The Worst Health Outcomes In The Developed World

Are in America, according to The Institute of Medicine and the National Research Council. The New York Times gives us the rundown:

The 378-page study by a panel of experts convened by the Institute of Medicine and the National Research Council is the first to systematically compare death rates and health measures for people of all ages, including American youths. It went further than other studies in documenting the full range of causes of death, from diseases to accidents to violence. It was based on a broad review of mortality and health studies and statistics.

The panel called the pattern of higher rates of disease and shorter lives “the U.S. health disadvantage,” and said it was responsible for dragging the country to the bottom in terms of life expectancy over the past 30 years. American men ranked last in life expectancy among the 17 countries in the study, and American women ranked second to last.

Our love affair with guns is also hashed out in empirical fashion:

The rate of firearm homicides was 20 times higher in the United States than in the other countries, according to the report, which cited a 2011 study of 23 countries. And though suicide rates were lower in the United States, firearm suicide rates were six times higher.

Sixty-nine percent of all American homicide deaths in 2007 involved firearms, compared with an average of 26 percent in other countries, the study said. “The bottom line is that we are not preventing damaging health behaviors,” said Samuel Preston, a demographer and sociologist at the University of Pennsylvania, who was on the panel. “You can blame that on public health officials, or on the health care system. No one understands where responsibility lies.”

That, as an aside, demonstrates the lethality of guns. 69% of murders in the US are from guns compared to 26% in the other nations.

Panelists were surprised at just how consistently Americans ended up at the bottom of the rankings. The United States had the second-highest death rate from the most common form of heart disease, the kind that causes heart attacks, and the second-highest death rate from lung disease, a legacy of high smoking rates in past decades. American adults also have the highest diabetes rates.

Youths fared no better. The United States has the highest infant mortality rate among these countries, and its young people have the highest rates of sexually transmitted diseasesteen pregnancy and deaths from car crashes. Americans lose more years of life before age 50 to alcohol and drug abuse than people in any of the other countries.

Americans also had the lowest probability over all of surviving to the age of 50. The report’s second chapter details health indicators for youths where the United States ranks near or at the bottom. There are so many that the list takes up four pages. Chronic diseases, including heart disease, also played a role for people under 50.

“We expected to see some bad news and some good news,” Dr. Woolf said. “But the U.S. ranked near and at the bottom in almost every heath indicator. That stunned us.”

You won’t read a sadder or more surprising report than this. How can the richest country in the world, the country that spends the most per-person on healthcare have such horrid results? That’s the debate we need to have.

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22 Responses to The Worst Health Outcomes In The Developed World

  1. Pingback: Our Healthcare Problem IS Our Spending Problem | Reason and Politics

  2. Jarret R. says:

    You should take a look at this WaPo article,, which discusses the study you’r referencing in this post. For me, the key part is this:

    “…at age 65, Americans enter a health-care system that ceases to be exceptional when compared with the systems in the other 16 nations studied. They leave behind the private provision of medical coverage, forsake the genius of the market and avail themselves of universal medical insurance. For the first time, they are beneficiaries of the same kind of social policy that their counterparts in other lands enjoy. And presto, change-o: Their life expectancy catches up with and eventually surpasses those of the French, Germans, Britons and Canadians.”

    This is the benefit of a truly universal system, single-payer or otherwise. Americans know it, but they don’t necessarily want to admit it.

    • Blake’s (Tina’s son) grandfather is an old-school William F Buckley Republican, and even he says single payer is the optimal form. He’s been a doctor his whole life, an Army full bird Colonel, and is now Chief of Staff of a hospital. He said the best system he’s ever worked for is the Army medical corps, which is fully socialized (all the personnel work for the government). I had a long conversation with him a few weeks ago, and it was enlightening to say the least.

  3. Very interesting article.

    What I find even more interesting is the interpretation associated with it. While you (reasoningpolitics) seem to see this study as demonstrating the need for universal health care, I see it as the opposite.

    The way I see things is that switching to universal health care does nothing but change the name on the check. It is simply a question of who pays for health care. It does not engage the issues of health care costs or health care outcomes. I understand some costs may be reduced by granting universal access to health care especially preventative care. I fully agree with that.

    But I think that much of our problems is with our lifestyle or culture. Access to health care isn’t going to change our teen pregnancy rate, deaths from guns, drug abuse and obesity (which surprisingly wasn’t mentioned in the article). I believe many of those more general trends in our society drive our health care expenditures resulting in the US spending more per capita than anybody else.

    Note: If you want good national health care expenditure numbers for debates such as this I find the Centers for Medicare and Medicaid Services (CMS) to be helpful. They have numbers with tons of breakdowns for past, present and projections.

    • Thanks for the link. That’s good data to have. Another commenter pointed out cultural factors as well. I’ll just point out that of you read the free brief (the actual report cost $80 to purchase) the researchers themselves point to inadequate health systems are a key reason for the US’s poor numbers. They do also point to other factors, but since this is a political blog I chose to adress the post politically salient (and solvable) piece.

      You are correct that universal healthcare in and of itself will not fix the problem if all it does is change who pays the bill (although it will solve the problem of lack of access). I have written about the need for a properly incentivize structure that discourages excessive procedures and lowers costs. I interviewed a chief of staff of a Texas hospital for that piece. Universal healthcare is not a silver bullet if its set up poorly. If done right, it can cut costs and improve outcomes.

      Thanks again for adding to this important discussion. You sound intelligent, civil, and informed. You’re precisely who’m I’m writing for!

  4. Jarret R. says:

    Great Britain, the only Western country with a truly socialized medical system, generally has better health care outcomes than the U.S., and it is by no means an ethnically “homogeneous” country.

  5. paisstat says:

    We also have significant proportions of our population holding minority culture, which completely skews the results when comparing the United States to largely homogeneous countries in Europe for example. While the left will try to imagine this away as a product of racism and exploitation, the truth is that variances in income, success and yes, health outcomes depend largely on cultural attributes and habits.

    • Thanks for your comment. I’m really not following your line of reasoning. How does the presence of minorities affect health outcomes?

      • paisstat says:

        The presence of minorities skews the results, when comparing a multi-cultural country such as the United States to the mostly homogeneous ones of Western Europe because of extreme differences in attitudes towards health. The presence of minorities isn’t solely a racial issue, but more importantly a cultural one. The health outcomes in African-American inner city areas and largely white Appalachia are much the same for example.

        It is well documented that differences in culture produce differing outcomes with regards to health-related issues. Taking into account factors such as levels of smoking and alcohol consumption, levels of diet and exercise, level of risky behavior, prenatal care, etc, which are largely culturally based, we can get a clearer picture of the reality of the situation.

        Whereas surveys such as this one are intended to be a smear towards the United States and a call for more government intervention and point out the evil failings of our system, in truth, they are a senseless comparison when looked at from a more in-depth perspective and should be taken with a grain of salt indeed.

      • I’m not sure how that changes the fact that US health outcomes are worse than other advanced countries.

        You’re saying the poorest in our society have the worst health outcomes when compared to countries that have universal healthcare, but you’re citing the ‘culture of minorities’ instead of lack of proper healthcare?

        I still do not understand how the presence of minorities impacts these results.

      • paisstat says:

        I’m citing the fact that this, as with all issues, is multifaceted and can’t be explained simply by the lack of universal health care, racism or exploitation. It is not unreasonable to question the predominating orthodoxy on this issue.

        This type of analysis also fails to take into consideration the fact that the US in fact has greater outcomes in such areas as morbidity and survival rate for various diseases such as heart disease and cancer because of better testing, access to technology and medications and in fact the longest life expectancy in the world when controlled for accidents.

        It is indeed important to use logic and reason and to consider all factors, not only pre-decided conclusions when discussing issues such as this. By the nature of your previous question, you’re making the assumption that my analysis should be automatically dismissed out of hand because it doesn’t fit into the narrative.

      • I’m merely attempting to understand your argument. If you feel minorities somehow drag down our health and wellness statistics when compared to other nations, that’s not really a legitimate argument in my opinion.

        Even if I accept your premise, which I do not, minorities are still part of America, so the US still underperforms. You assertions do not change the facts of this study, nor did you try to dispute it. You attacked minorities to prevent the discussion from moving towards our healthcare systems and government policies. Correct me if I’m wrong.

      • paisstat says:

        I’m not attacking anyone. but merely point out some of the reasons behind the lag, which can’t be explained simply by referring to policy. Similar policy in varying countries and cultures will not produce the same results because of underlying cultural differences, challenges and attributes.

      • I do agree with you there. Various nations have chosen to enact universal healthcare through a variety of policies. Some, like the UK, have chosen full state control where hospitals themselves are run by the state. Others like Switzerland and now the US have chosen to use the private sector and mandates to ensure universal coverage. The goal of universal healthcare is admirable, and I agree that there are different ways to achieve it based on culture, demographics, and economics to name a few.

        I still have to disagree with you when you site minorities as the reason we have poor health outcomes. The other nations surveyed have had universal healthcare for decades. The US has not had this and the ACA still has not been fully implemented.

        Spain, for example, has better health outcomes despite vastly different cultural groups within it. The culture of Barcelona or the Northern Baque regions are so different that they have two different major separatist movements who are actively trying to secede from Spain. Despite these cultural differences, they have vastly better health outcomes.

      • paisstat says:

        So, we are in agreement that policy alone can not account for vast differences in outcomes in various areas, including health care.

        My insistence on the skewed results for the American system is not a value judgement nor an attack on minorities or other sub-groups within the population, but a fact check on the reality of the situation. The facts exist that various populations within the United States have vastly different attitudes and habits toward health. Part of the differences can indeed be attributed to access, but culture should not be downplayed or eliminated from the equation.

        With respect to your statement on Spain, the various regions are not as vastly different as those of the United States, where double digit percentages exist. The experiences of the Basque in fact would fit well with my example. Their separatist instincts come greatly from the fact that they are the suppliers of wealth to the Spanish state, whereas regions such as Andalusia have traditionally had a more ‘relaxed’ culture towards economic performance, health, literacy, etc. In short, the cultural values of the south of Spain have not been able to bring about the level of wealth and prosperity that the Basque have.

        Lastly, you state that the goal of universal healthcare is admirable. It is on paper, but the failure, as with most leftist ideology is that it makes a good narrative, which must be strictly followed, no matter what the reality of the situation is. In reality, we should judge policy not on its good intentions (and most policy is very well-intentioned), but on its outcome. The old adage ‘the road to hell is paved with good intentions’ is indeed one that we would do well to remember.

      • Judging the outcomes, not intentions, is exactly what I am doing. This study compared many nations. All these nations have minorities and sub-cultures contained within them. Disparate culture and minorities cannot possibly be the variable that has affected these outcomes. The main variable that stands is our healthcare system.

        Universal healthcare is not leftist. The right wants universal healthcare as well. Its in how to deliver these services where the true debate resides.

        “Universal healthcare” as idea is far from a failure. Nations that have it, whether through the private market or through a single payer system have far, far better health results than nations without.

        It is in how the healthcare system is managed and how incentives are structured where some universal healthcare systems outperform other. Not in the mere presence of universality.

      • paisstat says:

        I’d like to make a few points:

        1) Judging the outcomes: It depends on which set of outcomes one is basing it on. When looking at the level of insurance coverage, other systems outperform. However, when evaluating other factors, such as morbidity and survival rates for a whole host of diseases, including heart disease and cancer as well as wait times for procedures and access to care and medication and production of new technologies and methods of treatment, the United States outperforms hands down. I’ll take that situation over the rationing of services.

        2) It is true that all countries have some minority or sub-culture groups, but no developed country has variation to the extent of the United States. The original point being that this presence skews the results when comparing the United States to other developed countries. The region, which most American liberals point to with regards to the social-welfare system succeeding is Scandinavia, whose countries are very homogeneous with regards to ethnicity, religion and shred cultural traits such as thrift and community spirit.

        3) The idea of universal healthcare is indeed leftist by any definition of the word. When it is presumed that the state and the collective takes precedent over the individual, that is the very definition of ‘leftism’.

      • I’ll offer a quick response to each:
        1. The US ranks very low when compared to other advanced nations when health outcomes are considered. We had horrible rationing in the US, just from insurance companies. Before the ACA, lifetime limits were commonplace.
        2. You still haven’t shown how culture could possibly impacts US health stats to the degree shown in the study when lack of healthcare is the key variable difference between the nations studied.
        3. Within the context of left vs right in the US universal healthcare is not a leftist idea. One would have to include libraries, roads, sanitation, and fire departments in the ‘leftist’ category as well if we accept your healthcare premise. That would mean the vast majority of right wing politicians and intellectuals are actually leftist because they don’t want to privatize the interstates. I can see how a libertarian could define it that way, but it doesn’t leave much room for nuance in a debate.

        Thanks again for this stimulating conversation, by the way.

      • paisstat says:

        First, I have enjoyed the exchange as well and look forward to possible other topics. I can completely understand your mindset and the basis for your arguments and appreciate that you offer them in a rational and respectful manner. I was a lifelong Democrat and a raging leftist for the good part of my life, but gradually made the progression to libertarianism.

        As with many areas, statistics can tell two stories. As Mark Twain said ‘there are three types of lies; lies, damned lies and statistics’ and they can be used to support or deflate any argument depending on the context, and not always with intended malice.

        I believe the outcomes in this country are better than those of other developed countries, but do recognize the failings of our system. The statistics you cite do support your argument and point to some of the facts, but leave out others, such as the ones I mentioned.

        I think we will have to call it a draw on the culture issue, as I know that you are unwilling or unable (I am not being facetious here) to see that point because we have been indoctrinated not to speak things such as that or question the orthodoxy that it can play no part!

        With regards to your last comment, you do make a very good point and yes, I would advocate eliminating funding at the federal level for those other things you mentioned. The states, counties, cities and town have the capability of providing such services as the citizens within those realms see fit within the democratic system.

        Again, thanks for the exchange!

      • I’m glad you enjoyed this as much as I did. I myself am not particularly ideological, but as you can see I have strong opinions (although they change as I discover new evidence).

        I look at political ideas as tools, to be used when situations call for them. Conservative, progressive, or libertarian, they can all be useful depending on the issue. That’s just the way I look at things, so in the case of healthcare you might find me to be on the left, while I might advocate the full privatization of Social Security at the same time.

        I recently had a long debate with a more progressive reader about Social Security, and he thought I was a raging Tea Partier!

        Anyway, I do hope you stop back and discuss some more issues here. I’ll be sure to stop by your blog as well. Have a great night.

      • paisstat says:

        I’d like to think I’m not ideological either and I don’t necessarily like labels, but I know for certain that I am what the rest of the world would term libertarian. Essentially I believe in low taxes, limited government according to the rule of law, respect for the individual in terms of rights and responsibilities and community involvement on the local level.

        I believe that liberal programs have contributed to a deterioration of the community and civic spirit by passing the buck from us to the federal government and at the same time have perpetuated poverty and created an underclass. In lieu of this, I believe in localism with communities deciding what is best for them on the local level as the best possible form of democracy.

        I do believe we have an obligation to provide support for those who are less well off and less fortunate, but believe that we can do that better than any program full of government workers in an office.

        Lastly, I believe the leftist thought process is flawed by the fact that it misinterprets the reality of human nature. Essentially humans are self-interested and that can not be changed, nor should it! On the surface, that sounds terrible, but it is the human condition nonetheless. We each seek to maximize our happiness and that of our loved ones and that can’t be changed. In fact it is this very drive, which produces great things for us all and advances civilization. This drive produces a want for profit, which makes our lives happy and allows us to take the time to stop and think about issues such as this.

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