Why the U.S. Ranks 37 Among World Health Systems, Plus Four Alternative Models

When Ms. Dixon addresses her ethical reason for guaranteeing some citizens the rights to the services of other citizens, real dialogue can begin. Until then, declaring the services provided by the work of other people a "right" is not only useless it is misleading and avoids the real issue.

This might be the crux of the health care debate. Is access to basic health care part of the rights that are defined in our Declaration of Independence: the rights to life, liberty, and the pursuit of happiness. Is acccess to health care a right-to-life issue (for those already born, not just those not yet born)?

To say that the assertion of health care access being a right-to-life issue doesn't necessarily mean that we need to set up a single-payer health bureaucracy -- that's not what Ms. Dixon or anyone who holds the right-to-life position means. There are various ways to guarantee acess to health care as a basic right-to-life.

But then we get to that basic question: is access to health care a basic right to life, in that it preserves life? Or is life -- that is provided by some guarantee of access to health care -- merely a privilege?

I agree with you here. To simply declare something is a human right seems to be a conversation-ender, intended to assume a morally superior position to that of the other side of the argument, without actually defending why it is morally superior (because it may in fact be the right view). It is also ignored that to declare such a thing a "right" is to declare a right to the property and labor of somebody else. Perhaps this is okay, but there is no justification stated for such a position, other than "we all live in community" or some other "social welfare" sort of answer. Again, that may be correct, but I find it troubling to tell doctors, nurses, and other medical practitioners what they have to do because other people (the government) tells them it is the right of other people to their labor or property.

A side note: the Declaration of Independence holds no legal authority as the Constitution does.

I think this is a great issue on which all sides of the political spectrum have high-value contributions to make. It is the opportunity to craft "win-win-win" legislation. Will we together govern our affairs with responsibility and justice or battle each other for dominance and the spoils of a fight?

It would be interesting if, just as major construction projects must first undergo an environmental impact study, that legislative reform processes would be preceeded by some kind of socio-ethical review and call to action.

As Congress can (when it chooses) operate under rules that any legislation passed must be funded; it too could operate under a rule that any major reform legislation fit within an ethical framework that is first established by a bi-partisan that essentially defines the problem, identifies the fundamental ethical issues, establishes the fundamental transcending values held by all, reviews current governmental engagement in the issue and somewhat outlines the parameters of possible legislative responses.

Then let the debate begin with all sides bringing their best contributions to the table with a commitment by bi-partisan leadership to turn out the best possible legislation reflecting an explicit, shared ethical commitment.

moving past the fact the column doesn't answer the question posed in the title, there's a reason why US ranks low, and it's not logic. Liberals love to quote the 'US is ranked 37' headline, and then fail to examine the details why.

REQUIRED READING! Especially for Valerie:

http://www.cato.org/pub_display.php?pub_id=9236

The WHO ranking system is dumb. It is based on 5 different criteria, many of which reward ideology or have nothing to do with health care. Bonus feature: also includes 80 percent uncertainty level for each country!

-The more gov't pays for health care, the higher rating they receive. And then people use this fact to argue for more gov't funding. Hello circular reasoning!!

-Unequal distribution decreases rating, even though overall health care could be better than another county. e.g. US gives health care rated an 8 to New Yorkers and a 6 to Minnesotans, but they get a lower score than Zimbabwe which spreads misery equally at a rating of 4 to everyone. (not actual numbers)

The link is to a small pdf, well worth the read.

"It has some of the best-trained physicians and best medical facilities on earth. It is a leader in medical innovation and medical education. However, when the World Health Organization studied the health-care systems of some 191 countries, the U.S. ranked 37."

Yeah, that's why it costs a lot more. It's better. For the 85 percent of Americans that have health insurance there is no issue. They have the best medical stuff on earth. I don't know exactly what the WHO's criteria was for their rankings, but I suspect the US is ranked 37th because of the 15 percent that is not insured.

Thus, the solution to the health care problem is to find a way for the uninsured to afford health insurance. This can either be done by their wealth increasing or the price going down. Unfortunately for those in favor of a government solution to the health care problem, the government is terrible at increasing private wealth or making things cheaper.

And what about the US being a leader in medical innovation and education? Why do you think that is? Are we smarter than other industrialized countries? Are we luckier than other industrialized countries? Of course not. We lead the world in these fields because there are still market incentives to innovate and educate in America. Where would the 36 countries on the WHO's list be without American medical innovation and education?

The point I was making is that many libertarians I know are using the argument that the right to access to health care isn't a real "right" as such; it is a privilege that can be acquired or not acquired according to fate or efforts or whatever. I would state that access to health care is a right to life.

However, many progressives go from the conclusion that access to health care is a right to life: therefore, government is required to provide it via a government health plan.

Being a believer, both in access to health care as a right to life and a believer in regulated free markets, I would say that government is obliged to protect people using regulations such as that insurance companies cannot deny coverage due to pre-existing conditions or that they cannot suddenly drop someone on spurious grounds once they actually become sick.

And perhaps that some sort of "safety net" should be provided for those who cannot afford insurance or medical expenses. This "safety net" could be provided by giving tax deductions and exemptions to those private agencies who provide this sort of care -- it's not necessary to create a government bureaucracy to do this.

Government cannot just sit there and do nothing if people are being denied their rights to access to health care. Any more than can they sit there and do nothing if people are being denied police or fire protection. Some sort of enforcement is required.

I understand that the Declaration of Independence is a historical document without the weight of the law. Still, it does outline our natural rights.

Yes it is true that market forces can and does support innovation. As such, I view attempts to eliminate or curtail markets with skepticism. That being said, however, there are numerous reasons for arguing that health care, as currently practiced, is NOT a free market. Reasons include (but are not necessarily limited to) the following.

1. Lack of price transparency. Doctors' offices do not have a price list available to the consumer, and the consumer does not know what the bill will be before going. Some things like surgery fees are negotiated and so forth, but it's hard to rationally compare prices and to get a baseline of what's expected when the information is difficult to impossible to obtain. The lack of price transparency makes it that much more tempting for hospitals to have the most beautiful buildings, facilities, and so on because those things become what they end up competing on, rather than price.
2. Inelasticity. Health-care is, just like food, inelastic in that you either need it or you don't (sure, we'll *always* need food), and when you do need it, you need it badly. That fact by itself does not doom market mechanisms, as seen by the food example, but it does create limits. Here's a morally tricky example. Suppose there was a condition X that can be treated sort of effectively with generic drug X, but can be treated more effectively with expensive patented drug Y. Do people all have a "right" to be treated with Y, or only with X? What if Y can save a life? What if Y simply prolongs life? Y's inelastic, yet is protected by patent which leads to great potential for abuse.
3. Perverse incentives. Some insurance (esp in the past) made it artificially cheap to see the doctor for even minor things, leading people to overconsume. Deductibles and copays put a damper on that the way they were supposed to. Doctors have an incentive to practice defensive medicine, since any damages came from their pockets while the costs of defensive medicine are passed to the patient. Furthermore, doctors have an incentive to order more tests than necessary, since they get paid for doing so in many cases. Insurance companies have an incentive to enroll as many healthy people as possible, and then drop them if they get sick. To them, ideally they'd never pay a claim! Without some sort of rule forcing coverage to be offered to those who get sick, the sick (who need care most) become uninsurable. People sometimes end up being unable to change jobs because they'd lose coverage if they did - this fact creates a drag on the economy, and removing it should net economic benefit.

I believe it is possible to reform health-care within a private model, with some change of the rules. The profit motive CAN keep things efficient, which is something people often forget. My ideas: (1) tort reform, (2) price openness, (3) prescription drug patent reform... trade price caps for longer patent terms, and (4) shifting doctors to good salary independent of individual services rendered, and (5) have "basic package" that insurance companies have to offer to everyone - let the companies compete on price of said package.

The reason we're in dismal, miserable, pitiful, pathetic 37th place is because we're afraid of change even though it can't get any worse..
And not enough of us are capable of thinking for ourselves.
We're told what to think by corporate stooges.
The corporate elite own our government, lock stock and barrel.
They're spending our money to keep it just the way it is.

We're the laughing stock of the civilized world.

Did you watch Obama's health care speech last night?
What a great speech!

Did you notice the Republican Congressional delegation?
Angry expressions on their faces?
Looking at each other to see if it was OK to clap or stand up?
Holding up copies of their bogus health care bill?
Shouting "you lie!" at Obama?
Do you think they're capable of bipartisanship?
I don't.

Democrats should leave the GOP jerks in the dust.
And get it done.

Yeah, that's why it costs a lot more. It's better.

It costs a lot more and it sucks.

good argument. i'm convinced.

csack needs an argument to be convinced that our 37th place loser health care system sucks.

Csack and the CATO institute think the WHO rating system is unfair because it doesn't tell them what they want to hear.

Typical libertarian hogwash:
"There's nothing wrong with our health care system,
therefore no need to worry about it."

Talk about circular reasoning!

It is however a fact that longevity in the US is lower than in any developed nation. Infant mortality is also lower.

Yeah it is due to unequal distribution alright! But you are blaming the victims themselves. Poor kids don't have an equal chance in the US to grow up healthy or educated. And then the religious right turns around and smacks them on the head for not being able to get the jobs that the wealthy kids can get. That leads to despair and hopelessness. It's a vicious circle that the US needs to break.

"There's nothing wrong with our health care system,
therefore no need to worry about it."

Quote me one libertarian who says this. Just one. You'll never find it. I've searched the 'net for libertarian thoughts on health care reform and have found overwhelming support for massive reforms... just not the ones you want. But you will find ZERO who believe that nothing is wrong with the entire system. ZERO.

Just about every libertarian posting on the God's Politics blog has this
opinion about America's health care system.

Do you guys ever listen to yourselves?

It didn't take much thinking to realize that Bush's GOP is a crime
syndicate masquerading as a government.

Yah, it's all because we're afraid of change. Has nothing to do with our obesity epidemic. Or our huge numbers of immigrants. Or our huge rates of poverty. Or our massively huge and diverse population. No, we're just "afraid."

You've been watching too much CNN.

You've been watching too much Fox Noise.

If the Republicans have health care plans, show us the plans and defend
them right here on God's Politics.
I don't think you can.
And stop whining.
Republicans lost the last election.

Do you think Bush was accessible and bipartisan?

Do you think Bush was accessible and bipartisan?

So, Republicans lost the last election... and that means?? The President should just write them all off and ignore their opinions and views? Refuse to work with them?

And BTW, as of today, 56% oppose Obamacare. Those are not all people who voted for Obama. His ratings are plummeting, faster, in fact, than any other U.S. President at this point and time in their Presidency.

Many who voted for Obama no longer support him. I can think of a few. A black police official and friend of the officer accused of being racist by Obama. She said to a reporter: "I voted for Obama. I will not vote for him again." And then there's this man where I live in CA who voted for him but now does not support or like him due to what Democrats are doing to the water for farmers in CA and Obama's apathy and nonaction on it.

There are others. But my point is... just because Republicans "lost" doesn't mean you just write them off. There are MILLIONS who did not vote for Obama. And there are many who now no longer support Obama. And to write them off and dismiss and/or ignore them is simply foolhardy.