What’s Wrong with American Health Care - (Hint:  It’s Not What You Think!)

As Americans consider whether to move forward in expanding government’s role in controlling our health care system, it’s important to have a balanced picture of the current system’s strengths and weaknesses.  

Certainly the current American health care system is far from perfect, but the current critique of the U.S. health care system often relies on skewed data.  

PREMISE: America’s infant mortality rate is higher than 47 other countries, according to the U.S. CIA World Fact Book. This includes many much less developed countries and many countries with government-run health care systems.

REALITY: Our infant mortality rate appears to be high primarily because we count more babies as born alive than other countries do, and because of other measurement and demographic variables.

  • U.S. Counts More Babies as Born Alive than other Countries Do:  Many babies who are born too premature have little to no hope of living.  Yet the United States counts these babies as born alive and therefore as infant deaths, when other developed countries categorize them as “Still Born.”  Analysts estimate that this fact alone could inflate the United States infant mortality rate by 40 percent. (See the National Institute for Health)
  • U.S. Doctors Take Extraordinary Measures to Save Preemies:  “U.S. physicians often go to great efforts—at the prenatal and postnatal stages—to save a baby with poor survival chances. The additional prenatal care an American doctor provides may improve the odds of the live birth of a baby with poor survival chances, who is then likely to require extensive neonatal care. Accordingly, the U.S. uses substantially more neonatal intensive care units (NICU) than other industrialized countries. In this case, the additional health care may actually worsen reported infant mortality rates and misleadingly suggest poor care in the United States.”  (Written by professors from the University of California and University of Minnesota, and an OECD official, American Enterprise Institute).
  • Bernadine Healy, former head of the National Institutes of Health, warns that cross- country comparisons in infant mortality are not apples-to-apples: “In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don't reliably register babies who die within the first 24 hours of birth. (US News)
  • Other Demographic Factors:  Factors such as obesity, substance abuse, race, and age contribute to the United States misleadingly high infant mortality rate.  For example, teenagers who give birth are more likely to have low-weight babies, who are less likely to survive.  The United States has a much higher rate of teen age births than do other OECD countries. (National Bureau of Economic Research and the American Enterprise Institute).  
  • A study for the National Bureau of Economic Research found that if you control for weight at birth alone, the United States has a lower infant mortality rate than does Canada. (see MSNBC).


    REALITY: Because life expectancy is driven by the way we count infant mortality (see above), lifestyle, and accidental and violent deaths, this measure doesn’t tell us much about the effectiveness of the U.S. health care system:
    • The flaws in infant mortality (discussed previously) directly affect life expectancy numbers.
    • Demographic and life style factors (such as obesity, incidents of smoking) also have a profound effect on a population’s life expectancy, and have little reflection on the effectiveness of the health care system.  
    • The United States also has a much higher rate of death due to accidents and crime than other developed countries, which reduces the average U.S. life expectancy.  This is a serious problem on its own, but it is largely unrelated to the quality of our health care system

    A better assessment of a health care system’s effectiveness is how it addresses actual illnesses.

    • Did you know that the United States is ranked #1 in the world for “responsiveness to the needs and choices of the individual patient”? (World Health Organization)
    • Did you know that the United States has the highest survival rate for cancer of any OECD country? (see Forbes and the Lancet Oncology journal).
    • This is consistently proven in cross country comparisons: In a 2000 study, for the major sites of lung, breast, prostate, colon, and rectum cancers, US survival rates were the highest of any of the 18 countries investigated. (Gatta et al. study cited in this Univ. of Pennsylvania working paper
    • An updated analysis of survival rates, published in 2007, reached similar conclusions: Based upon period survival data from 47 European cancer registries, 5-year survival rates were found to be higher in the US than in a European composite for cancer at all major sites. For men, 47.3% of Europeans survived 5 years, compared to 66.3% of Americans. For women, the contrast was 55.8% vs. 62.9%. (Verdecchia et al. study, cited in this Univ. of Pennsylvania working paper) In short, if you are diagnosed with cancer and treated in the United States, you are more likely to survive than if you were treated in Europe (or any other country for that matter).

    PREMISE: Americans are commonly told that moving toward a government-run or single payer health care system such as the one in Canada will allow Americans of all incomes to have better access to treatment, including preventative care.

    REALITY: Studies show that income plays a greater role in determining health status in Canada than America, that preventive treatments are more accessible and wait times far shorter in America, and that Americans like their health care better.

    • Analysis found that far from abolishing any relationship between income and health outcome, after controlling for outside factors, income played a greater role in determining health status in Canada than in the U.S. (National Bureau of Economic Research).
    • Americans are more likely than Canadians to access preventative care treatments, such as mammograms, PAP smears, and colonoscopies, and that among patients with eight common health ailments (Asthma, Arthritis, Emphysema, Diabetes, High Blood Pressure, Heart Disease, Coronary Heart Disease, and Angina) those in the United States were more likely to be getting treatment on six of those eight ailments (National Bureau of Economic Research).
    • In 2011, Canadians had to wait an average of 9.5 weeks before seeing a specialist. (Fraser Institute).  The average wait time in Canada for a knee replacement surgery is 12 weeks.  In the United States, it is 5 weeks (National Bureau of Economic Research).
    • Americans also report better health and more satisfaction with the health care system than do Canadians (National Bureau of Economic Research).

    REALITY: Americans should be aware of ways that the American system is actually superior.

    Did You Know?

    The United States leads the world in new medical innovations.

    • A 2009 study shows American scientists won the Nobel Prize in 33 out of the previous 40 years, whereas scientists from the entire rest of the world won it in only 25 out of those 40 years (often it was shared between Americans and non-Americans).  Additionally, of the top 27 drugs and devices, U.S. physicians, companies, and scientists had a hand in developing 20 of them, whereas European physicians, companies and scientists only had a hand in 14.  (Cato Institute)
    • This means that even the health care that patients are getting in Canada, Europe, Australia, and other places is partly due to the creative capacities of the U.S. health care system.

    Americans actually report significantly shorter waiting times than patients in other countries.

    • Just 5 percent of Americans report having to wait more than four months for elective surgery, compared to Australia (23 percent), Canada (27 percent), New Zealand (26 percent) and the United Kingdom (38 percent). (OECD report)
    • Americans had more access to new cancer fighting drugs than Canadians or Europeans because of a longer approval process.  In some cases, it took Canada more than 180 days longer to green light a new cancer treatment than in the U.S. (Fraser Institute)
    • Canadians periodically have to turn to the United States for the use of their highly specialized medical facilities.  For example, in 2007, a woman from Calvary, Canada had to be flown to Montana to deliver quadruplets, because there were no adequate neonatal facilities available.  Similarly women from Alberta, Canada had to be transferred to Montana to deliver babies because of a shortage of neonatal facilities.  (See CBC News)

    The United States spends more than any other country in the world on health care, and more Americans worry about the cost of medical care than other countries.  But did you know that there many reasons why the U.S. spends more, and that some of those are because of government policies that drive up costs?

    • Working Hard to Save Every Life:  The United States develops most new health care techniques and treatments, and makes use of these new innovations to try to save lives that other countries might deem hopeless.  As described previously, babies born prematurely receive extensive—and expensive—treatment protocols.  These extreme measures can be costly.  (See this discussion at the American Enterprise Institute).
    • A Complex Multi-party Payer System:  Most working age Americans obtain health insurance through their employers.  They do not pay directly for health services, and they don’t even directly choose their health insurance provider.  This means that many Americans have no reason to consider cost when making health care decisions, which encourages overconsumption and makes it possible for health service providers to charge higher prices.  (For a discussion of health care costs see this Health Affairs and Forbes).

    REALITY: It’s not just health insurers between us and our doctors; it’s also the government. The federal government runs Medicare and Medicaid, two expensive government insurance programs that cover about 30 percent of the Americans (See The Henry J. Kaiser Family Foundation).  The way these programs are operated has a profound effect on the private market.

    • Government Regulations: Governments require insurers to include more and more treatments and services in our insurance policies.  This encourages over-consumption of some procedures, and means that we are paying to finance many treatments that we may not want, need, or use.  State and federal mandates raise health insurance premiums by between 10 and 50 percent.  (See the Council for Affordable Health Insurance)
    • Lawsuits Encourage Defensive Medicine, Raise Costs:   Hospitals and doctors fear costly medical malpractice suits so carry insurance and issuing unnecessary tests to minimize the potential for lawsuits. .  These push our overall health care spending higher, and affect the insurance prices for all Americans.  Analysts estimate that the medical malpractice increase health care costs by between 7.2 and 12.7 percent. (See Heartland Institute and for a discussion of the tort systems by state, see the Pacific Research Institute)

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