We're Number 37!

Paul Hipp has penned this little diddy celebrating the fact that the World Health Organization ranks the US healthcare system the 37th best in the world.  His lyrics are below the fold.

The United States devotes 17.6% of its GDP to healthcare. And we fail to cover some 47 million people making the US the only OECD country that does not even attempt to cover everyone. Mexico and Turkey aim for universal coverage but have yet to achieve it. On average, OECD nations spend $2,964 per person and 8.9% of GDP. In the US in 2007, we spent $7,290 per person. The next highest dollar spending (normalized for purchasing power parity) was in Norway, which spent $4,763 per person, in Switzerland spending $4,417 per person, in Luxembourg at $4,162 per person, and in Canada $3,895 per person. You can access the OECD Health Data for 2009 for a complete overview.

Beyond the fact that US simply spends more, the life metrics are inferior not just to OECD nations but to even some middle income countries. The United States is ranked 26th in infant mortality among industrialized nations but that's an overall number. While infant mortality is 6.7 deaths per thousand live births in the US in 2006, for African-Americans the rate 13.7 deaths per thousand live births. The infant mortality rate among blacks is actually rising in 16 states. Meanwhile a country like Brazil has reduced infant mortality by more than half between 1990 and 2006, from 48 deaths per thousand live births to 19.

In the United States, life expectancy at birth increased by 8.2 years between 1960 and 2006, which is less than the increase of almost 15 years in Japan, or 9.4 years in Canada. In 2006, life expectancy in the United States stood at 78.1 years, almost one year below the OECD average of 79.0 years. Japan, Switzerland and Australia were the three countries with the highest life expectancy. Costa Rica, a middle-income country, now has a life expectancy of 78.8 years. We are clearly not number one in life metrics. The only top ranking that we achieve is in the category of medical bankruptcies. In France, the number of medical bankruptcies is zero. In the US, over two million Americans annually file for bankruptcy because of medical bills. From Physicians for a National Health Program:

1. Illness and medical bills were linked to at least 62.1% of all personal bankruptcies in 2007. Based on the current bankruptcy filing rate, medical bankruptcies will total 866,000 and involve 2.346 million Americans this year – about one person every 15 seconds.

2. Most medically bankrupt families were middle class before they suffered financial setbacks. 60.3% of them had attended college and 66.4% had owned a home; 20% of families included a military veteran or active-duty soldier.

3. 78% of the individuals whose illness led to bankruptcy had health insurance at the onset of the bankrupting illness; 60% had private insurance.

4. 69% of debtor families had coverage at the time of their bankruptcy filing; 60% of families had continuous coverage.

Clearly, we are doing something wrong.

The WHO ranks the healthcare system in my native Colombia as the 22nd best in the world. Colombia spends 5.5% of its GDP on healthcare. Our current system dates to 1993 and believe it or not, the decision to implement it was spurred in part by the then on-going debate in the United States and by a collective decision to make universal basic healthcare a right guaranteed in the Colombian Constitution. Prior to 1993 Colombia had health insurance for about a fifth of the country with the rest of the country accessing the Instituto de Seguro Social (ISS) that ran a series of overburdened public hospitals and clinics.

Passage of Ley 100 (Law 100) in 1993 created a new system, modeled on the principle of managed competition. Ley 100 created two separate insurance programs and set forth the goal of universal coverage. The Contributory Regime (régimen contributivo ) is for the formal sector and self-employed workers, and is financed by employer and employee contributions. The employer pays about two-thirds of the cost and the employee the balance but no more than 12% of his or her salary. The Contributory Regime now covers about 65% of the population. The Subsidized Regime (el régimen subsidiado), a social insurance scheme, is for the poor and it is publicly financed. Enrollment in the subsidized health system means that the cost of health care is partially covered, on a sliding scale depending on one's level.  Those at Level Zero do not pay to see a doctor. As of 2008, insurance coverage either through the Contributory Regime or through the Subsidized Regime is at 90%. What the Colombian experience demonstrates that a social insurance approach (i.e. a public option) can close the gap and achieve universal coverage.

The aim is to cover everyone but services continue to lag in rural areas. Because the subsidized health care system does not have the capacity to meet demand, a third system has developed for those who are "linked" (vinculados) to the subsidized health care system but are not part of it. The vinculados are the approximate 5 million Colombians (Colombia has a population of 45 million) that are outside the system. The Uribe government has committed itself to achieving universal healthcare coverage by the time it leaves office in August 2010. It is doubtful that their target will be met.

Consumers choose from a set of health plans which act as purchasers for enrollees. Because the Colombian government mandated a strict benefit package (with an emphasis on primary and preventative care) for each insurance company to provide, competition in the sector is based mostly on quality and not on price. Colombia became the first middle-income nation that adopted the managed competition strategy to reform its health care system. The system is by no means perfect but there has been a vast expansion of healthcare services.  The International Development Research Centre found that "the main achievements of the Colombian health system reform has been an overall increase in health insurance coverage, resulting in improved equity, with significantly lower urban-rural and socioeconomic differentials and better targeting of subsidies to the poor."

When I reflect on the differences between my native land and my adopted one, I find that in Colombia we are actually trying to do much with little while here in the United States, a far wealthier country, there is a segment of the population that seems to view healthcare as a privilege for some. We have learned in Colombia that markets don't create fair access. Only the state can ensure reasonable coverage for all. In Colombia we have accepted that healthcare is by economic necessity rationed but we have given priority to children, pregnant women, elderly and handicapped persons. And the Colombian state has paid special attention to the rights of the neediest increasing the share of the national income spent on healthcare from just 2.2% in 1993 to 5.5% as of 2008.

The lyrics:

Come one, Come all
Down to the hall
We're gonna make noise
We're gonna bust balls
We're gonna disrupt
We're gonna jump in the fray
I got a list of all the things that were supposed to say
We're gonna get real rowdy
Have a barrel of fun
But we're the USA so by the way be sure to bring a gun
And buddy

We're Number 37
We're the USA
We're Number 37
And were so proud to say
We got old people crying at the pharmacy
Pay your deductible
This ain't the land of the f-f-f-free Grandma
We're Number 37
We're the USA

People of the town come on down
And if you got a crazy rumor you can spread it around
I kind of like my insurance and I like my health
The other 47 million can go treat themselves
To some prayer in chapel
Fold your hands and pray
Because we are a Christian nation and that is the Christian way
And brother

We're Number 37
We're the USA
The big Number 37
And were so proud to say
We're #1 one in tanks
We're #1 in planes
We're #1 in war with #2 for brains
We're Number 37
We're the USA

I drew a Hitler mustache on the president
Yea! Aint that neat
My brother had a hernia operation last year
And now he's living out on the street

We're Number 37
We're the USA
The big Number 37
And we want to keep it that way
Be sure to bring the kids
All of the boys and girls
Because the #1 health care system in the world.

Is in France???

We're Number 37
We're the USA
We're Number 37
And we got something to say
We pay more for less
40% in fact
Let's bite some fingers off
Shout at the handicapped
Cause buddy
We're Number 37
We're the USA

We're Number 37
We're the USA
We're Number 37
We're the USA

Tags: US Healthcare Reform, World Health Organization (all tags)



Re: We're Number 37!

Yet, politicians in America keep telling voters we are #1, and that there is something in the present health care approach that we want to preserve as the "best in the world." We are this declining empire that like a former star still has delusions of being the most powerful star in town when clearly that is no longer the case in many instances.

by bruh3 2009-09-20 09:56AM | 0 recs
Re: We're Number 37!

Yes we are and it has little to do with lack of coverage and much more to do with the fact that we practice disease management instead of preventive medicine and lifestyle management...until we change our approach, how many we cover will be meaningless...

by BuckeyeBlogger 2009-09-20 09:56AM | 0 recs
Re: We're Number 37!

Yes, if only those uninsured would do better at getting the preventive medicine they need instead of waiting to go to the emergency room when they need care, we'd be back near the top of the list. Then if we could get the seemingly-insured to get the with the program when their coverage is denied and just go practice lifestyle management, that would just about put us back to #1.

by fsm 2009-09-20 11:53AM | 0 recs
Re: We're Number 37!

I would amend your comment to include the insured. One of the lesser understood facts is that if reform is not done right people still will be using emergency medicine since if the deductibles are too high, they will not be able to afford regular care. This is implicit, for example, in the discussion between Bill Maher and the former health insurance industry executive. Often, people think of insurance or not insurance. But the core issue is also under insurance due to deductibles even if they eliminate all the stuff about pre-existing conditions etc.

Here's that interview

http://www.youtube.com/watch?v=0iT5a81yu 3k

by bruh3 2009-09-20 12:00PM | 0 recs
Re: We're Number 37!

p.s. in the interview, just to explain why I linked to the clip- the former health insurance exec discusses going to health fares. Those in attendance were not uninsured. They had insurance. The problem was that the coverage was so crappy that they had to go obtain free care from one the health fares.

by bruh3 2009-09-20 12:02PM | 0 recs
Re: We're Number 37!

We do have an underinsurance problem as well.

by Charles Lemos 2009-09-20 12:06PM | 0 recs
Re: We're Number 37!

Which is one of the reasons (beyond the regressive tax) that the Baucus plan is bad. For example:

"Under this plan, if you had medical costs of $8,725, or more, you would get back more than you paid in, that is, your premiums plus your co-pay plus your deductible would equal your costs. If you had $5,000 in expenses, maybe the cost of falling and breaking an arm (you'd be amazed how hard it is to find the cost for a medical procedure), you'd be out your premium and $2,750, a total of $6,862.50 that year. That is going to be a real problem for someone making $35,000 per year.

I'd call that a pretty good definition of junk insurance. The key point in any insurance policy is whether people can pay the costs of their health care without wrecking their budget. I don't really see how this insurance would help anyone who got seriously hurt and had to miss time off from work, with all the attendant costs, including drugs and drug co-pays, and whatever else the insurance company could wiggle out of paying."

http://firedoglake.com/2009/09/07/the-ba ucus-plan-junk-insurance-by-definition/

I have not checked to confirm these numbers are correct, but if they are, then we will see a severe increase in the under insurance problem while creating the illusion of having reformed health care.  I keep saying these debates are not about the left or right as Pres Obama frames them. They are about economics.  Calling them a dispute over the left versus right or idealogue versus not is a disservice to the underlying problems we face.

by bruh3 2009-09-20 12:30PM | 0 recs
Re: We're Number 37!

"fairs" not "fares"

by bruh3 2009-09-20 12:22PM | 0 recs
Re: We're Number 37!

You realy misunderstand. The point is we can cover everyone and if nothign else changes we will bankrupt ourselves irregardless. Preventive medicine includes the concept of educating people from childhod about proper nutrition and excercise. Its about taking personal responsbility for our own health and lifestyle habits. We are the wealthiest nation in the world and have I believe the highest obesity rates? Why? Greatly due to poor dietary and excercise habits. No healthcare plan will fix that. We need to change our own behavior. Further we need to change the curriculum in our medical schools. There is far to much emphasis on evidence based medicine and disease managment and little on preventive and integrative medicine.

Again its doesnt matter if we cover everyone, if we dont change how our behavior, dont change how we educate our physicians, and how we practice medicine, we will simply be adding cost to the system without accomplish long term change to the issues that drive cost.

by BuckeyeBlogger 2009-09-20 12:46PM | 0 recs
Re: We're Number 37!

If I remember correctly, research disprove your assertion that right living will solve the problem. Indeed, the central issues are one of cost containment and an aging population. Right living is one of those things that tries to shift the debate to personal responsibility rather than accepting the reality that the issue is systemic.

by bruh3 2009-09-20 01:53PM | 0 recs
Re: We're Number 37!

This simply isn't true.  We engage in as much "preventive medicine" as almost any other country--the fact is, there is very little preventive medicine going on in the world.  

And, individual risk factors in total explain less than 10% of variation in health.  I study this issue professionally and it's simply true that we overemphasize the role of nutrition and exercise in our health.  The most recent research shows exercise has no real effect on bodyweight, for example, and the link between obesity and health is now known to have been overstated.  Your argument that we won't accomplish anything without changing behavior simply doesn't hold water.  

by slynch 2009-09-20 02:00PM | 0 recs
Re: We're Number 37!

We enagage in as much preventive medicine as every one? Healthcare costs aroudn the world in countries like Canada and the UK who have universal care are exploding threating bankruptcy. Your belief that we practice preventive medicine are delusional....do yourself a favor for example and go get the Book by Andrew Weil (who is a proponent for Universal Coverage) entiteld "why our health matters". He details our failures in thsi county and aroudn the world and how oru emphasis on disease mgmt and evidence based care has led us down a path of disaster.

No what is broke is how we practice medicine and the fact that we take no personal responsibility for our own well being.

by BuckeyeBlogger 2009-09-20 03:47PM | 0 recs
Re: We're Number 37!

here is where you're showing your ignorance.  Countries with universal care are not experiencing exploding costs.  Apparently you just like to make stuff up.

I said we practice as much prevention as most other countries.  For example, in the last 20 years, annual well physicals have now become common again.  Mammograms and colonoscopies, as well as digital rectal exams for males are but three examples of early detection, which, while not preventive, are not reactive either.  Most medications Americans take are now geared toward prevention--aspirin, statin drugs, beta blockers, etc. for example.

You simply don't know what the hell you're talking about.

by slynch 2009-09-20 04:23PM | 0 recs
Re: We're Number 37!

The link between obesity and health is overstated....well by that token I guess the link between lack of breathing and death are overstated....not sure where you claim to get your facts but your dead wrong on the issue. sorry pal

by BuckeyeBlogger 2009-09-20 03:49PM | 0 recs
Re: We're Number 37!

I do not feel like debatingyou. HEre's a so-so article about the subject:

"Does prevention really cut health-care costs?

...At first blush the answer seems obvious. If I don't need a new heart stent, then no one has to pay for it. But the question becomes more slippery when you start to look at life-time health costs. We're all going to die eventually -- there's no preventing that -- and that means it's hard to prevent the period of very poor health that comes right before death -- a period which tends to be very, very expensive.

In 1997, a group of scientists at Erasmus University in Holland famously showed that smokers have lower total life-time health-care expenditures than non-smokers. Smokers do cost a lot more per year of life, but because their lives are so much shorter on average, the non-smokers end up with higher costs in the long run. Recently people have started to make a similar argument about obesity: that overweight people will cost less overall because they don't live so long. I have yet to be convinced of this. Obesity causes all kinds of expensive disability, driving up costs per year of life, while in fact the link between excess weight and early death is surprisingly weak. But the point here is that it's not impossible for prevention -- prolonging life, and even prolonging healthy life -- to lead to higher health-care costs overall.

So does prevention cut costs? It turns out that the answer really can depend on how you're counting. The authors of the 1997 paper about smokers' health found that eliminating smoking would have cut costs in the short run -- for about 15 years -- even as long-run expenditures increased because people were living longer. Similarly, if we're willing to assume for minute (and I'll suspend my disbelief) that obesity, like smoking, actually cuts a person's life-time health costs because it cuts his or her lifespan, we could still probably decrease each person's current health-care costs by preventing obesity-related illness today. (If we don't assume that obesity is like smoking in this respect, then preventing obesity-related illness will cut costs both now and in the future.) ..."

http://wellness.blogs.time.com/2009/08/0 4/does-prevention-really-cut-health-care -costs/

There's a lot more out there. I found this in less than a minute of googling the issue ,and I know for a fact there is better data but the thesis remains the same. The chief issues are one of an aging population. Can better quality help? Sure. Is it anymore the solution that blaming Mexicans or tort deform? No.

by bruh3 2009-09-20 04:00PM | 0 recs
Re: We're Number 37!

Prevention includes not smoking.....if they didn tsmoke int he first place than not only would they not incur the short run costs, but they might not die earlier......isnt that the point of personal responsibility in regards to lifestyle and disease prevention?

by BuckeyeBlogger 2009-09-21 06:59AM | 0 recs
Re: We're Number 37!

I'm not your pal, and you're the one who is dead wrong.  I study these issues professionally, and that involves, beyond simply reading the literature, actually analyzing health and mortality data.  And I've been doing it for more than a decade.  I suggest you go pick up some scientific literature.  You can start with JAMA, NEJM, and the AJPH.  The words might be a little big for you, though.

As for Weil, he has a set of beliefs that, though somewhat common, aren't completely backed up by research.  In fact, some of his views are simply factually wrong.  Evidence simply does not support the position that organic foods are better for your health than nonorganic foods, and no evidence suggests that new-agey diets work either.

by slynch 2009-09-20 04:18PM | 0 recs
Re: We're Number 37!

Actually, you misunderstand me. Then again, I needn't have been so sarcastic.

So let me point out clearly: if you believe that preventive care and maintenance are likely to lead to lower health care costs (which I agree with), then the best way to get that outcome is to have universal coverage. The reason we lag in preventive care is precisely because we have so many uninsured (and underinsured).

So the best way to address your concern is, in fact, to adopt a system of universal insurance.

by fsm 2009-09-20 02:55PM | 0 recs
Re: We're Number 37!

Also, the uninsured have a 40% greater chance of death, and are 3.2 times more likely than those with insurance to die in the hospital.

Your saw about "personal responsibility" is pretty rusty, when shown in the light of fact.

by lojasmo 2009-09-20 03:41PM | 0 recs
Re: We're Number 37!

Directed at Buckeye blogger.  Sorry.

by lojasmo 2009-09-20 03:43PM | 0 recs
Re: We're Number 37!

Directed at Buckeye blogger.  Sorry.

by lojasmo 2009-09-20 03:45PM | 0 recs
Re: We're Number 37!

We are the wealthiest nation in the world and have I believe the highest obesity rates? Why?

There is an inverse relationship between income and obesity rates.  The poor are also medically under served, and likely to be without insurance.

by lojasmo 2009-09-20 03:40PM | 0 recs
Re: We're Number 37!

not exactly.  At the macro (national) level, wealthier countries tend to be heavier.  At the micro (individual) level, those with less income tend to be heavier.  The direction of the relationship depends on the unit of analysis.

by slynch 2009-09-20 04:26PM | 0 recs

...stands for "Organisation for Economic Co-operation and Development" in case anyone didn't know that.

I didn't...had to look it up. I really should get out more.

by Spiffarino 2009-09-20 10:07AM | 0 recs

Well I tend to use their research a fair bit. The organisation is based in Paris and it is essentially the group of the world's 30 most advanced economies.

by Charles Lemos 2009-09-20 12:01PM | 0 recs


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