What we get for our health-care dollars

Soon, they tell us, Congress will or will not pass a health-care bill. Detractors think universal health care will raise health-care costs, lower health-care outcomes, and dangerously increase the power of the federal government. Those are interesting theoretical positions, but let's take a final look at what actually has happened in countries who already have universal health care.

These countries are not hard to find. I used True Cost's list of 33 developed countries as a starting point. Thirty-two of them have universal health care, "with the United States being the lone exception." The list describes each country's type of health-care system--single payer, two tier, or insurance mandate--and gives the date that it was begun (ranging from 1912 to 1995).

I then went to the World Health Organization's detailed database search page and checked statistics for 32 of the countries (Hong Kong is listed at True Cost as a separate country but is considered part of China on the WHO list). I found that

• America's adult mortality rate is better than Slovenia's but worse than that of every other developed country. 
• Our infant mortality rate is better than that of Brunei, the United Arab Emirates, Bahrain, and Kuwait; but worse than that of the other 27 countries. 
• Our life expectancy at birth is better than that of Brunei and Bahrain; the same as that of Kuwait, the United Arab Emirates, and Slovenia; but worse than that of the other 26 countries. 
• Our maternal mortality rate is better than that of Luxembourg, Brunei, Singapore, South Korea, Bahrain, and the United Arab Emirates; the same as that of Portugal; but worse than that of the other 24 countries.

For these dispiriting results, our government spends less than the governments of eight countries (Luxembourg, Norway, Iceland, Denmark, Switzerland, France, Sweden, and the Netherlands) but more than the governments of the other 23 countries. But wait--it gets worse. In addition to government funds, Americans also spend a lot of private money on health care. In fact, we spend more on health care than any other nation on earth.

What are we getting for our health-care dollars? I decided to look at the countries that most closely resemble ours in government investment in health care. In 2006--the most recent year for which statistics are available--the United States government spent $3074 per capita on health care. Nine European nations and Canada spent between $2536 and $3541. Six spent less than we did; four spent more. How do our outcomes rank?

• The adult mortality rate (the probability of dying between 15 and 60 years per 1000 population) for the other ten countries ranged from 78 (Sweden) to 124 (France). The U.S. came in last, at 137.
• The infant mortality rate (per 1,000 live births) ranged from 3 (Sweden) to 5 (Canada and the U.K.). The U.S. came in last, at 7.
• Life expectancy at birth ranged from 82 (Switzerland) to 79 (Belgium, the U.K.). The U.S. came in last, at 78.
• The maternal mortality rate (per 100,000 live births) ranged from 1 (Ireland) to 8 (Belgium, the U.K., France). The U.S. came in last, at 11.

What would happen if we devised a health-care system like one of theirs? Why do we think our costs would go up, when theirs are considerably lower than ours? Why do we fear that our outcomes would go down, when theirs are considerably higher? Do we really believe the U.S. government is less capable or more corrupt than the governments that have created successful universal health-care systems?

Well, maybe. Transparency International prepares an annual Corruption Perceptions Index of 180 countries. The United States' rank is 19--better than Belgium or France, but not as good as Sweden, Switzerland, the Netherlands, Canada, Germany, Ireland, Austria, or the U.K. A lot of us fear that we have the best Congress money can buy.