The Untied Nations WHO has America Ranked as #37. American doctors tend to reject this number. Here is an analysis and results from several other lists.

A recent post about a U.S. medical policy maker who will decline health care after 75 also noted that the World Health Organization ranked U.S. health care #37. This led to the following reactions:

Noted L.A. oncologist, “…on the other hand, I refuse to subscribe to the tenant that American healthcare is #37 in the world.  That is a ridiculous and otherworldly conclusion.  You [Dr. Mike] and I both know that can’t be true.”

Dr. Mike responded,” The way the WHO ranks countries, had the US developed a pill that cured everything and resulted in physical immortality but had an out-of-pocket expense of $1 we would still be ranked rather low as their system is strongly weighted toward ‘universal, socialized healthcare’ regardless of health outcome measures. “

Would be interesting to know what the drug companies would actually charge for such a pill, given what Gilead charges for their Hepatitis C cure.

But more to the point, just how does WHO rank health care systems? According to Wikipedia, the rankings are based on an index of five factors:^[2]

Health (50%) : disability-adjusted life expectancy

Overall or average : 25%

Distribution or equality : 25%

Responsiveness (25%) : speed of service, protection of privacy, and quality of amenities

Overall or average : 12.5%

Distribution or equality : 12.5%

Fair financial contribution : 25%

Not clear what fair financial contribution actually means here, but perhaps that did take us to #37. But that’s a fourth of the rank. Half of it is life expectancy. Let’s look at that.

Again from WHO, the U.S. is #36. Now, this particular statistic is a bit harder to dismiss. Why do people in 35 other countries live longer?  Well perhaps it isn’t health care per se, but policy. The food pyramid, or subsidies for growing starches, or the beatification of whole grain. Something like that.

Let’s  look at one more WHO statistic that surely has little to do with health policy: infant mortality. Again a chilling disappointment. U.S. is #34. This is a national travesty. If we can fix one thing……

Lets look at someone else’s numbers. The Commonwealth Fund, a hundred year old health care policy group, does their own ranking. France didn’t finish first in this one. U.K. did. Out of 11, U.S. was a disappointing #11. Of interest though is the breakdown. In ‘effective care’ the U.S. was #3. This may be the area of greatest concern to the above mentioned doctors. (I have been a patient of both. I can attest that their care is very effective.) The U.S. was #4 in ‘patient centered care’, and #5 in timeliness. What took us to last place was partly cost, but we were also dead last in efficiency (how much of the health care dollar does the insurance industry hoover up), equity (one sixth of the population remains uninsured), and finally, U.S. were dead last in a category called ‘healthy lives’. Not sure exactly what that means, but somehow I don’t have a hard time believing it.

At the end of the day, it is a little hard to argue against all these statistics. Many things are clearly broken and Obamacare has only partially fixed some of them. There is still a lot to do, and seemingly little political will for it.

A major reason is national attitude. In every one of the three dozen countries out performing the U.S., public attitude is that free health care is a fundamental right, like fire departments and police protection. And the medical profession, the government, the policy makers are completely in accord with this. No matter how poor or desperate, a mother of a sick baby can walk into a hospital or clinic and get care.

This is not the case in America. Under Obamacare, about 15 million are now insured that weren’t before. Bravo. However, about 50 million remain uninsured. When the poorer of these get sick, or their babies get sick, they are completely dependent on public largess, meaning they basically have to go beg for minimal health care. Perhaps if this were fixed, the U.S. would not be in 35^th place any more. Or does the insurance industry need to be extricated from the health care equation as well.

After 50 years of battle with this industry, I finally qualify for America’s only large socialized medical program: Medicare. My opinion: I Love It. It works far better than any health insurance I ever had. To get full Medicare coverage, you have to pay. Many can’t afford this even though the rates are graduated, so another strike against U.S.  However, I am happy to pay. If private health insurance were free, I would still pay and keep Medicare.  Of course, I can afford to….

I have had the honor to be the patient of both doctors mentioned above, and can attest that the medical care I received was excellent, valuable, and timely. However, 15% of the country does not have access to this level of care. For a variety of reasons, 50 million people are still not covered, and until this is fixed, I suspect the U.S. will continue to run last among the developed countries.

Hello! This is one of the few times we will be coming out of our co-authorial mask to speak in our own voices. The above is from Dr. Davis. This is Mike, Dr. Mike, and what is to follow is my editorial addition to the above.

There are two strains of my demurral from the above and the WHO assessments of US healthcare. First, the US is a very different statistical ‘kettle of fish’ than almost any of the other countries the WHO ranks higher than the US. For example, Hispanics, who, for socioeconomic reasons, have poor access to healthcare and who suffer a higher than normal incidence of obesity and Adult Onset Diabetes, have longer disease free life expectancies than native born Caucasians. Weird, but true. On the other hand the US is home to some very health challenged groups that skew any group/national analysis. I could pile on details but my point is the WHO does not make important, fine distinctions that would wildly vitiate any national healthcare comparability. After all, the US is ranked number one for life expectancy after diagnosis for almost any cancer and all forms of heart disease.

The second line of my demurral runs this way: I have seen American health so badly harmed by the regulatory state that I am always very, very slow to suggest that further regulation is the path to a better future. As an example The McGovern Commission’s recommendations for a fat and cholesterol, limited, starch unlimited diet have been the cause of many, many unnecessary deaths. Another example: the FDA is renowned for its thorough review of medications before authorizing the use of medications. That is one version; the other version is they have been terrible at screening, their screening is, in fact, an obstructionist tool of the state run regulatory entity known as ‘Big Pharma’ which is not a friend of creative, new and helpful pharmacy. The FDA has created a regulatory environment that precludes creative new entries into the therapeutic environment.

So, in sum, and very short of thoroughly argued and presented here, I do not think the WHO’s assessment provides any useful guide to a better US healthcare system, nor do I think that essentially small, socially and genetically homogenous societies/countries provide a useful model for US healthcare.

Solutions? I can make suggestions but that is not the purpose of Charlie’s and my note today.

 

U.S. READERS: We KNOW you have a strong opinion on U.S. Health Care – please chime in and comment.

 

PS  We both agree that Dr. Immanuel’s idea that 75 marks some kind of ‘end of life’ inflection point is absurd in any healthcare system.