Reality check: Medical outcomes in the United States

The United States spends more on health care than any other industrialized country. In 2024, the last year with complete data, the U.S. spent $5.3 trillion, or about 18 percent of our gross domestic product on health care.

Even though over 40 percent of Americans receive their health care through the government programs of Medicare, Medicaid, and Obamacare, advocates of a single-payer system in the U.S. believe our current health care system is detrimental to patient care. They argue that the government has the power to control and improve individual medical outcomes, as well as control health care costs, so everyone should be in a government-run system.

The two organizations that are most often cited in assessing international health care rankings are the World Health Organization (WHO) and the Commonwealth Fund.

The World Health Organization’s seminal paper looked at all 191 countries in the world and is arguably the most often quoted by media organizations. Officials there ranked the U.S. 37th, behind Greece, Colombia, and Morocco. They ranked communist Cuba 39th, to put their study method in perspective.

The researchers at the Commonwealth Fund studied 11 industrialized countries. They ranked the United States last, with smaller countries, Australia, Norway, and Switzerland, ranking one through three, respectively.

The critical issue in both studies is the emphasis on the supposed “equity” in a country’s health care delivery system. The WHO study put percentages on its criteria. At least 62.5 percent of its ranking is based on a country having a single-payer, or at least a government-run, health care delivery system in which every citizen has health insurance, although not necessarily timely access to good care. The U.S. does not have a single-payer system and was therefore punished in the rankings before the study was even published.

The Commonwealth Fund paper did not place percentages on its criteria. Yet, it is very clear that emphasis was again put on “equity” in the system and countries were ranked accordingly. Like the WHO study, the Commonwealth Fund paper did not address the issue that simply having health insurance does not guarantee timely access to necessary care.

The most important aspect of a country’s health care delivery system is its responsiveness and success in treating specific diseases. When a person becomes ill, the critical issue is the medical system’s ability to reduce the morbidity and mortality of that patient.

Cardiovascular (CV) 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. Yet 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 Centers for Disease Control and Prevention show that 74 percent of Americans are overweight and 40 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 personal lifestyle choice and, again, should not reflect on the quality of a country’s health care delivery system.

The most important aspect of a country’s health care delivery system is its responsiveness and success in treating specific diseases. When a person becomes ill, the critical issue is the medical system’s ability to reduce the morbidity and mortality of that patient. A fair measurement of the effectiveness of health care delivery should be based on clinical outcomes, not government-provided insurance coverage.

The goal of a health care system should be to provide world-class medical care, not taxpayer payment of insurance.