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Time for a checkup

Merrill Goozner
21 September 2004
This article first appeared on the Tom Paine website

How is it that the richest nation in the world can barely meet the health benchmarks set by former Soviet Union countries? It's all about averages, says Merrill Goozner of the Center for Science in the Public Interest. There's a huge race- and class-based health care disparity in the United States. And it's a problem that's going to take more than promises of universal health care to solve.

The United States spends more on health care than any country on earth - nearly 15 percent of its overall economy. That's nearly a half again as much as other countries and on a per capita basis, no one else is even close. Yet if one looks at the performance of our health care system, we're clearly not getting what we pay for.

USA Today last week published a list of the top 50 countries in terms of life expectancy. The United States ranked third from the bottom. That's right. We're number 48. This year, Americans can expect an average life span of 77.4 years, nearly four years behind the Japanese.

Of course, our longevity has been rising every year by a small amount. But many countries that spend nowhere near our levels on doctors, hospital stays, drugs and sophisticated tests are clearly getting a lot more for their money.

Take the oppressed citizens of the British isles, for instance. We're constantly told they are suffering under the yoke of an incompetent national health care system. Yet they live nearly a year longer on average than Americans.

How about those beer-swilling, sausage-stuffing Germans? They live 14 months longer on average.

Just over the border in Canada, the press constantly claims that our northern cousins are suffering endless waits for basic procedures that we take for granted. Surely they must be dying off at a faster clip. Uh-uh. They have two-and-a-half more years than the average American. Perhaps they spend it waiting on lines for their health care.

Among large industrialized countries, the life expectancy leaders - all with an average life expectancy over 80 years-were Japan, Switzerland and Sweden. What do they have in common? They have national health care plans. But more importantly, they have a high degree of income and social equality across their societies - which, more than any other single factor, correlates with superior health outcomes.

A quick look at the Centers for Disease Control website at health disparities in the United States gives a few clues about why our health care system performs so poorly despite outlandish costs. While the overall U.S. life expectancy rate is 77 years, the rate for blacks is about 72 years with black males at a Third World-level of 68 years.

Infant mortality - a prime indicator of how well health care services are distributed in a society - is another area where the United States lags sadly behind its industrialized rivals. The CDC rankings of selected countries showed the United States at 28th out of 37 countries.

Who fell below us in safe and healthy childbirths and infant care through the first year of life? Virtually all the laggards (other than the United States) are countries of the former Soviet Union and Eastern Europe. How can it be that we not much better off than Romania in this vital statistic? It's not middle-class moms in suburban hospitals losing babies. It's poor mothers without prenatal care. It's teenagers who hide their pregnancies, deliver low birth weight babies and have few support systems to help them care for their newborns.

The health effects of race and class are America's hidden health care story. Low-wage work leads to lousy diets because the foods that are plentiful and cheap happen to be the worst for you. Fear of unemployment and economic decline defines America's large lower middle class today and this produces tremendous psychic stress - an unreported epidemic. We spend billions on drugs to lower blood pressure, reduce cholesterol and treat diabetes, but almost nothing on social programs to offset the income-related lifestyles that lead to these conditions.

In this election season, by all means let's have a debate about how to provide health insurance to the 43 million Americans without it. But let's also talk about who in this society suffers from ill health, why they suffer and what can be done about the social and economic disparities that lead to ill health. It will take more than universal insurance coverage to tackle those issues.

Merrill Goozner is director of the Integrity in Science project at the Center for Science in the Public Interest and a contributing editor to The American Prospect. He has been a journalist and researcher for more than 20 years.