Hey, we're number 44! That's where the United States ranks in regards to life expectancy according to the latest figures from the U.S. Census Bureau's National Center for Health Statistics. The 2006 United Nations World Population Prospects report puts us at 38, just behind Cuba. The United Kingdom is 22, Canada 11, and France 10. If you don't believe the U.N., how about our own CIA? Their 2008 World Factbook ranks life expectancy in the United States at number 45, just ahead of Saint Helena, the island where Napoleon was sent to die. The CIA ranks the U.K. at number 37, Canada 14, and France 8.
What do most of the countries ranked ahead of us in life expectancy have that the United States does not have? A government run health care system. Yet to many people here a government run health care system is the beginning of the end of civilization as they have known it. They equate "universal," "single-payer," and "government sponsored" as socialized medicine, which ranks somewhere between communism and terrorism as scary terms. (Better dead than red?) Rep. Zach Wamp (R-TN) called Obama's health care plan "probably the next major step towards socialism." Never mind that Obama doesn't yet have a health care plan.
Rep. Wamp's own medical care and that of all members of Congress is of course federally insured and provided by government employed doctors at government run facilities, and none of them are demanding that it be privatized. It probably helps account for the longevity of so many senators and representatives.
Medicare and Medicaid are government run programs and there is no demand by its recipients to terminate them.
The problem is certainly not that the U.S. is cheap when it comes to paying for medical care. In fact, we spend more per capita than countries where people live longer, approximately twice as much as France or Canada (United Nations Human Development Report, 2007). The one area where we do better than most other countries is in the promptness of appointments for elective surgery. Socialized systems prioritize health care appointments according to urgency. That sometimes leaves people wanting an elective procedure with long waits. If they can afford it, they sometimes choose to come to the United States for their operations rather than wait. Those are the people defenders of our privatized system point to as evidence of the failure of government run systems.
During a recent vacation in Barcelona I got sick. Fever, chills, nausea. My wife asked the hotel desk clerk to recommend a doctor and we were directed to a clinic not far away. There, without an appointment and in less than an hour, we were introduced to an English speaking physician. Afterwards, prescription in hand, we asked what the exam would cost and were told that it was too bad we were not from a European Union country. If we were, there would be no charge. As it turned out, rather than go through the paper work necessary to bill us, he sent us on our way. "It's a gift from Spain," he said.
Competition is supposed to keep prices down in a privatized system. Obviously, that is not working. A major reason is that prices are seldom discussed. Doctors and hospitals do not post price lists, and patients are embarrassed to ask. Or, costs are covered by insurance so patients don't care, even as they complain about the price of insurance. The move away from employer covered insurance will exasperate those complaints.
In the 1970s, Ralph Nader's Public Interest Research Groups launched efforts to publicize physician prices. In Bellingham, Washington some students from Western Washington University and I canvassed local doctors and produced a booklet with that information, but it proved impractical to keep it current. Not only do prices change, but many physicians and hospitals have more than one price for the same procedure, depending on a patient's insurance, and sometimes on the patient.
(A new internet company called PriceDoc has just started in Seattle and plans to go nationwide. Physicians advertise their specialty and prices on it, and prospective patients can also bid on a procedure. The site is http://www.pricedoc.com.)
There is another way to beat the high cost of American medical care. Some people--over 100,000 last year--are going overseas. In countries such as India, Thailand, South Africa, Costa Rica, and others, patients are finding American-trained doctors in facilities equal to American clinics and hospitals, with the same equipment, but charging approximately half as much. Transportation increases the cost, but many people simply add a vacation to their hospital stay or dental care. Patients Beyond Borders by Josef Woodman (Healthy Travel Media, 2007. http://www.patientsbeyondborders.com) is a guide to the practice, or Google "medical tourism."
We do have a kind of universal health care system in this country, only it's the most expensive and inefficient system possible. It's called the emergency room.
Jerome Richard is the author of the novel The Kiss of the Prison Dancer, and the editor of The Good Life.
This is an updated and revised version of an article that appeared on HarvardSquareCommentary.org (now defunct) in 2008.