Home > Decline of the USA, Quality of life indicators > The USA is 27th (chart)

The USA is 27th (chart)

from David Ruccio

The usual excuse, from mainstream economists and politicians, that the U.S. healthcare system should remain mostly in for-profit, private hands is because the outcomes of that system make it the best in the world.

But a new study (published in the Journal of the American Medical Association) of the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 in comparison to the other countries in the Organisation for Economic Co-operation and Development (OECD) countries reveals a quite different story.

So how did we do compare to other countries? Not particularly well. Between 1990 and 2010, among the 34 countries in the OECD, the United States dropped from 18th to 27th in the age-standardized death rate. The United States dropped from 23rd to 28th for age-standardized years of life lost. It dropped from 20th to 27th in life expectancy at birth. It dropped from 14th to 26th for healthy life expectancy. The only bit of good news was that the United States only dropped from 5th to 6th in years lived with disability.

In other words, the United States spends the most per capita on health care across all countries and falls below the mean for all OECD countries on most indicators. As we can see in the chart below, the United States has lots of red (higher than the mean), a bit of yellow (close to the mean), and only one green (lower than the mean).


What the study demonstrates is the U.S. healthcare system is not designed to produce the best health outcomes for the population but, instead, to produce healthy profits for the private insurers and providers on which the system is based.

  1. July 13, 2013 at 5:58 am

    Since graduate school in the 80’s, I’ve been exposed to similar conclusions such as these, and yet any suggestion that American healthcare is of poorer quality than other countries does not fit my experience as an RN. As a successful economy, we see that we don’t lack for access to calories, evenings on the couch, and exceptional control over our individual climate by way of heating and air conditioning so I strongly recommend caution in going any further on ethereal aggregate conclusions.

    It’s unrealistic to blame healthcare for obesity and the pathology that results; there are few other places in the world you would want to be if you needed your gallbladder removed.or a knee (engineered in America) replaced.

    Regardless of the statistics, calculus and econometric’s, what will always remain is this: only you can do your own healing, and in the end only you will do your own dying. So what do you want to do?

    TACoss, RN

  2. Podargus
    July 13, 2013 at 6:21 am

    Is this news? it has been well known for years that the USA has one of the worst health care systems in the first world and it does not have all that much to do with poor lifestyle.
    This is because of the reliance on private insurance,the dominance of the drug companies and the ideology of “free” enterprise.
    Mr Coss,as somebody inside the system it may appear to you that all is sweet.But it seems you don’t have the insight which is necessary to see the multitudes who don’t get anywhere near your system.

    • July 13, 2013 at 3:55 pm

      I would not begin to defend the system which is now singularly driven by naive, feckless and expensive government policies, but I can defend the medicine. I’ve never dealt with a parent of a gravely ill child who made decisions based upon probabilities, IRR or NPV or any other metric. Sure healthcare is expensive because we insist upon the best for everyone; you have a head ache, get a CAT Scan, not because it’s a clinical imperative, but the family insists. How do you have Patient Rights without the right for advanced procedures and diagnostics regardless of indications?

      In real terms, a Critical Care RN makes less today than I did when I worked as one in the early 90’s, physician wages have been flat or declining. Labor aren’t the cost driver, we have fewer hospitals today than we had 20 years ago, along with fewer beds.

      I’m just saying that healthcare is complicated because biology is complicated and healthcare providers and doing the best they can every day. Holding the hand of a dying child is no walk in the park.

      And yes, Marko, we use Econometric models in healthcare

  3. Marko
    July 13, 2013 at 7:59 am

    “Regardless of the statistics, calculus and econometric’s, what will always remain is this: only you can do your own healing, and in the end only you will do your own dying….”

    If this is the case , why do we need a healthcare system at all , and why are we wasting our money paying the salary of people like yourself ?

    ( Also …. “econometric’s” ?? )

  4. July 13, 2013 at 11:26 am

    I have no direct experience. What I can say is that a couple of friends of mine that live in California (the husband – a retired business man – still has a Portuguese citizenship card) every now and again, they fly all the way from California fo Lisbon-Portugal por medical care…

  5. john
    July 13, 2013 at 3:25 pm

    That’s why I live in the U.S. – I am just waiting for the day I need to have my “…gallbladder removed.or a knee (engineered in America) replaced.” And according to the chart above, I am sitting pretty if I have a stroke. “So what do you want to do?”

    Cheers John

  6. July 13, 2013 at 9:57 pm

    Where I believe the chart is misleading is that we are blind to the criteria of the other countries. We are far more likely to do procedures on patients who present with multiple clinical risks, other countries do not. It’s easy to have superior outcomes if one is free to choose the healthiest patients, and simply deny services to those who’s risks are deemed to high. Consider also the infant mortality statistic. In the US we count every birth with a pulse as a “live birth”, in other countries a “live birth” has weight and size limitations and the child must live over 24 hours, sometimes a week; we start the clock immediately upon delivery. Additionally when it comes to multiple births, there is simply no where in the world you would want your wife to be than in the US, the data isn’t even close.

    So to answer your question, you want to stay close to the US when you need highly specialized care, Medicine is no better at understanding probabilities and statistics than is Wall Street.


  7. charlie
    July 14, 2013 at 12:00 am

    Coss is a true believer in the exceptionalism of the US evidence of the contrary must be biased.
    Among other exceptions to his beliefs: Other countries have high expectations and deliver them to almost everyone, not just those who can afford the services of the rich doctors. I lived in Canada while in grad school. The medicine was very high quality.

    I grew up when doctors lived in out block in houses not unlike ours. Today they live like millionaires. They have done very well for themselves. They are not hurting like the rest of the middle class.

    • July 14, 2013 at 1:39 am

      To be a physician in the US you need to graduate college in the top 10% of your class, go through four years medical school, two to four year residence during which the average physician works 60 hours a week, in effect spending your 20’s and potentially part of your 30’s in training during which you make less than your high school peers. After which there is another 10 years paying off loans. The average work week for physicians is 51 hours, 44 hours for Attorneys and the average work week for all non-farm employees is 34.6 hours which turns out to be over 31% less than the average physician.

      From a medical standpoint, all I can offer is that the clinical outcomes with you and only you must live will be the least onerous and most successful.here in the US than any where else in the world. Given that counter factual options don’t exist to any one individual, it’s more than risky to presume otherwise.

      Here are some first for US Medicine to consider: We discovered the AIDS virus, produced the first artificial kidney, heart, stent, knee, hip replacement, laproscopic surgery, robotic assisted surgery, laser eye surgery, cochlear implants for hearing impaired, and for us guys, the PSA test, and our aggressive use of hypothermia treatment is helping trauma victims every day, patients that would otherwise be badly impaired, walking home.

      • Reiner Buchegger
        July 15, 2013 at 6:02 am

        My heart bleeds for the poor doctors – let’s have a collection for them!
        No doubt: There is excellent high quality treatment available in the US – but alos in many other countries.
        The major problems with the US health system are the great inequality and the large number of people who are far away from the high quality services – distribution is the issue.

      • globbleflock
        July 18, 2013 at 4:54 am

        First Artificial Kidney – Dr. Willem Kolff – 1943 – University of Groningen Hospital in the Netherlands

        First Artificial Knee – Leslie Gordon Percival Shiers – 1954 – Royal College of Surgeons in the UK

        First Artificial Hip – Professor Themistocles Glück – 1891 – Emperor Frederick Paediatric Hospital in Berlin.

        Laproscopic Surgery – Hans Christian Jacobaeus – 1910 – Karolinska Institutet in Stockholm in Sweden.

        Your bias is showing.

  8. Randy Legault
    August 29, 2013 at 7:21 pm

    If you take the poor out of the equation the US likely jumps up the rankings, while most others with more equitable access shift less, I expect. I haven’t done the research and won’t, but would bet on it.

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