No, Chris Christie, U.S. Health Care Is Not the 'World's Greatest'

Let's be clear on Christie's claim about the U.S. health care system's superlative quality.

christie-615.jpgEric Thayer/Reuters

Last night at the Republican convention, New Jersey Governor Chris Christie had this to say in the latter third of his speech:

oecd insurance coverage chart-615.pngHealth insurance coverage rates by country, 2009 (OECD)
Mitt Romney will tell us the hard truths we need to hear to end the debacle of putting the world's greatest health care system in the hands of federal bureaucrats and putting those bureaucrats between an American citizen and her doctor.

Let's stop right there. "The world's greatest health-care system"? There are a lot of wonderful things about the United States -- and not to get all Newsroom on you -- but if the last few years of political debate have proven anything, it's that the health-care system is not one of them. It's complex, it's expensive, and it's riddled with inefficiencies.

Exactly what metric was Christie using? It's not clear. Perhaps he was talking about how our system has performed historically. But even in the past, we've underwhelmed. A 2000 World Health Organization report placed the United States 37th in the world. 

Like any ranking that's been through a mathematical rinsing process, the WHO report came under criticism, but we have a good amount of subsequent studies in this area, none of which suggest that we're even a serious contender for "greatest health-care system."

infant-mortality-oecd.pngNumber of infant deaths per 1,000, in descending order by country (OECD)

It's an uphill climb by any measure to argue that the United States has the world's best health-care system, bar none. If the claim were true, then under no circumstance should the United States find itself behind its peers. Under very few circumstances, at any rate, if we're being generous. And yet... Let's start by considering these two facts from the OECD: We spend at least -- at least -- 53 percent more on health care per capita than any other nation in the developed world. We also pay more than three times what the British or the French pay out of pocket per capita on health care -- that's the third-highest rate among all OECD nations.

You might think spending a lot leads to superior outcomes; that might be true in some instances, but certainly not in so many that we could claim first place overall. For instance, we've got the fourth worst rate for infant mortality in the OECD. The United States is third-to-last in terms of mortality for children under 20, and it's 12th from the bottom when it comes to child suicide. We have the second-highest teen birth rate in the OECD, we're eighth from last on overall life expectancy at birth, and we're tied with Slovenia for third-worst place in terms of doctor density -- a count of how many doctors are available per 1,000 citizens.

bottom-10-doctor-density.pngBottom 10 OECD nations by number of doctors per 1,000 citizens (OECD)

In 2009, we were in fourth-to-last place in terms of health insurance coverage rates (Excel) -- ahead of Chile, Mexico, and Turkey, but behind the Slovak Republic, Estonia, and Poland. As a percentage of total health expenditures, we rank seventh when it comes to prioritizing preventive care; countries that spend more on preventive services include Canada, New Zealand, Slovenia, and Hungary. Our hospital admission rates for heart attack patients alone are astronomical; compared to other Western developed countries, Americans can expect to go back to the hospital after a myocardial infarction a whopping 68 percent more than their foreign-born peers.

Again, we're great in a lot of ways. America has some of the best doctors, the best technology, and an amazing repository of medical and scientific knowledge. But to have an intelligent conversation about the future of health care, we ought to be realistic about what the country has and hasn't accomplished.

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Brian Fung is the technology writer at National Journal. He was previously an associate editor at The Atlantic and has written for Foreign Policy and The Washington Post.

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