by Gilles d'Aymery
(Swans - September 21, 2009) I've read that last year over 20 percent of medical claims in California were denied by the private health-insurance companies. According to the knowledgeable and often-entertaining Harper's Index (Harper's Magazine, September 2009) the average premiums paid to large US health-insurance companies have shot up 87 percent in the past six years. During that same period the profits of the top ten insurance companies have multiplied by 428 percent. (Average CEO compensation in that rarefied field is $12 million.) The Harper's Index tells us that 7 in 10 American families bankrupted due to medical bills have health insurance. Washington State's subsidized health plan intends to reduce its membership by one-third by jacking up insurance premiums 70 percent.
With this benign introduction let me invite the readers to visit or revisit the dossier published on Swans in September 2004: "America #1 -- Score Card 2004," which had the byline A Model of Freedom and Democracy for the World to Emulate ™. In this dossier, I went through a series of "metrics" -- a word much in favor in Washington, D.C. -- that provided a statistical picture of the U.S. In the section on health care, I compared health care expenditures, performance ranking, life expectancy, infant mortality, number of physicians and nurses, number of hospital beds per population, etc. in four countries: the USA, France, Cuba, and Israel. All the sources were official and meticulously documented so that I could not be charged with somehow doctoring the data. Please take the time to carefully review the results. Better yet, make a printout of the dossier. You will need it later.
Since nothing is static -- data change -- I revisited the World Health Organization (WHO) Web site to look at its latest 2009 World Health Statistics Report. The full report is available in six languages -- Arabic, Chinese, English, French, Russian, and Spanish -- at this Web page. The English version, a 6 MB Adobe Acrobat (PDF) file, can be downloaded directly from:
Once again, I looked at a few metrics for the USA, France, and Cuba (I did not cover Israel this time around.) Since the US government has been debating health care (non)reform for months, I wanted to see how the so-called wealthiest country in the world was measuring up to the much-denigrated French "socialist" system and the much-demonized "totalitarian communist" Cuban one. I only picked ten metrics, which I am presenting below.
1) General government expenditure on health as percentage of total government expenditure (2005)
(The lower the better)
2) General government expenditure on health as percentage of total expenditure on health (2005)
(Here, the higher the number the more health care is financed by the government or, like in France, a private organization that has a public character -- i.e., Social Security and health insurance in France are not administered by the government.)
3) Total expenditure on health as percentage of GDP (2006)
(The lower the better, assuming that the results are equivalent)
4) Number of hospital beds per 1,000 population (2000-2008)
(Measures the availability of rooms/beds for patients -- the higher the better)
5) Number of physicians per 1,000 population (2000-2007)
(Fewer physicians means less attention or time dedicated to patients)
6) Number of nursing & midwifery personnel per 1,000 population (2000-2007)
(More nurses means that the burden of health care is placed on the shoulders of nurses rather than physicians)
7) Life expectancy at birth (both sexes, 2007)
(The higher the better)
8) Healthy life expectancy at birth (both sexes, 2007)
(The higher the better)
9) Infant mortality rate -- probability of dying between birth and age 1 per 1,000 live births (both sexes, 2007)
(The lower the better)
10) Under-5 mortality rate -- probability of dying by age 5 per 1,000 live births (both sexes, 2007)
(The lower the better)
Now is the time to look at the printout of my 2004 dossier (or open it in a new tab of your browser) and look at the trends. Total health expenditures as percentage of GDP have remained relatively constant in Cuba, around 7 percent; France went up from about 10 percent to 11 percent; and the U.S. from less than 14 percent to over 15 percent (it's estimated that in 2009, the percentage may reach 18 percent). While life expectancy has increased both in France (from 79.44 to 81) and in Cuba (from 77.04 to 78), the US advance was much more modest (from 77.43 to 78). The same trend applies to infant mortality: France went down from 4.31 to 3; Cuba from 6.45 to 5; and the U.S. from 6.63 to 6. The trends are repeated over most (but not all; see below) metrics. The improvements in health care are more significant in Cuba and in France and far more modest in the U.S., while American spending is going through the roof.
Highly significant, however, are the areas in which the trends are inverted, namely, amelioration in both Cuba and France and a marked deterioration in the U.S. These areas are the number of hospital beds and the number of physicians and nurses. While hospital beds, physicians, and nurses have increased in France and in Cuba -- quite possibly a logical reflection of the growth in their respective populations -- the U.S. has experienced a substantial decrease in these three metrics. In the mid 1990s, the U.S. had about 2.8 physicians, 9.7 nurses (and midwives), and 3.5 hospital beds per 1,000 people. These numbers have gone down to respectively 2.6, 9.4, and 3.1, while the general population has increased from 263 million in 1995 to over 300 million in 2006.
The French health care system is rated #1 in the world by the World Health Organization. It is 80 percent financed by the government and 20 percent by private non-profit insurance companies (called mutuelles). It is worth noting again that the system is not, repeat not, administered by the government, but by a private organization that has a public charter and is, of course, not for profit. It's a mixed system in which doctors, nurses, hospitals, clinics, etc. are either public or private. Everybody is covered from pre-cradle to deathbed -- it's called Universal Health Care. Operated at a much lower cost per capita than in the U.S., it delivers far superior results than its American counterpart. While you'll hear quite a few complaints by French people who have little idea how good they have it in comparison to us in the U.S., I have yet to read one word of complaint about, or denigration of, the French system in all the comments posted on the Web by American expatriates. A system that serves society is simply known as a socialized system. It's constructed to help the wellness of the whole population to the detriment of the profits for the few.
Whether the Cuban system is entirely socialist -- that is, the means of health delivery (hospitals, doctors, etc.) is "owned" by the people through their government -- cannot be assessed due to my unawareness of all the facts on the ground. Furthermore, to compare a poor country, in material terms, with two wealthy countries like France and the U.S. may not be relevant. However, since Cuba is spending less than 10 percent per capita than what the U.S. spends, it is indeed relevant to note that the outcome of the Cuban health care system is either at par or better than its monopoly-capitalist equivalent in America. There too, as "poor" as the country may be, everybody is covered from the womb to the grave. There too, wellness for all is not encumbered by profits for the few.
So, how to explain the discrepancies? How come the US health care system is so costly and delivers relatively poorer results than its counterparts in other countries, rich and poor? The answer, of course, is found in the first paragraph of this article. The U.S. privileges profits and social Darwinism. It's the only system in the Rich World that does not provide universal health care, leaves a substantial proportion of its citizenry uncovered, and transfers money from the masses to the happy few. It's also a society whose culture does not mind seeing almost 45,000 people a year die because of the lack of health insurance. Finally, it's NOT a health care system. It's a sick care system that eschews preventive medicine because there is more money to make in treating the sick rather than in keeping people healthy. It is not about wellness. It is about money -- like absolutely everything else is in the USA (often disguised under the notion of moral/religious/political/philosophical "values").
No reform to the health/sick care system can take place without changing the entire socioeconomic system.
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