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Health rankings, ‘Spinal Tap’ style

By Jay MacDonald ·
Tuesday, June 24, 2014
Posted: 6 am ET

At first glance, I thought perhaps the Commonwealth Fund had been binge-watching "This is Spinal Tap" and accidentally turned the U.S. health care rankings "up to 11," as Christopher Guest's clueless rock star Nigel Tufnel does with his amplifier in Rob Reiner's classic rockumentary/mockumentary.

But sadly, no. The "11" in this case is the place that U.S. health care ranks in comparison to 10 peer nations, including Canada, Australia, New Zealand and seven Western European allies, according to Commonwealth Fund's 2014 update to its "Mirror, Mirror on the Wall" report.

We spend a ton on health care

First, the bad news: We spend a ridiculous amount per person on health care in this country, a staggering $8,508, based on 2011 figures. That far exceeds runners-up Norway ($5,669) and Switzerland ($5,643) and is more than double what half of the countries in the survey group spend, including: © photosync/

  • France ($4,118)
  • Sweden ($3,925)
  • Australia ($3,800)
  • Great Britain ($3,405)
  • New Zealand ($3,182)

What's worse, we're no better off for it. Based on patient and physician responses to quality-of-care surveys, the U.S. placed dead last in key health outcome measures, including affordability, efficiency, equity and healthy lives. While our rankings for patient-centered care (No. 4) and effectiveness (No. 3) are commendable, the quality and timeliness of our care measures are middling (No. 5) and our access to care remains just plain embarrassing (No. 9).

In fact, the best you can say for U.S. health care's place in the developed world is, we're consistent. After all, we've placed dead last on this survey every time (previously in 2010, 2007, 2006 and 2004). You want top-of-the-line health care? Move to:

  1. Great Britain
  2. Switzerland
  3. Sweden
  4. Australia

Oh, Canada? Our northern neighbor ranks just ahead of us, at No. 10.

At least we're making progress

The nonprofit Commonwealth Fund has never minced words as to why we yanks routinely tank: "The most notable way the U.S. differs from other industrialized countries is the absence of universal health insurance coverage," it notes this year.

Now, some good news: We're making progress, albeit it slowly.

"Under the Affordable Care Act, low- to moderate-income families are now eligible for financial assistance in obtaining coverage," the report says. "The U.S. has significantly accelerated the adoption of health information technology … and is beginning to close the gap with other countries. Based on these patient and physician reports, and with the enactment of health reform, the United States should be able to make significant strides in improving the delivery, coordination and equity of the health care system in coming years."

At which point perhaps we'll really be able to turn it up to 11.

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June 29, 2014 at 3:32 pm

Most people haven't got a clue at what are the true causes;
Malpractice litigation and awards out of control;
Health insurance companies whose main focus is on declaring higher and higher profits;Drug companies ditto;
The explosion of MBA/MHA administrators ,hospital CEO'S making more money then Wall Street brokers,meanwhile the actual providers doctors and nurses,make less and less.
Government regulations and paperwork out of control it grows exponentially each year,there is more time wasted by doctors on compliance then care of patients;and the biggest problem of all unlike these other countries the American people are irresponsible,they abuse themselves with food ,drugs,bad lifestyle choices,etc.and then don't want to be held accountable,even the "informed" don't vaccinate their children,so we have outbreaks of diseases we had eradicated years ago;medical education funding cut so we produce fewer doctors and the younger doctors who are more interested in mountain biking this weekend then seeing patients or working after 5 o'clock. And a lot more.

June 29, 2014 at 2:28 pm

PS: BJ needs some medicine.

June 29, 2014 at 2:24 pm

Greed. Pure and simple. The AMA has a monopoly, limiting medical degrees. Drug companies charge what the market will bear, with the actual price masked by insurance payments. (Other countries pay a lot less.) Foreign doctors come to the US with the sole intent of making a profit and taking it home. Doctors skimp on actual medicine, collude with insurance and drug companies, and own secondary businesses that take their attention. Powerful lobbies funded by PACs permitted by insanely stupid laws defeat every measure of reform. Misinformation and disinformation is rife. Doctors display misleading political advertising in their offices. Every scam imaginable, from insurance fraud to criminal prescriptions is rampant and little regulated. The medical establishment skimps in every area of medicine and patient comfort, as a matter of routine. People remain untreated, are poorly treated, are bankrupted, and die on the streets. It is hard to say, indeed, that there IS a functional medical system!

June 29, 2014 at 2:04 pm

Regardless off this pole of other countries and there systems, I work in the system here in the US as a registered nurse. I can tell you that it is all about the bottom line. Its like investing in the cheapest nuts and bolts for a job and still be able to get the job done. That is what it is like. Quality sometimes suffers for it. Common sense doesn't figure into it unless it serves the bottom line. On the one hand many tests are ordered by the physician, whether warranted or not, because he/she does not want to be sued. This also drives up the high costs. We should have a universal system like Medicare. Its not perfect, but would serve everyone, and without charging 5.00 per pill of ordinary Tylenol(referring to a Time magazine article from Spr. 2013). No system is perfect, but some systems are further away from ideal than others. We think everything we do here comes out smelling like roses. How naïve we are to think this way. It is always us vs. them. On the other hand, we always want something for free. That is not realistic, either. Raise taxes on something worth raising taxes.....a better quality, accessible, healthcare for all!

June 29, 2014 at 12:51 pm

In my experience with this system . . . you can go to a doctor that is an approved provider in your insurance plan . . . a hospital that is in your insurance . . . but if any of those two use a provider that isn't part of your network (lab that tests specimens), you get slapped with a bill as if you didn't have insurance. And what is worse . . . neither one of the approved providers care . . .

June 29, 2014 at 12:16 pm

If this survey is based on "wellness" in that people who are sick, are made to be "well", then I am inclined to agree. THERE IS NO MONEY IN THE CURE!!!

The sicker you are and the longer you are sick, earns money for the following BUSINESSES:

Providers (and all the sub-specialists)
Facilities (hospitals and diagnostic centers)
Pharmaceuticals (need I say more?)
Insurance Companies (premiums and what they DO NOT PAY OUT TO PROVIDERS)
DME if necessary.

Just think of yourself (your body or your illness) as a one-dollar bill that gets sliced and diced and distributed to the above.

Anne Gray Haynes
June 29, 2014 at 10:48 am

The reason our health care is sooo expensive is because for the most part, doctors are making money off our being sick and treating us with procedures and screenings that don't add to our getting well, but do add to thier pockets. There is very liitle effort in the US to promote healthy lifestlyes so we are sicker than most other countries. We have staggering obesity and children 1 to 19 are dead due to gun violence as the major cause! So there is much we have to do to turn all this around!