Best Health Care in the World?
An American Myth
A guy walks into a doctor’s office, and tells the doctor that he has debilitating headaches and nothing he’s tried has worked to relieve them. The doctor runs a battery of tests on the patient, and then goes back to him with a diagnosis. “Well, I’ve found the cause of your headaches,” the doctor tells the patient. “Your testicles are pressing up against the base of your spine creating pressure on your spinal column which is causing your headaches. Unfortunately, the only cure is to remove your testicles.”
The patient thinks about this for a few minutes contemplating life without testicles, but figures what good are they when he can’t really live life anyway with these headaches. He tells the doctor he would like to go through with the procedure and they schedule the operation.
Immediately after waking up from the surgery, the man realizes that his headaches are completely gone, and for the first time he has hope for a new life. After being discharged, the man is walking down the street whistling a happy tune when he passes by a clothes store, and decides that since he feels like a brand new man, he’s going to buy some brand new clothes.
He tells the tailor that he would like to buy a new suit. The tailor looks him up and down and says, “You need a 42 long.” The man is amazed at the tailor’s accuracy without measuring him and tells him so. The tailor replies, “I’ve been doing this for 30 years and have a pretty good eye for sizes. I’m never wrong.”
The man also tells him that he would like some new shirts. The tailor looks at the man and says, “You need a 14 neck and 33 sleeve.” The man is amazed and complements the tailor on his accuracy again. '“Like I said, I’ve been doing this for over 30 years and I’m never wrong,” replies the tailor. The man decides to buy some shoes as well. The tailor looks at the man and says, “You need a size 10 shoe.” The man is amazed once more and tells the tailor so. Again, the tailor just nods his head and says, “Yep, like I said, 30 years doing this and I’m never wrong.”
The man then tells the tailor that he would like to buy some new underwear. The tailor looks at the man and says, “You need a size 34.”
“Aha!,” the man exclaims excitedly. “For the first time in your 30 years you’re wrong! I’ve been wearing 32s my whole adult life.” The tailor replies, “Oh no, 32s are too small for you. They’ll press your testicles up against the base of your spine and give you one hell of a headache.”
- Unknown
We often hear that America has the greatest health care in the world. We point to our shiny new hospitals being built at an ever faster pace. We trumpet our game changing diagnostic technology and surgical robotics. We celebrate our drug companies and are rewarded with never ending drug commercials and ads that promise a happy, care free life.
Not only do we believe we have the world’s greatest health care, we have the world’s most expensive health care by far. In fact, Americans spent $11,172 per person on healthcare in 2018 which is $3.6 trillion (17.7%) of our national GDP. Switzerland is the next closest in per capita health care costs at $7,732.
A whopping 9.2%, or $330 billion, of the $3.6 trillion was spent on prescription drugs. By the way, the United States and New Zealand are the only two countries in the world that allow direct to consumer advertising for prescription drugs. Why allow advertising to people who don’t have the expertise to determine the best treatment for their condition, nor the ability to buy the product directly without a prescription from a doctor?
I can think of 330 billion reasons why. Drug companies don’t spend their ad dollars for no reason. They know that patients who ask their doctors about a specific drug often end up with a prescription for that drug.
The financial success of the companies in the health care industry cannot be disputed. However, the true success of a nation’s health care should be based on outcomes, not how much is spent. So what do we actually get in return for our hard earned money and tax dollars being spent on health care? Well, not that much as it turns out.
Life Expectancy
Life expectancy is one measure often used to gauge the trajectory of a country’s health and quality of care. Personally, I don’t believe life expectancy is a great metric to determine health since you can be very unhealthy for a long period time with a poor quality of life before you finally die.
It’s also not completely accurate to state that we are living longer. Walk through any old cemetery and you will see plenty of examples of people who lived well into their eighties, nineties, and one hundreds. The reality is that fewer people die before 5 years of age now than past generations which skews the numbers in a positive direction. Once a child makes it beyond the first few years of life, they have a high probability of making it into their later years. Regardless, let’s see how we stack up against other countries.
According to the CIA’s World Fact Book, women in the U.S. can expect to live to about 83 years while men tap out around 78 years for an average life expectancy of 80 years. Sounds pretty good until you consider that the United States is only ranked #46 which puts us at the bottom of the developed world.
Infant Mortality Rate
As noted above, infant mortality has a significant impact on life expectancy rates. In modern times, having a large number of children to help around the homestead is not much of a necessity. In the past though, many families had agrarian roots, and needed large families to operate a farm or ranch. A high infant mortality rate meant having more children.
This metric is a better indicator for health and quality of care. While we may not live the longest, we put top priority on our most vulnerable, right? The infant mortality rate in the United States is 5.22 deaths/1,000 live births with male infant mortality rate being slightly higher than females. Where does that put us in relation to other countries?
The United States comes in at #51 behind Lithuania, Cuba, Poland, Hungary, Slovakia, and Latvia. Slovenia has the lowest infant mortality rate at 1.53 deaths/1,000 live births. Not exactly countries we think of as health meccas. Our infant mortality rate is also a far higher rate of death than what infants and kids under 17 years of age can expect from a COVID-19 infection.
Maternal Mortality Ratio
Maternal mortality is also a better indicator for health and quality of care. The U.S. maternal mortality ratio is 19 deaths/100,000 live births. Again, we lag behind countries such as Belarus, Czechia, Slovakia, Lithuania, Turkmenistan, Slovenia, Croatia, Qatar, Estonia, Kazakhstan, Albania, Iran, Turkey, and Tajikistan coming in at #55.
Other Health Indicators
According to the CDC , the U.S. has the highest prevalence of diabetes among developed nations with almost 11% of the total population having diabetes. In a December 2015 article in Endocrine News, in absolute numbers the U.S. has almost two thirds the number of cases as the other 37 nations in the developed world combined.
Type II diabetes, previously termed adult-onset diabetes because it used to primarily occur in older people, is preventable and reversible without drugs or medical intervention, and accounts for 90-95% of diabetes cases in the U.S. It is also estimated that over 34% of U.S. adults over the age of 18 years have prediabetes. Total direct and indirect costs of diagnosed diabetes was $327 billion in 2017.
In 2017 - 2018, 42% of the U.S. population were classified as obese with an estimated annual medical cost of $147 billion. Obesity is also preventable and reversible without drugs or medical intervention. The combined medical costs of obesity and diabetes constitute 14% of annual U.S. medical expenditures. The same causes of obesity and diabetes also contribute largely to heart disease, kidney disease, liver disease, auto-immune disorders, cancers, so on and so forth.
I find it ironic that some of our leaders and medical experts want to exclude people who refuse COVID vaccines from being able to receive healthcare or pay higher health insurance premiums because of their choice to not get vaccinated. What about holding people people accountable for the poor choices resulting in diabetes and obesity which are essentially bankrupting the nation and overwhelming the health system? That would fly in the face of the woke culture so it probably won’t be addressed.
It should be painfully obvious that the U.S. does not have the greatest health care in the world. Many people who do recognize our failings try to attribute our poor health outcomes to wealth inequality or inadequate health insurance and limited access to health care. However, I would argue that we don’t have health care at all, but instead have a sick care system and no amount of free “health care” as it exists today will address the chronic issues that plague the overall health of the people in this country.
Modern medicine is phenomenal when it comes to treating people with acute emergency conditions, traumatic injuries, and true genetic disorders, but it does not work very well for improving health in general. The problem is that current treatment protocols are focused on treating symptoms instead of the actual underlying causes of poor health. The emphasis is on managing a person’s “numbers” to thresholds that have been deemed desirable by the medical establishment regardless of health outcomes.
The prevailing medical view is that we are hostages of our DNA, and nothing we do will change the course of our health. So, we must resort to modern interventions that the latest science provides us in order to have a chance of surviving. Ignore a couple million years of human evolution where we became stronger and more capable to survive and thrive in conditions that most of us cannot even begin to imagine.
This will undoubtedly be viewed as cynical, but treating the actual causes of our chronic conditions is not very profitable. The current sick care system is reliant on more and more customers for life to survive and grow. The most profitable approach is to prescribe medications that manage disease which often require other medications to counter the undesirable effects of many medications. Or, operations are performed that remove “faulty” organs and tissues which then requires medications to manage the conditions resulting from missing organs.
If we actually focused on the true causes of chronic disease, we would not be building more, bigger hospitals. We would not need more prescription drugs, diagnostic devices, or surgical robots. The current sick care system would implode as we spent far less on something that does not contribute to our overall physical or economic well-being. Other areas of our economy would boom as healthy people re-directed their newly found energy and resources into productive endeavors.
The good news is that you don’t have to wait for somebody else to create a true health care system. You can take the initiative in developing your own customized system, and reap the benefits of improved health. It will require a change of mindset, some work, flexibility, and trial and error to fine tune your system, but the rewards are worth it. A future article will address what I view as the basics on how to get started.