How do you tell if your country has a good health-care system? Does it give individuals few choices over treatment? Does it rely heavily on central planning and rationing of health care? If so, it’s top notch. Anything else falls short of the ideal.
That, at least, is the distinct impression given by a recent World Health Organization report which ranked the nations of the world by the quality of their health-care system. France’s heavily socialized system came it at number one, while the United States was way down the list at number 37.
Why? Largely because in the United States, health care spending is done by individuals and corporations rather than the state. To the WHO, if an individual spends $100 out of his or her pocket on health care, that’s a travesty, but if the government taxes a citizen $100 and then spends that money to pay for a doctor visit, that’s the hallmark of a great health care system.
To WHO it also depends who the health care dollar is spent on. The WHO report includes a measure of “disability-adjusted life expectancy” which is the average number of years a person lives without a serious illness. Essentially that means that to WHO every $1 spent on providing care for people with long-term chronic illnesses is an inefficient expenditure. This is a value judgment there that spending money on the disabled wastes resources that might go to say reducing infant mortality (this is a common value judgment
The fatal flaw in the United States system is the one area where it excels, according to the WHO report — the United States ranks number one in the world using WHO’s criteria for responsiveness to patients. There aren’t any long waiting lists to receive medical treatment as there are in many countries. The state doesn’t dictate which medications can be prescribed or forbid people over a certain age from having certain treatments. Unfortunately that very element of choice interferes with the ability of the state to plan the “correct” outcomes.
And central planning is really what constitutes a good health care system for the WHO. An article on the rankings in the Washington Post captured the flavor and intent of the report when it noted the poor ranking given to China’s health care system:
A generation ago, China emphasized disease prevention and universal primary care. (It was one of the first Third World countries to eradicate smallpox and was famous for its “barefoot doctors.”) With the arrival of a market economy in the 1980s, medical care became financed largely by out-of-pocket payment by consumers. Today it ranks 188th out of 191 nations in the WHO assessment’s “fairness of financing” measure.
The erosion of organized planning for health may be one reason Chinas’s life expectancy has barely budged in the past 20 years, despite the huge growth in its national wealth, a traditional driver of health improvement, [WHO’s Julio]Frenk said.
The WHO report and rankings reflect the values of bureacrats who long for the sort of power and control over people’s lives that a country like China exerted at the height of its centralized planning.