U.S. Healthcare Paradox: The Best and Worst in the World

Watch Michael Moore's new movie "Sicko," about the state of U.S. healthcare, and you might want to swim shark-invested waters to Cuba, where healthcare is inexpensive and largely on par with care in the United States.

After all, Cubans smoke, drink and hang out in the sun at far higher rates than Americans do and still live as healthy and long. They must be doing something right down there.

Yet President Bush maintains an opposing view, saying on numerous occasions in his weekly radio addresses and other speeches that Americans "have the best health care system in the world." Presidential candidate Rudy Giuliani, on the campaign stump, echoed this sentiment last week with his claim that Americans have the "best medical care in the world."

So, who's right? Everyone. U.S. health care is both fantastic and barbaric, depending on what America you live in.

We're number 1 ... and 37!

In an editorial in May in the Journal of the American Medical Association, Ezekiel Emanuel, a bioethicist at the National Institutes of Health, compared the president's lofty assessment of the U.S. healthcare system to Papa Bush's surprise in the early 1990s about the existence of supermarket checkout scanners—"a sign that [the president] fails to appreciate the experiences of the average American who interacts with the health care system," he wrote.

Nearly 50 million Americans, or more than 15 percent of the population, don't have health insurance, and millions more are under-insured. In nearly every other industrialized nation, close to 100 percent of the population is insured. This lack of coverage is a main reason why the U.S. healthcare system ranked 37th out of 191 nations in an analysis by the World Health Organization.

The uninsured comprise the much-discussed urban poor but also the vast expanses of lower-income citizens across rural America and a great deal of the middle-class unable to afford insurance. For most of these uninsured and under-insured, their "primary care physician" is a hospital emergency room.

Those who do have insurance have, for example, a good chance of detecting breast or colon cancer early, when survival rates exceed 90 percent. Those without insurance might not realize they have cancer until, perhaps, a free mobile health unit comes to the neighborhood. And at this point it is too late.

Healthcare for all

Some Americans, including many politicians, seem to think that there is no health inequality because of the multitude of free health services, such as clinics for inner cities or health mobiles for Native American reservations and other remote areas. These services are crucial, but they don't go far enough.

As a result of poor access to healthcare, coupled with poor education and no national emphasis on preventive medicine, health problems accumulate. Weight gain translates to obesity, which translates to diabetes, which translates to lost limbs and renal failure, resulting in lost work, higher welfare payouts and expensive treatments at "free" clinics.

Conversely, if you are wealthy and are shot by the Vice President, or are in need of hip replacement surgery to parachute from an airplane for your 80th birthday, you will have your pick of any specialist in the country to treat any complications that might arise.

Where we fail ... and succeed

Two of the most important health measures for any country are the infant mortality rate and life expectancy. The infant mortality rate speaks of the health of mothers. Life expectancy is a sign of the health of the health system.

On both measures, the United States fails miserably. We rank at the bottom among industrialized nations and 27th among all nations for infant mortality. The rate of 6.37 deaths per 1,000 live births is indeed higher than Cuba's; and even among U.S. whites only, the rate of 5.7 deaths is double that of Singapore, Sweden and Japan, according to data from the Organisation for Economic Co-operation and Development.

As for life expectancy, we only recently overtook Cuba by a fraction. Our life expectancy of 78 years places us 45th on the world list, behind Bosnia but still edging out Albania.

The United States does excel on high-tech procedures, which is why the wealthy from other countries come to the United States for complicated surgery. The nation also excels in curing late-stage cancers and in emergency room care for violent injury, because practice makes perfect.

Moore's new movie is his typical mix of shocking truths and glaring omissions. France, England, Canada and Cuba, all idealized in "Sicko," have their share of problems. Yet by any rational measure, the U.S. system is only the best in the world for limited situations.

Christopher Wanjek is the author of the books “Bad Medicine” and “Food At Work.” Got a question about Bad Medicine? Email Wanjek. If it’s really bad, he just might answer it in a future column. Bad Medicine appears each Tuesday on LiveScience.

Christopher Wanjek
Live Science Contributor

Christopher Wanjek is a Live Science contributor and a health and science writer. He is the author of three science books: Spacefarers (2020), Food at Work (2005) and Bad Medicine (2003). His "Food at Work" book and project, concerning workers' health, safety and productivity, was commissioned by the U.N.'s International Labor Organization. For Live Science, Christopher covers public health, nutrition and biology, and he has written extensively for The Washington Post and Sky & Telescope among others, as well as for the NASA Goddard Space Flight Center, where he was a senior writer. Christopher holds a Master of Health degree from Harvard School of Public Health and a degree in journalism from Temple University.