How Does U. S. Health Care Compare?

The post at RealClearPolitics by physician Roger Stark on the rankings of the U. S. health care system by the World Health Organization and the Commonwealth Fund caught my eye. As should surprise no one the rankings are heavily dependent on what you value most. Since the WHO places almost 2/3s of the weigh of its ranking on having a single payer health care system, the U. S. scores relatively low. How does it do in other areas?

Cardiovascular disease, such as heart attack and stroke, remains the leading cause of death globally and in the United States. Research from the Kaiser Family Foundation shows that the 30-day mortality rate after admission to the hospital for a heart attack patient is 4.9 percent in the U.S. compared to a 5.8 percent average for five other industrialized countries. The stroke numbers are similar with a 4.1 percent mortality rate in the U.S. compared to an average of 6.4 percent in five similar countries.

The combination of all cancers is the second leading cause of death for virtually all countries. The Concord-3 study is one of the largest international cancer reports. Researchers examined records of 37 million patients and looked at five-year survival rates for 18 different types of cancer in both adults and children. Again, the U.S. ranked either first or in the top five countries in the most common types of cancer – breast, prostate, and lung.

The U.S. does fall behind other industrialized countries in certain health areas, such as premature death, longevity, and maternal mortality. The U.S. also has a high incidence of major physical trauma, such as gun violence and car crashes, as well as a significant rate of suicide. These trauma issues definitely contribute to poor longevity numbers in the U.S. However, they are a consequence of serious social problems and should in no way be a reflection on the health care delivery system.

Data from the Center for Disease Control and Prevention show that 74 percent of Americans are overweight and 43 percent are obese. Weight problems are associated with heart attacks, stroke, type II diabetes, and certain types of cancer. Maintaining an ideal body weight is a life-style choice and, again, should not reflect on the quality of a country’s health care delivery system.

I want to quibble with Dr. Stark’s observation about obesity to some degree. Contrary to Dr. Stark’s claim I think that maintaining an ideal body weight is multi-factorial with important factors including gender, age, heredity, culture, and, as Dr. Stark contends, lifestyle choice. I think that holding it up as solely a lifestyle choice is a step too far. Just for the record for my age I am categorized as being in the ideal weight range. I’m just about the same size as I was 50 years ago.

I do think that far too many Americans are overweight and obese with factors including all of those I mentioned above. It’s hard for me to compare what things were like 60 years ago with today since then I was in St. Louis, now I’m in Chicago, and the prevailing phenotypes in the two places were quite different and have changed dramatically over the intervening years. 60 years ago I was struck by how much fatter Chicagoans were than St. Louisans. I suspect that’s even truer now.

One thing unmentioned in Dr. Stark’s post is how much more Americans pay for the outcomes we do achieve than people in other countries do. Here’s a comparison for OECD countries:

I don’t know how to weight the factors involved in those differences. I’m sure it’s multi-factorial as well. I doubt as much of the difference is attributable to our lacking a single payer system as advocates for single payer systems like to believe.