The Common Good

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

The United States is the richest nation on earth. 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. Under the leadership of Dr. Christopher Murray of Harvard University and Julio Frenk, former health minister in Mexico, the WHO analyzed financing, organization operations, and availability of care in different systems. Its 2000 report, which was intended to help countries improve their health care systems, found the United States far behind its industrialized peers.

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This information comes from T.R. Reid, a Washington Post correspondent and bestselling author, in his recent book The Healing of America. In this book Reid compares and contrasts the American health-care system with those of other nations. He presented some of his findings in a documentary for the PBS series Frontline.

What Reid found can go a long way toward informing our thinking about the urgent need for health-care reform in the United States. There is a measure called Disability-Adjusted Life Expectancy (DALE) that measures "healthy life expectancy." This comes about through a healthy lifestyle and the access to medical care for both the prevention and cure of illness. The U.S. ranks 24 according to the DALE measure (70 years). This is lower than Israel and ahead of Cyprus. According to Reid the U.S. received this ranking because it fails to provide access to basic health care for some 45 million people.

In his book, he describes four basic models of care:

1. In the Bismarck system, private insurers and private providers with employers and employees pay the premiums. In most countries that use it, everyone is covered and insurance companies are highly regulated and are prevented from making a profit on basic health care. Government pays for those who are unemployed. This corresponds to the kind of insurance most working people in the U.S. have.

2. In the Beveridge system, government owns the health-care facilities, most providers are government employees, and the government pays all the bills. This corresponds to the Veterans Administration system in the United States.

3. In the National Health Insurance model, the medical facilities and providers are private, but the government pays for the services. This corresponds to Medicare in the U.S.

4. Then there is the out-of-pocket system. Those who have money get health care and those who do not have money do not get health care. This is the case for the 45 million uninsured in the U.S.

So, in our public discourse, when we worry about "socialized" medicine coming to the U.S. and dealing a death blow to our freedoms, let us remember that we already have "socialized" medicine for military personnel, veterans, Native Americans, everyone over 65, and the poor. Part of the problem with our system is that it is not a unified system, and there is no equality built into it. And to think that the emergency room answers the problem is also deeply mistaken.

Reid tells us that the industrialized nations who made a decision to provide universal health care to their citizens first made a moral decision. They decided that basic health care ought not to be a for-profit enterprise, and they based their moral decision on a value that defined them as a people. For France and Switzerland the value was solidarity. What moral value does the health-care system in the United States demonstrate?

Dr. Valerie Elverton Dixon is an independent scholar who publishes lectures and essays at She received her Ph.D. in religion and society from Temple University and taught Christian ethics at United Theological Seminary and Andover Newton Theological School.

To learn more about health-care reform, click here to visit Sojourners' Health-Care Resources Web page.

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