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U.S. health care's dismal showing

June 22, 2007 | Page 5

HELEN SCOTT explains why the U.S. health care system ranks so poorly compared to other advanced countries.

EVEN BEFORE its release, Sicko has been faulted for idealizing the health care systems of Europe, Canada and Cuba.

It is true that no country currently has a perfectly equitable and ideal health care system. But the problems don't stem from "socialized medicine," as some claim--but from the culprit in the U.S.: a profit-driven market approach to health care.

The stark inequality within the U.S. is replicated on a global level. The World Health Organization classifies 72 of the 192 nations in the world as "high-mortality developing countries." People living in these countries lack the basic necessities of life, including health care, and many die from preventable conditions such as respiratory infections and diarrhoeal diseases.

Structural adjustment policies imposed by the World Bank and International Monetary Fund have required countries to cut spending in health care and other human services in order to qualify for loans, and then to meet the obligations of debt repayment.

At the same time, foreign assistance has dropped. By 2002, the U.S. was contributing only 0.13 percent of its gross national income to foreign aid.

What else to read

The Physicians for a National Health Program Web site makes the case for government-administered single-payer programs, and has downloadable slide shows about the state of U.S. health care. Healthcare-Now posts a regularly updated calendar showing events around the issue of health care--including activities coordinated with the release of the film Sicko.

For a compact history of U.S. health care policy and the struggles for a national health program, from the progressive Era to today, read One Nation, Uninsured: Why the U.S. Has No National Health Insurance, by Jill Quadagno. Donald L. Barlett and James B. Steele's Critical Condition: How Health Care in America Became Big Business--and Bad Medicine is a fact-packed expose of the for-profit health care industry.

Marcia Angell, a former editor of the New England Journal of Medicine, takes on Big Pharma in The Truth About the Drug Companies: How They Deceive Us and What to Do About It. Another recent book on the crisis is Uninsured in America: Life and Death in the Land of Opportunity, by Susan Starr Sered and Rushika Fernandopulle.

For the international perspective, the World Health Organization Web site is an invaluable source of research on global health, especially its annual World Health Report (the 2007 edition is due in August).

London Health Emergency publishes a newsletter and monitors stories about Britain's NHS and campaigns to save it. The Council of Canadians reports on threats to the Canadian health care system--its online pamphlet, "Profit is Not the Cure," has excellent information on the dangers of privatization.


As a result, life expectancy is dropping in many countries. In Haiti, for example, it is down to 49 years for men and 51 for women; in Sierra Leone, it is 32 for men and 35 for women.

Yet even though the U.S. is the most privatized and least effective health system in the world, the "American system" is still touted as a solution to the problems plaguing these poor countries. In Health Affairs last year, for example, the World Bank and the Wharton School argued that state approaches have failed, and recommended private insurance as an alternative.

An extensive comparative research project recently published in the International Journal of Health Services exploded this idea. "We have found that the expansion of private insurance and reduction of publicly insured services in general have not improved health services for poor people," reads the report. "Rather than reducing out-of-pocket expenditures, these policy shifts often have increased such expenditures and have worsened access barriers."

The study concludes: "We must find ways to enhance the delivery of public-sector services to those in need, rather than continuing to implement the mostly failed policies of privatization."

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THE UNITED States spends more on health care than any other country in the world, and yet the quality and accessibility of health care is among the worst in the industrialized world.

Canada, France and Britain all offer some version of a national health care system. They offer more and better care than is available in the U.S., but battles have been waged around them since their inception.

Britain's National Health Service (NHS) was launched in 1948 under the post-war Labour Party government. Before then, as in the U.S. today, only the wealthy had access to good health care; the NHS for the first time offered free health care to all, through a system financed by taxation and administered by the government's Department of Health.

The NHS became one of the best systems in the world, but it was attacked from its beginnings. The minister behind its inception, Aneurin Bevan, resigned three years later to protest the introduction of some fees. In 1979, the neoliberal government of Tory Prime Minister Margaret Thatcher published a White Paper, "Working for Patients," that proposed various privatization measures.

The Labour government of Tony Blair was elected at least in part to save the NHS, which remains overwhelmingly popular with the British public. But instead "New Labour" delivered "The New NHS"--one desiccated by underfunding, outsourcing, layoffs and forced competition with a parallel private system propped up by public investment.

A spokesperson for one of the British health care unions recently referred to this "market madness that is wrecking the NHS." Unions and other groups have launched campaigns and strikes to fend off further attacks.

France and Canada both have national health care systems that guarantee coverage for all citizens: the Canada Health Act requires public payment for medically necessary health care; the French social security system refunds medical costs on a sliding scale.

In reality, both systems combine public and private sectors and have faced increased privatization in recent years. In both countries, public campaigns have fought to defend universal health care as a right, pointing to the failed U.S. system as the epitome of for-profit medicine.

The country that has drawn the most ire from critics of Sicko is Cuba, where Moore takes a group of Americans injured in the 9/11 recovery operation to get the treatment they were denied at home.

In an article in the conservative National Review, former Sen. Fred Thompson--now a frontrunner for the 2008 Republican presidential nomination--asserts that the image of Cuba's great health care system is a myth. "What is it that leads people to value theoretically 'free' health care, even when it's lousy or nonexistent, over a free society that actually delivers health care?" he asks. "I guarantee even the poorest Americans are getting far better medical services than many Cubans."

Thompson is clearly utterly disconnected from the reality of life in the U.S. Even the New York Times' Anthony DePalma had to admit: "While all Cubans have at least minimal free access to doctors, more than 45 million Americans lack basic health insurance."

It is true that Cuba's health care system reflects the inequalities of class and race that mark the broader society in that country. But according to the World Health Organization, life expectancy in the U.S. and Cuba are practically the same, while child mortality is higher in the U.S.--despite the fact that the U.S. spends $6,096 per capita per year on health care, compared to $229 in Cuba.

In the end, despite claims from U.S. politicians that our system is the "best in the world," the reality is clear: For-profit health care leaves millions of Americans to suffer for the sake of corporate greed.

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