U.S. Health Care Is the Best! And the Worst.

It all depends on what kind of care you need and how rich you are.

A pedestrain crosses a street at Cedars-Sinai Medical Center in Los Angeles on September 7, 2012 in California, where veteran French rocker Johnny Hallyday underwent examinations this week following a health scare in the Caribbean. Hallyday's manager Sebastien Farran said the ?general? tests on the 69-year-old singer were due to be finished Friday? with Hallyday released from hospital. 
AFP/Getty Images
Ronald Brownstein
March 13, 2014, 5 p.m.

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.

What We're Following See More »
GOP Budget Chiefs Won’t Invite Administration to Testify
17 hours ago

The administration will release its 2017 budget blueprint tomorrow, but the House and Senate budget committees won’t be inviting anyone from the White House to come talk about it. “The chairmen of the House and Senate Budget committees released a joint statement saying it simply wasn’t worth their time” to hear from OMB Director Shaun Donovan. Accusing the members of pulling a “Donald Trump,” White House spokesman Josh Earnest said the move “raises some questions about how confident they are about the kinds of arguments that they could make.”

Snowstorm Could Impact Primary Turnout
13 hours ago

A snowstorm is supposed to hit New Hampshire today and “linger into Primary Tuesday.” GOP consultant Ron Kaufman said lower turnout should help candidates who have spent a lot of time in the state tending to retail politicking. Donald Trump “has acknowledged that he needs to step up his ground-game, and a heavy snowfall could depress his figures relative to more organized candidates.”

A Shake-Up in the Offing in the Clinton Camp?
8 hours ago

Anticipating a primary loss in New Hampshire on Tuesday, Hillary and Bill Clinton “are considering staffing and strategy changes” to their campaign. Sources tell Politico that the Clintons are likely to layer over top officials with experienced talent, rather than fire their staff en masse.