We’re Number 11, Again! :(

Eleven years ago New York Times columnist Thomas Friedman wrote an opinion piece titled “We’re No. 1(1)!

The title was in reference to a Newsweek ranking of the 100 best countries in the world. The U.S. didn’t even make the top 10; we came in at No. 11. Not bad, but it seems that for a country with our resources we could do much better.

I was reminded of that article earlier this week when I read that the U.S. had come in at No. 11 in another world ranking. The only problem this time around was that there were only 11 countries included in the ranking.

The ranking report is the seventh international comparison of countries’ health systems by the Commonwealth Fund since 2004, and the United States has ranked last in every edition, David Blumenthal, MD, president of the Commonwealth Fund, told reporters during a press briefing.

Researchers analyzed survey answers from tens of thousands of patients and doctors in 11 high-income countries. They analyzed performance on 71 measures across five categories — access to care, care process, administrative efficiency, equity, and health care outcomes.

Here are the countries, ranked from best to worse:

  1. Norway
  2. the Netherlands
  3. Australia
  4. the United Kingdom
  5. Germany
  6. New Zealand
  7. Sweden
  8. France
  9. Switzerland
  10. Canada
  11. United States

One of the biggest problems with the health care system in the U.S. is inequality.

Half of the lower-income adults and 27% of higher-income adults say costs keep them from getting needed health care. “In no other country does income inequality so profoundly limit access to care,” according to David Blumenthal, MD, president of the Commonwealth Fund.

Blumenthal notes that “to catch up with other high-income countries, the [Biden] administration and Congress would have to expand access to health care, equitably, to all Americans, act aggressively to control costs, and invest in the social services we know can lead to a healthier population.”

Here are some specific metrics:

  • the United States has the highest infant mortality rate (5.7 deaths per 1,000 live births) and lowest life expectancy (living on average 23.1 years after age 60) compared with the other countries surveyed
  • The U.S. maternal mortality rate of 17.4 deaths per 100,000 live births is twice that of France, the country with the next-highest rate (7.6 deaths per 100,000 live births).
  • The only category in which the United States did not rank last was in “care process,” where it ranked number 2 behind only New Zealand. The care process category combines preventive care, safe care, coordinated care, and patient engagement and preferences.
  • The United States and Germany performed best on engagement and patient preferences, although US adults have the lowest rates of continuity with the same doctor.
  • New Zealand and the United States ranked highest in the safe care category, with higher reported use of computerized alerts and routine review of medications.
  • the United States is only one of the 11 countries that lacks universal coverage and nearly 30 million people remain uninsured.
  • Top-performing countries in the survey have universal coverage, annual out-of-pocket caps on covered benefits, and full coverage for primary care and treatment for chronic conditions
  • more than two-thirds of U.S. adults say their potential out-of-pocket costs would figure prominently in their decisions to get care if they had coronavirus symptoms

What makes our poor ranking even more striking is that that the U.S.  spends more than twice as much of its GDP (17% in 2019) as the average country studied.

I guess my family and I have been among the lucky ones. We have had access to high-quality healthcare, at relatively little cost, since I began teaching over 35 years ago.

As an example, the cost of a recent three-day stay I had at a local hospital, along with several imaging tests,  was nearly $80,000. My out-of-pocket cost for all of that care has been less than $200. I do have monthly health insurance premiums in addition to those direct care out-of-pocket costs, but such insurance premiums come nowhere near that $80,000 cost.

I am quite grateful to have access to such good health care, but I realize there are many people in the U.S. who do not. That is part of the disparity noted in this report.

It seems like the first step is to join the rest of the world and provide universal health care. Hopefully from there, the rest will follow and we will see improvements in these various metrics.

Hopefully, we can crack the top 1o next time…

56 thoughts on “We’re Number 11, Again! :(

  1. Much as I like the idea of universal health care, I don’t think that will fix our system. I think the fundamental problem is corruption. Whether private or universal, when anything is corrupt it won’t work well. Clean up the fraud, waste, and abuse first, and then I can feel confident that universal health care will work.

    Liked by 3 people

  2. I guessed a Scandinavian country would be tops, though I thought they would all be up there. The NHS puts us in a high place and I am proud my daughter works for the NHS. But of course we have terrible inequalities lurking elsewhere.

    Liked by 1 person

  3. We pay so much money for our health insurance. The rates are going up astronomically each year. We’ve had to take a lesser plan to control the costs.

    Liked by 2 people

    1. I was wonderfing if retired California state employees had health insurance for life; sounds like you do not. I may be asking you for advice when we retire as to what you do for health insurance…

      Liked by 2 people

      1. OK. We plan to wait until we are least 65 (that’s only 13 months away for me) to retire, with access to Medicare being one of the reasons. I hope you never have to use your insurance for anything serious!

        Liked by 1 person

  4. This is a sad state of affairs for our proud nation. But what really hurts is Blumenthal’s suggestion that the answer lies in the administration and Congress enacting sweeping laws and policy changes. We can’t get both sides to agree on masks during a deadly pandemic. How can we expect people who do not suffer from any failures of the healthcare system to come together to care for the rest of us? Although, I hear that the health coverage benefits for someone in Congress are top notch.

    Liked by 4 people

    1. great point, Brad. Before we start talking about changing our health care system, let’s start talking about getting along with each other first. And I am sure members of Congress have the best health care our money can buy 🙂

      Liked by 2 people

  5. it is definitely something that needs to change, though as brad said, it will be a huge challenge to overcome those who oppose it. I feel that it is a basic human right and should be in place, for everyone’s sake. a common good – when did we lose that focus?

    Liked by 4 people

  6. The US is unlikely ever to rank higher on that list unless it removes the commercial aspects from its system – profit shouldn’t play any part in healthcare. It’s disappointing that we have dropped down to 4th but under this government, and its pathetic response to the pandemic, it doesn’t surprise me: our National Health Service is underfunded and undervalued by the government. It still provides a great service though: my recent 11 days in hospital were so good in the way I was cared for, and the cost to me was £0.

    Liked by 3 people

      1. By US standards, I regard that as only mildly crazy. What is crazy is that you have a game played by a squad of zillions, padded up like terminators, only two of whom ever kick the odd-shaped ball, yet you call it ‘football.’ Weird.

        Liked by 2 people

  7. Yet whenever anyone tries to expand access to healthcare the right screams ‘socialism’ as if that’s a bad thing. It’s criminal that people need to forgo mandatory treatments because of cost. Wow, $80K? I hope it wasn’t too serious — but three nights and $80K, sounds serious.

    Liked by 1 person

    1. I never understood the socialism argument either, and there are many aspects of socialism that I find appealing. the $80K was related to discovering a blocked carotid artery that was likely the result of falling down while exercising! fortunately, things seem under control at this point…

      Liked by 1 person

      1. So in your example, without insurance, the options are risk death or get treatment that one can’t pay for, whereas the hospital needs to recoup those losses by overbilling everyone else. Seems like we already have a poorly working system of socialized medicine. Why not fix it with working models from ten better functioning democracies. I just don’t get it (along with 50% of everything else I read in the news).

        Liked by 2 people

      2. universal health care seems to work well in other countries, seems like to should work here as well. people shouldn’t have to the decision to seek health care based on their ability to pay…

        Liked by 2 people

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