The Best Health Care System in the World

From Harold Meyerson in the WaPo:

January has turned out to be a banner month for fans of American exceptionalism. As documented in voluminous detail in a 404-page report released last week by the National Research Council and the Institute of Medicine, Americans lead shorter lives than Western Europeans, Australians, Japanese and Canadians. Of the 17 countries measured, the United States placed dead last in life expectancy, even though we lead the planet in the amount we spend on health care (17.6 percent of gross domestic product in 2010 vs. 11.6 percent each for France and Germany). We get radically less bang for the buck than comparable nations. If that’s not exceptionalism, I don’t know what is.


But a funny thing happens to Americans’ life expectancy when they age. The U.S. mortality rate is the highest of the 17 nations until Americans hit 50 and the second-highest until they hit 70. Then our mortality ranking precipitously shifts: By the time American seniors hit 80, they have some of the longest life expectancies in the world.

What gives? Have seniors discovered the Fountain of Youth? Do U.S. geriatricians outpace all our other physicians?

Part of the answer is Darwinian: Those Americans who have been less able to access reliable medical care, maintain good diets and live in neighborhoods that are not prey to gun violence have disproportionately died off before age 80. That isn’t natural selection but social selection — the survival of the economically fittest in a nation that rations longevity by wealth.

But the larger part of the answer is that 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.

Interestingly, of course, Medicare is not only provides better health outcomes than the rest of the system in the aggregate, but it also controls costs better. And it could control costs even better if the Republicans would stop screaming “death panels!” for just a few minutes.

But… but… but… freedom! Ugh.

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54 replies
  1. 1
    Odie Hugh Manatee says:

    Very interesting and it does makes sense. It could explain why so many seniors are dead set against affordable health care for younger people; because they think it might water down the excellent care that they now enjoy.

    The ol’ ‘pull up the ladder’ trick, so to say.

    Thanks for the link, I’ll be sure to club some conservative baby seals over the head with it.


  2. 2
    daverave says:

    And what does this have to do with Manti Te’o’s imaginary girlfriend?

  3. 3
    Chris says:

    Our complete inability to face the concept that there might be SOME thing, SOME where, that SOME other nation does better than us, or that we might want to imitate it if that’s the case, has become one of the biggest crippling flaws in our society.

  4. 4
    Haydnseek says:

    @daverave: Not a thing, until his real girlfriend makes the decision to have an abortion, only to realize that she has imaginary healthcare.

  5. 5
    Ted & Hellen says:

    Maybe send this link to President Obama?

  6. 6
    Yutsano says:

    @Chris: That’s not really the sad thing. What is sad is the answer has been staring us in the face since 1965 and we’ve been blithely ignoring it becuz SOCIALISM!! or something.

  7. 7
    Older says:

    Years ago, in my spare time while working as a statistician for the US Govt, I figured out that the govt is already supporting two systems that could be extended to the entire population for less than is spent by our ugly patchwork system. One is Medicare-Medicaid (my personal favorite since it is a single-payer system), the other is FEHP (Federal Employees Healthcare Program, for civilian employees) and whatever they call the military system (I think these days it’s Tristar, or maybe Tricare). They could both be extended without too much screaming from the insurance industry because they each have well-defined slots for insurance companies to fill.

    Personally, I’m tired of us being “exceptional”. I’m working now as a process server, and let me tell you, the entire process serving business would waste away to nothing without all the people who go into debt, including facing foreclosure, because they have no medical insurance, so when they had that accident, or that illness, a while back, they had to go to the emergency room.

    As a retiree, I still have my fine FEHP and also Medicare, and when I have to go to the emergency room, I don’t have to pay a thing out of pocket. I’m willing to give up the job, if my fellow citizens can get a reasonable healthcare plan, one that doesn’t require that about half of all employees at doctors’ offices and clinics are employed solely to argue with insurance companies about whether they will pay the bills they promised the subscribers they would pay.

  8. 8
    tystik says:

    You mean “Freedumb”.

  9. 9
    Haydnseek says:

    @Chris: A thousand times this. We can’t evaluate the policy decisions of other countries on their merits. We refuse to learn from the rest of the world. The fact that solutions to serious problems may originate elsewhere makes them instantly suspect because they aren’t AMERICAN! The course that America follows can’t be questioned, however, because it’s AMERICA doing this, and anybody that questions this is instantly branded as un-American at best, or a Communist promoting Sharia law at worst. Dog Bless Amerika!

  10. 10
    Chris says:


    Because it’s foreign. That’s why. A massive chunk of our population lives in utter horror at the prospect of adopting a system that, truth be told, they really has no understanding of, but must be rejected at all costs because it’s not American and therefore can only be inferior (because any other conclusion would imply that we might not be the Ultimate and Everlasting Answer to the question of How A Country Should Work, and that’s just too horrific a thought to contemplate).

  11. 11
    BGinCHI says:

    If this healthcare system couldn’t save Manti’s girlfriend, then it’s time for a change.

    Everyone join me for a rousing chorus of “Candle in the Wind.”

  12. 12
    piratedan says:

    @Older: I hear ya Older…. it’s like it’s SOP for the insurance companies to deny initial claims because not many figure out how to petition for payment for service on the policies that they purchase. When I went through the caretaking of my Mother and her 2nd husband last year when they were on their spiraling decline in health. I kept hearing from MetLife that everything was fine and that there was no need to pay on the long term care claim because they were still capable of lifting a fork from their plates to their mouths. Nevermind the fact that they couldn’t shop, couldn’t drive, couldn’t cook, much less clean the dishes from what was prepared for them.

  13. 13
    General Stuck says:

    One of the downsides of being the most technically advanced countries on earth, can be seen in the health care world. Where the ever more complex the machines and the chemical compounds become, there is a point reached to where they become self aware and begin to run the show.

    If you build a fancy imaging device and it costs a gazzilion fucking dollars, then that sucker has to be kept running around the clock to pay for itself. It may or may not provide better diagnostic capabilities, but it got made and has to be used.

    Similar with drug makers, where the parameters and threshold for diagnoses and recommended medicinal treatment keeps getting lower and lower, until if you aren’t a 19 year old bronking buck and possess lab results that indicate such, then the pills come out, or else.

    Examples are ever lower BP thresholds, now down to 80 diastolic or you must take more and sooner meds to control it. Ditto lowering of total cholesterol threshold limits, to feed the statin gawd profits.

    My favorite is the last couple of visits to my primary care doc, that am blessed as he is a very good one, where he informed me that my A1C test for diabetes had finally crossed into the diabetic zone. When I checked the numbers myself on the computer screen, I noticed it was 5.8, to where that is had actually dropped from the usual 6 reading. That it has been for a couple of years now, only now the cutoff had been lowered to 5.6 from where it was at 6.0 as the long running threshold. When I pointed this out, along with my fasting blood sugar at only 110, he once again got the sheepish look of embarrassment over what we had talked about many times, and several other examples where this had happened with other test readings. The various players doing the technologies for treatment are wagging the health care dog.

    Then there is the racket of specialty docs for everything, that are expensive and must be used as well, to justify their existence. You sprain your ankle and they send you to a podiatrist and charge insurance out the yazoo. Where a simple x ray first by an internist of family doc could make that totally not needed.

  14. 14
  15. 15
    Haydnseek says:

    @The prophet Nostradumbass: Bloody hell, that’s perfect. Still funny after all these years……

  16. 16
    General Stuck says:

    @The prophet Nostradumbass:

    LOL Perfect it is

  17. 17
    Heywood J. says:

    @daverave: It might have cured her imaginary leukemia?

    (Sorry, that was insensitive, wasn’t it? That whole Te’o hoax story smells like last week’s fish anyway.)

  18. 18
    Anne Laurie says:

    Thanks for highlighting this, Bernard.

  19. 19
    Wag says:

    As a Primary Care doctor, I say This. A thousand times. This.

  20. 20
    karen says:

    Don’t worry. I figure by the time I’m old enough to use it (18 years) I totally figure that and Social Security will be gone already.

  21. 21
    Mandalay says:

    I’ve just been reading that report (;page=240), and it is depressing. This country is paying more for worse outcomes in all areas of health care.

    Democrats had a recent victory on taxes, fighting the sound bite lie that “We don’t have a revenue problem, we have a spending problem”. Well now it’s time to fight the sound bite lie that “America has the best health care system in the world”. We truly don’t. It’s not even close.

    Why can’t we have some Democrats (Wasserman Schultz? Grayson?) screaming about this? Call it a national disgrace. Even if it changes nothing on a practical level, at least it calls Republicans on their bullshit.

    Is there a political downside to saying “Our health care is not the best in the world, and we want to fix that!”? I don’t even recall anyone saying that during the passage of the ACA. I feel like Democrats are almost apologizing for aspiring to do what should be the noblest aim of anyone in government: caring for its citizens. I just don’t get it.

  22. 22
    pattonbt says:

    @BGinCHI: God damned the Te’o thing is not going to get old anytime soon.

    Hope (for his sake) he never has to play in Philly!

  23. 23
    mdblanche says:

    @Odie Hugh Manatee: Let’s say, hypothetically speaking, that these “pull up the ladder” seniors were to become the lynchpin in the voting coalition of a political party that is hostile towards Medicare. And let’s say that the younger voters being denied similar access to health care mostly voted for a different political party while the first hypothetical party and those who voted for it couldn’t even be bothered to hide their seething hostility towards them and/or their friends half the time. And let’s also say that during one of the various periodic budget crises that hypothetically seem to keep popping up for some hypothetical reason, the first party would to demand cuts to and/or dismantling of Medicare in exchange for not blowing up the Earth. And let’s say the second political party was more committed to Medicare but noticed that this compromise would fall more heavily on the first party’s hypothetical voting coalition than on its own. Would it be irresponsible to speculate at what point “pull up the ladder” seniors might face the nasty shock that they’d been sold out out while the younger people they’d antagonized were too busy trying to find a free clinic to care?

    I ask this hypothetically of course.

  24. 24
    Odie Hugh Manatee says:

    Irresponsible? Not at all.

    Hypothetical? I thought you were being tongue-in-cheek. ;)

  25. 25
    Yutsano says:

    @Mandalay: ACA is a step not an endgame. I think when single payer takes off in Vermont it will be pretty much game over from there, especially if Jerry keeps his promise in CA and agrees to reconsider it there now that they’ve got the budget finally under control.

  26. 26
    Bubblegum Tate says:

    Yes, but rich people from all over the world come here for health care, ipso facto cogito ergo sum QED, we have the BEST HEALTHCARE IN THE WORLD! ‘MURRICA! FUCK YEAH!

    (It really is beyond pathetic that the answer is basically slapping us across the face, but conservative dumbfucks won’t let us use it.)

  27. 27
    👽 Martin says:

    @Yutsano: CA going single payer will be the ballgame nationally. Employers won’t tolerate the costs of healthcare in other states, and there’s not much most employers want that CA can’t provide.

  28. 28
    Gretchen says:

    House Democrats introduced the “Public Option Deficit Reduction Act” today:

  29. 29
    eemom says:

    I’m glad that Meyerson seems to rub Bernie the right way.

    Show that even a stopped clock can hook up with Father Time once in a while, or something.

  30. 30
    mdblanche says:

    @Odie Hugh Manatee:

    Hypothetical? I thought you were being tongue-in-cheek. ;)

    I don’t know what you could be talking about.

  31. 31
    Mandalay says:

    @👽 Martin:

    CA going single payer will be the ballgame nationally.

    Not so sure about that since some states don’t have the means or the political will. But OTOH, in CA the Democrats have a super majority in both houses, and a projected budget surplus…

  32. 32
    Odie Hugh Manatee says:

    @mdblanche: “I don’t know what you could be talking about. “

    Neither do I, that’s why I hang out here. :)

  33. 33
    Darkrose says:

    @pattonbt: I can’t wait to see what the Stanford Band puts together for their halftime show vs. Notre Dame next season.

  34. 34
    Thor Heyerdahl says:

    A 404 page report highlighting mistakes of the American system?

    Is that a 404 error?

  35. 35
    👽 Martin says:


    Not so sure about that since some states don’t have the means or the political will.

    It’ll force single payer to happen nationally.

  36. 36
    Maude says:

    @👽 Martin:
    When it works in CA, it will be adopted by the other states over time.

  37. 37
    Applejinx says:

    Wait, Vermont is also on that list of ‘about to make single payer be a thing’?

    I’d like to keep hearing about this. The last time I heard a lot of get-up-and-do-it talk out of Balloon Juice, I got up and drove over to NH to volunteer for Obama, and worked my ass off for a week alongside others doing the same, and we fucking won…

    What do I do about this one, then? I even live in Vermont so this one’s mine.

  38. 38
    PeakVT says:

    @Chris: But it’s not foreign. Medicare is a single-payer system (and the VA is single-provider, like the NHS, for that matter). American seniors are opposed to the rest of America getting a health care system that is immensely popular with … American seniors.

    America, what a country!

  39. 39
    danielx says:


    Yup. Behind Door Number 2 is…American Exceptionalism! Whether a medical system other than the market-based system produces verifiable better results is not relevant, because it’s not the American way. Wingnuteria in general does not care if more people die when such mortality could be prevented under an alternative system*. Because Freedom, and soshulism, and Ayn Rand, and death panels…etc. Also, too, the current system is the rice bowl for a great many people (both breathing and corporation-type) who make substantial campaign contributions and they like things just fine the way they are now, thankyewverymuch. After all, they don’t have to worry about bankruptcy due to overwhelming medical bills, because they’re blessed…or something.

    *This applies to many things in the wingnut universe, viz.; current debate over gun control, defense spending, foreign policy, etc.

  40. 40
    Davis X. Machina says:

    @PeakVT: There’s a choice on offer.

    It’s between a.) you getting something sub-optimal and paying more than you have to, and the other fellow getting nothing, on the one hand, and b.) your getting something optimal, and paying only what you need to, but the other fellow getting the same deal.

    Nothing is more toxic in a democracy than actual equality. The mudsill theory wins every time.

  41. 41
    Original Lee says:

    @General Stuck: Oh, this this this-ity this. People look at me crazy when I talk about it, but it’s absolutely true. I noticed it first with my blood pressure about twenty years ago. I dread my next blood test, because I know I will have slipped from “OK” to “diabetic” even though I have the exact same score I’ve had for the last five years. Not to mention I’ve started getting phone calls from insulin supply companies, which honks me off no end and will lead me to getting really testy with my doctor the next time I see him.

    My 12-year-old son, who is into karate, soccer, and swimming and is basically skin, bone, and muscle, got one of those “how to lower your blood pressure” info sheets when he went in for a sinus infection recently. Excuse me, the kid’s in pain because his face is trying to fall off. Surely that would temporarily increase his blood pressure??

  42. 42
    Omnes Omnibus says:

    @Chris: I’ve been wondering if there isn’t a way to leverage American Exceptionalism to our benefit. Sort of a “Look, those greasy foreigners can deliver good healthcare to everyone for x dollars a year. We are Americans; I bet we can deliver great healthcare for x/2 dollars a year.” I keep running aground on the fact that, for this to work, these people would have believe the facts about the foreign healthcare systems.

  43. 43
    qwerty42 says:

    @mdblanche: I keep thinking these crazy old coots will finally recognize they are being sold out, but they are always being told “don’t worry, this won’t affect you, it’s those other people we are going after. We’re going to restore that wonderful, imaginary world you believe once existed, and that these ‘younger folks’ don’t appreciate.”

  44. 44
    Lurking Canadian says:

    @Omnes Omnibus: That’s the problem. During the ACA debate I was shocked at the sheer quantity of misinformation and lies that were being told about healthcare in Canada, which is apparently a Stalinist hellhole. All of it could have been cleared up by, you know, asking a Canadian, but that’s just silly.

  45. 45
    liberal says:

    @General Stuck:

    Examples are ever lower BP thresholds, now down to 80 diastolic or you must take more and sooner meds to control it. Ditto lowering of total cholesterol threshold limits, to feed the statin gawd profits.

    Sing it, brother!

    Every time I go to my PCP (an internist), I steel myself for the “let’s put you on statins” talk, even though the Cochrane Collaboration says (IIRC) that the evidence supporting using statins for primary prevention of heart disease (ie, before disease has occured) is “weak”.

    H. Gilbert Welch, in his recent book Overdiagnosis, discusses this lowering of the threshold BP for getting treatment. When BP treatment first came out, many of the patients had BPs so high that the NNT was 1.4 (yes, 1.4). Nowadays, the NNT for the lowest BP that can get you in for treatment is much higher.

  46. 46
    Cacti says:


    Years ago, in my spare time while working as a statistician for the US Govt, I figured out that the govt is already supporting two systems that could be extended to the entire population for less than is spent by our ugly patchwork system. One is Medicare-Medicaid (my personal favorite since it is a single-payer system), the other is FEHP (Federal Employees Healthcare Program, for civilian employees) and whatever they call the military system (I think these days it’s Tristar, or maybe Tricare).

    FEHP is wonderful.

    For those who aren’t in the know, you get a cafeteria selection of multiple private insurance plans with varying levels of coverage. It’s what Congress has, and what they’re trying to emulate with the state insurance exchanges.

  47. 47
    Yutsano says:

    @Applejinx: U already haz!! There was some rule that pushed it out to 2017 that had to do with some quirk of ACA. But yeah, it’s already a done deal.

  48. 48
    wuzzat says:

    In that case, statins are an entirely pointless prescription for most people since there have been multiple studies indicating that statin use does not decrease your risk of having a 2nd heart attack. Save your money for baby aspirin and soluble fiber.

  49. 49
    lol says:

    @Lurking Canadian:

    But some rich Canadian went to the US for treatment once so that proves Canadian health care is horrible.

  50. 50
    Vanya says:

    The dirty secret, or not a secret at all, is that America has far and away the best health care in the world, if you can pay for it. So the top 10% of Americans are doing just fine, thank you very much. I’m living in Western Europe, and basic health care is cheap and does a decent job for most of the population most of the time. But I am always hearing American expats bitch about the crappy facilities, the rude doctors, the waiting times, lack of private rooms in hospitals, etc. etc. Because most of these American expats are 10 percenters themselves and are used to a certain level of quality. None of our elite want to have to “suffer” like the German and Austrian upper middle class do.

  51. 51
    JustRuss says:

    @Lurking Canadian:

    All of it could have been cleared up by, you know, asking a Canadian, but that’s just silly.

    Oh come on, we all know you Canadians are too polite to complain, so you’d have left out all the bad stuff.

  52. 52
    Ruckus says:

    Pompous arrogance is always a good thing.

    Just ask anyone with an overabundance.

  53. 53
    Mnemosyne says:

    @👽 Martin:

    Employers won’t tolerate the costs of healthcare in other states, and there’s not much most employers want that CA can’t provide.

    That can’t possibly be true, because conservatives keep telling me that the only thing corporations look at when deciding where to move to is the corporate tax rate and any other costs of doing business are completely irrelevant.

  54. 54

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