Israel in the First World, U.S. in the Third

My mother liked to think that everything was better in America. She didn’t want to hear that we’d bought a German dryer because it was the best one in the shop. She was sure that she got the best health care in the world because she lived in America. The idea that by running off to some Third World country in the Middle East I might get better care was beyond unbelievable to her.

As an American, she certainly paid more, lots more, for medical care than Germans, Canadians or Israelis. But she got less for her money. The Commonwealth Fund recently came out with a report showing that the United States pays more for health care and gets less – in fact, that it rates poorly among industrialized countries on some measures. In think-tank jargon:

Across 37 core indicators of performance,the U.S. achieves an overall score of 65 out of a possible 100 when comparing national averages with U.S. and international performance benchmarks. Overall, performance did not improve from 2006 to 2008. Access to health care significantly declined, while health system efficiency remained low.

In what may be the most striking measure, the U.S. had the highest number of deaths that could have been prevented by care – 110 per 100,000. Portugal did better, and so did Greece. In “healthy life expectancy at age 60” – meaning the number of healthy years you can still expect to live at that age – the U.S. was also close to the bottom. Infant mortality? In the U.S., the rate is 6.8 per 1,000 births, compared to 5.3 in Canada and 3.3 in Finland. The 10 healthiest states in the U.S. came had more infant deaths than Denmark, slightly less than Canada as a whole.

The Commonwealth Fund, alas, didn’t include Israel in its charts. So I emailed my friend Gary Ginsberg, health economist to the world, and asked him for some comparisons. His answers: The infant mortality rate in Israel is 3.9 per 1,000 – better than Denmark, worse than Finland. Sadly, health in Israel shows inequality – the picture is significantly worse for non-Jews. So the infant mortality rate for non-Jews is 6.7 – still better than the U.S. national average.

In Israel in 2002, a man had a healthy life expectancy 16.8 more years, a woman of 18.2 more years. In America, the matching figures were 15.3 years for men, 18.1 for women.

The reason for these differences is pretty obvious: The United States, an underdeveloped country, lacks universal, socialized medical care. The free market flunks at health care. The invisible hand marks up the cost and provides shoddy goods.

Ah, but some well-off Americans might protest: Those pesky figures are for everyone in a country. If you are insured and well-off in America you will live longer and better because of the fabulous hospitals, the incredible techniques.

The incidental evidence is poor on that as well. Check this from the New York Times today: American doctors put in artificial joints that have already proven flawed and that wouldn’t be used in other countries – because the other countries have a national registry that reveals problems quickly, and the U.S. doesn’t. Skip all the arguments about exactly why the U.S. doesn’t. They boil down to: no national health care system. The free market is good at giving you expensive care, not necessarily good care.

Funny thing is, Mom would have been the first to warn me that the highest-priced item wasn’t necessarily the best. It just had the most snob appeal.

4 thoughts on “Israel in the First World, U.S. in the Third”

  1. A very interesting article, and well said.Everyone seems to be having problems with their health systems but the state of health-care in the US is truly astonishing. It is good to hear the case for social services made coherently. Its about time we rolled back the free-market dogma and found a more rational discourse. The right mix will be needed to avoid environmental meltdown.

  2. Hi,
    I think you make a few mistakes, although I agree with your basic orientation:

    -You confuse socialized medicine (e.g. the V.A. system in America or the system in the U.K.), where the hospitals and clinics are government owned and run and the doctors are government employees, with socialized insurance (e.g. Medicare in the U.S. or the system in Canada), where hospitals and doctors are private but health insurance is provided by the government.

    -Israel actually has neither: If I understand it correctly, Israel has a system like Switzerland’s with private insurance companies that are required by law to cover everyone who requests service and there is a national list of approved drugs and treatments. In Switzerland, the only profits the insurance companies are allowed to earn come from the sale of supplemental insurance for things not otherwise covered (private hospital rooms, alternative medicines etc.). In America, insurance companies earn profits by screening their customers and denying coverage for expensive procedures and treatments.

  3. Boy did you hit it on the head .The trouble is most Americans won’t believe the truth in regard to their healthcare because it’s unpatriotic to believe that we aren’t the best in the world not a slow-adapting also -ran. As a lawyer I have had several defective hip prosthesis cases where the prothesis has cracked and had to be removed and a new one put in; all the technology based on devices no longer used in Europe. The manufacturers usually blame the surgeons or the victim rather than accept my metallurgists testing, based on unassailable data. Of course the culprits always point to approval by the ” holy of holies” the FDA. I have settled every one with a confedential order on disclosure of terms of settlement.

    Most of the enlightened healthcare systems in the world are based on service.The system in the US is based on profit. I look forward to “an awakening” but not in Anbar but in the US but Man it is sure slow in coming.

  4. The free-market might work for ipods, fruit or vegetables but does not work for health. This is because unlike for fruit and vegetables (where the consumer has knowledge — ie; I can guess how much I can appreciate apple pie and balance taht with how much I am prepared to spend on apples) consumers lack knowledge (ie: they have not studied medicine for 6-10 years) when it comes to buying health services and so rely on Doctors to be their agents. MD’s have the ability to both demand AND supply services to teh prospective patient. Guess what, they overprovide unessential services (eg: hysterectomies, caesarians etc..). The best of doctors merit Gehinnom says the Talmud, because doctors (for very good reasons) afflict pain on people..the Talmud is telling doctors to think twice before starting a proceedure….. so what do doctors who operate for unnecessary reasons merit???

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