where would we be? In the US, the poverty rate in 2007 was 12.6% of the population. 18% of those living in poverty in this wealthiest of nations are children, and nearly 10% of them are people over 65. Source: http://www.census.gov/hhes/www/poverty/poverty07/pov07hi.html If we didn’t have these socialized care / entitlement programs (Social Security, Medicare, WIC, etc) the lives of those living in poverty would be much, much harder.

Now we are at an important cross-roads. We either ensure that every citizen in the US has access to affordable health care, thus improving the overall health of the nation and thus decreasing medical costs long-term, or we sink even farther in the world rankings. It is better that our elderly enter the Medicare program healthy from a lifetime of adequate health care, because there will be fewer instances of catastrophic illnesses and other costly issues resulting from neglected health. And it is better that Americans enter the work-force healthy from adequate health care in childhood. Singapore learned that lesson big time. In 1969, Singapore was ranked #59 for GDP in the world, and today it is at #46, and the per capita income went from #38 in 1969 (Source: http://www.nationmaster.com/graph/eco_gdp_percap-economy-gdp-per-capita&int=-1&date=1969) to #9. What accounts for the upward mobility? Most people give a government focus on health care the bulk of the credit. Singapore once had a very high incidence of malaria, a disease that created a huge drag on their economy (and still has a profound effect on the health and economies of most equatorial countries) because a significant percentage of the population was too sick to work in any given time. In the same time frame, the US went from #1 in GDP per capita in 1969 to #10 per capita in 2008. In 2003, lost work days due to illness and injury carried total annual costs of nearly billion in lost work and productivity for private US employers, not including actual health care costs (Source: http://journals.lww.com/joem/Abstract/2007/07000/Cost_of_Lost_Work_and_Bed_Days_for_US_Workers_in.7.aspx). Could it be that the 9 point drop in US GDP per capita is at least partially related to the high costs of poor health maintenance? There is a lot of compelling data out there to suggest that it is in the best economic interests of every country to provide public health care — and all this without even touching upon the moral argument of the world’s wealthiest Christian nation’s unwillingness to provide for its poor and sick citizens as Christ chided us all to do.

If you’ve gotten this far, I hope you’ll at least give all of this some thought. I’ve provided the sources of all of the numbers I’ve quoted. Most of them are from the CIA Fact Book, as I’m sure you’ve noticed. It is my nature to question what others assert. I’ve never been very good at taking “because I said so” as an answer, and no matter how charismatic the person or compelling the argument, I’ve always, always, looked for the facts. Here they are. Make of them what you will.