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
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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.

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