From an international perspective, the American health care structure looks a lot like its system of education.
Each, at its pinnacle, is a wonder of the world. Just as the globe's best and brightest young people jostle for spots at Stanford and Harvard, the planet's richest and most powerful arrive by private plane and tinted town car at the Mayo Clinic or Cedars-Sinai hospital when they feel mortality's shiver.
Yet the health care and education systems in America produce much-less-impressive results for society as a whole. The annual procession of international test comparisons that rank U.S. students in the mediocre middle, far behind the perennial Asian and Nordic leaders, has become as reliable a feature of the school year as homecoming weekend. The United States may have pioneered mass access to higher education after World War II, but now we rank only 12th in the share of young workers with postsecondary degrees.
The picture in health care is more troubling still. An exhaustive 2013 study by the National Research Council and the Institute of Medicine comparing health in the U.S. against other major countries divulged its conclusion on the title page: "Shorter Lives, Poorer Health."
The report identified a "U.S. health disadvantage" that stretches across every stage of life. Examining 16 peer countries, it found that the U.S. ranked second from the bottom in the share of low-birth-weight newborns and was the very worst in infant-mortality rates. Through adolescence, the study found, U.S. teens scrape the bottom in obesity and teen parenthood. As adults, we are more likely to die in car accidents and vastly more likely to expire through gun violence (our rate of death by firearm is roughly 20 times the average of the other major industrialized nations). Later in life, we develop diabetes, heart disease, and chronic lung problems more frequently than our international counterparts do.
The news isn't all bad. We smoke less than the citizens of most other countries, consume less alcohol, generally have lower blood pressure, and are more likely to be screened and treated for cancer. And yet the bottom line is undeniable: The life expectancy for Americans at birth now trails that of 25 other countries.
"We are very good in treating highly specialized conditions after they have already developed — that's why people come from all over the world to get that treatment," says Paul Starr, a Princeton University sociologist who studies health care. "But we've allocated resources in such a way that we don't provide a lot of the up-front things — primary care, public-health services — that have a much bigger effect on the overall health of the population."
What makes these results so perplexing, even infuriating, is that the United States spends more on health care per capita than any other country. Likewise, despite its mediocre education results, the U.S. ranks near the top in per-pupil spending.
On both fronts, analysts don't attribute this nation's difficulties to any single cause. Nor are the shortfalls concentrated in any single group. Just as U.S. students even from the wealthiest districts lag behind their foreign counterparts, so too do illness and premature death invade the penthouse more frequently here than elsewhere.
But one clear message of the Institute of Medicine study is that, compared with the healthiest countries, the United States accepts far more divergence in life outcomes for its citizens. The study pointedly notes that the variation in life spans between American states is much larger than the geographic difference within most other countries. An intriguing international research report found that mortality rates among men ages 30 to 74 were 55 percent higher in the U.S. than in Sweden for people without a college degree, but only 24 percent higher for those who earned one. Another study concluded that the connection between health and socioeconomic status was stronger in the U.S. (and the United Kingdom) than anywhere else.
Similarly, international comparisons in education have discovered a wider gap between American students at the top and bottom of the income ladder than in most countries. Both of these trends point to the same conclusion: The United States is less committed than most of its competitors to maximizing the capabilities of all of its people. Until that changes, America will continue to look up at the leader board on education and health — and to pay a debilitating price in lost potential.