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Context of 'June 11, 2009: US: First in Health Care Spending, 50th in Life Expectancy'

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Ahmed Chalabi, an Iraqi exile, studies for his doctorate in math at the University of Chicago where he gets to know Albert Wohlstetter, a prominent cold-war strategist and a mentor for Paul Wolfowitz and Richard Perle. After receiving his degree, Chalabi moves to Lebanon where he works as a math teacher at the American University of Beirut. His brother, Jawad, is also living in Beirut and runs Middle East Banking Corp. (Mebco). [American Prospect, 11/18/2002; Salon, 5/5/2004; New Yorker, 6/7/2004; Christian Science Monitor, 6/15/2004]

Entity Tags: Ahmed Chalabi, Jawad Chalabi, Albert Wohlstetter

Timeline Tags: Events Leading to Iraq Invasion, Neoconservative Influence

For 16 available health indicators, the US ranks on average 12th out of 13 industrial countries. Ranking first is Japan followed by Sweden, Canada, France, Australia, Spain, Finland, the Netherlands, the United Kingdom, Denmark, Belgium, the United States, and Germany. For three of the indicators, the US ranks dead last: low-birth-weight percentages, overall neonatal and infant mortality, and years of potential life lost. Life expectancy in the US appears to improve with age. While the country ranks 11th and 12th for female and male one-year-olds, respectively, it ranks a high 3rd for life expectancy among 80-year-olds of both sexes. [Starfield, 1998; Starfield, 2000 pdf file]

Entity Tags: United States

Timeline Tags: US Health Care

In an op-ed, the New York Times calls the idea that the US has “the best health care system in the world,” as recently stated by President Bush, or provides “the best medical care in the world,” as recently stated by former New York City Mayor Rudolph Giulani, a “delusion.” “That may be true at many top medical centers,” the Times writes. “But the disturbing truth is that this country lags well behind other advanced nations in delivering timely and effective care.” The Times notes that in 2000, the World Health Organization (WHO) ranked the health care systems of 191 nations. France and Italy were first and second; the US came in 37th. The Times notes a more recent study by “the highly regarded Commonwealth Fund,” which “has pioneered in comparing the United States with other advanced nations through surveys of patients and doctors and analysis of other data”; the latest Commonwealth Fund study put the US last among six highly developed nations (see May 15, 2007). “Other comparative studies also put the United States in a relatively bad light,” the Times notes.
Lack of Universal Coverage - Unlike every other major industrialized nation, the US does not provide universal health coverage. In the US, some 45 million people have no health insurance whatsoever, and millions more suffer with poor coverage. The Times writes, “Although the president has blithely said that these people can always get treatment in an emergency room, many studies have shown that people without insurance postpone treatment until a minor illness becomes worse, harming their own health and imposing greater costs.”
Lack of Access - While citizens of foreign nations often face longer waits before they can see specialists or undergo elective surgery than do Americans in comparable situations, “[t]he real barriers here are the costs facing low-income people without insurance or with skimpy coverage.” However, “even Americans with above-average incomes find it more difficult than their counterparts abroad to get care on nights or weekends without going to an emergency room, and many report having to wait six days or more for an appointment with their own doctors.”
Unfair Disparities - The dichotomy between the care provided to economically well-off Americans and their more economically challenged fellows is worse than in any other industrialized nation. “Americans with below-average incomes are much less likely than their counterparts in other industrialized nations to see a doctor when sick, to fill prescriptions, or to get needed tests and follow-up care.”
Unhealthy Living - The US ranks last among 23 nations in its infant mortality rate—more American children die in infancy than in 22 other countries. “But the problem is much broader,” the Times continues. “We rank near the bottom in healthy life expectancy at age 60, and 15th among 19 countries in deaths from a wide range of illnesses that would not have been fatal if treated with timely and effective care. The good news is that we have done a better job than other industrialized nations in reducing smoking. The bad news is that our obesity epidemic is the worst in the world.”
Varying Quality - The Commonwealth Fund study notes that the US ranks first in providing the correct care for a given condition, and does very well in providing preventative care to its citizens. But it does much worse in coordinating the care of chronically ill patients, in protecting the safety of patients, and in meeting the needs and preferences of patients. Overall, the quality of health care in the US is the lowest among the six nations profiled by the study.
Varying Survival Rates - US citizens live longer than their foreign counterparts with breast cancer, and second-longest with cervical cancer and childhood leukemia. But US citizens rank last or next-to-last in life expectancy for patients with kidney transplants, liver transplants, colorectal cancer, circulatory diseases, respiratory diseases, diabetes, bronchitis, asthma, and emphysema.
Poor Patient Satisfaction - Only 40 percent of Americans are satisfied with the nation’s health care system. Of 17 countries surveyed, the US comes in 14th. The US ranks first in negative public perceptions, with a third of Americans calling for a system-wide revamp of American health care.
Poor Use of Information Technology - American health care providers are years behind their foreign counterparts in their use of information technology, electronic medical records, electronic prescriptions, and more. “This makes it harder to coordinate care, spot errors, and adhere to standard clinical guidelines,” the Times writes.
Conclusion - “With health care emerging as a major issue in the presidential campaign and in Congress, it will be important to get beyond empty boasts that this country has ‘the best health care system in the world’ and turn instead to fixing its very real defects,” the Times concludes. “The main goal should be to reduce the huge number of uninsured, who are a major reason for our poor standing globally.… The world’s most powerful economy should be able to provide a health care system that really is the best.” [New York Times, 8/12/2007]

Entity Tags: Commonwealth Fund, Rudolph (“Rudy”) Giuliani, World Health Organization, George W. Bush, New York Times

Timeline Tags: US Health Care

The US spends more than any other nation in the world on health care, but ranks only 50th among 224 nations in life expectancy, according to the 2009 CIA World Factbook. Experts say that this fact could raise serious questions in the debate over health care reform. Americans have an average life span of 78.1 years; the populations of 49 other nations live longer, on average. Japan is first in life expectancy, at 83 years; Australia, Iceland, Italy, San Marino, Switzerland, Andorra, Canada, and France round out the top 10 countries. Other countries, such as Sweden, Norway, Denmark, Singapore, Greece, Spain, and Portugal also do better than the US in life expectancy. The bottom 10 nations are, in reverse order, Sierra Leone, Afghanistan, Zimbabwe, Lesotho, Zambia, Chad, Uganda, Swaziland, Mozambique, and Guinea-Bissau, with life spans ranging from averages of 41 to 48 years. Some experts note that the US is the only developed nation to have a virtually completely privatized health care system. “What we are able to find in the industrialized world is that life expectancy will be influenced in a beneficial manner to the extent that health care expenditure is publicly financed,” says public health professor Harvey Brenner. “The higher the government expenditure on health care, the lower will be the mortality rate.” A study from the University of Chicago shows that a single-payer system—government-run health care—may be associated with higher life expectancy. The governments of such nations as Norway, Sweden, Denmark, Australia, and Canada have government-run health care, and their citizens have some of the longest life spans in the world. The author of the study, Bianca Frogner, writes: “Inevitably the conversation about reforming our health care system focuses on the question of what are we getting for our money and how are others doing with their health care dollars. Life expectancy, along with mortality and morbidity rates, are fairly straightforward numbers to rely on.” Other comparisons show that Scandinavian and other European countries have lower birth mortality numbers than the US, though babies born with abnormally low birth weights tend to fare better in the US system than in the Scandinavian systems. [CNN, 6/11/2009]

Entity Tags: University of Chicago, Bianca Frogner, Harvey Brenner

Timeline Tags: US Health Care

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