It's a popular leftist talking point that the US doesn't have the best health care system in the world. However, deciding which health care system is best really depends upon how we measure success. The WHO rankings are often cited as proof that the US system is not the best, but this ranking has several problems, the most obvious being that it's nine years out of date. But even aside from that, this study is open to question because it does not just measure health care quality but also, in part, health care equity and even potential health care quality given GDP.

Another oft-cited fact used to lampoon the US health care system is life expectancy. Though the US does rank a poor 35th in that statistic, this is not really evidence of very much because life expectancy depends on all sorts of factors besides the health care system, and that system probably isn't even one of the biggest.

Both the left and neoliberals have disputed the importance of life expectancy in various ways: researchers affiliated with the American Enterprise Institute published some bogus statistics at one point claiming that if violent deaths were removed as causes, the US would rank first in the world. (These statistics were later cited by Betsy McCaughey on the Daily Show, not to mention an alarming number of right wing blogs.) As it turns out this was completely false, and the OECD, which published the original statistics, actually took the trouble to point out the error in print. Meanwhile a study funded recently by the Commonwealth Fund claims that the US ranks dead last among 19 industrialized nations in "mortality amenable to health care." However, as pointed out in a review by University of Pennsylvania researchers, this is dubious methodology because even confining ourselves to factors like the roughly half of ischemic heart disease deaths judged most easily preventable, there are still many factors in play besides the health care system. (For example, the US ranks first in the industrialized world in obesity. If that did not have a large effect on heart attacks I would eat my hat.)

The most direct evidence we have for the success of the health care system in preventing deaths after diagnosis has to be survival rates. Here the US appears to do rather well. Its cancer survival rates are probably the highest in the world overall, while its survival rates from heart attacks are on the high side though probably not the best. Cancer and heart attacks together make up around half of all medical deaths and are by far their two largest sources.

Of course, it is possible to criticize using preventing deaths after diagnosis in the first place as the measure of success of the health care system. The United States is on the whole simply a sicker society than most other rich nations, partly due to cigarette smoking and obesity, and one could argue that a properly functioning health care system would prevent disease from ever occurring by helping people avoid these risk factors in the first place. That seems plausible, because after all, differences in prevention are generally more important than differences in treatment in lowering mortality from cancer and heart attacks. A properly functioning health care system would therefore put more money into nurturing this crucial contributor to health.

And while the US system does fare well on treatment of diseases that are often terminal, it appears mediocre in treating chronic conditions. For example, hospital readmission rates for asthma, an indicator of poor treatment, were 2nd highest among 19 OECD countries reporting. Life expectancy for patients suffering from end stage renal disease has also been found to be higher in Canada than the United States. A study of diabetics found that more than half had received four recommended services, comparable to the UK and Germany, though above Canada, Australia and New Zealand.

My conclusion from the evidence is that our system does do better than most industrialized nations at treating life threatening diseases once diagnosed, though some of this is no doubt attributable simply to our higher GDP per capita. Aside from that, however, there is one reality that we would be very foolish to overlook and is in fact routinely and quite comically overlooked by neoliberals touting the US health care system. This reality is Medicare: it's a single payer system that provides coverage for those aged 65 and over, precisely the group that accounts for most heart attacks and 60% of all cases of cancer. Not only does Medicare pay for treatment of most cases of these deadly ailments in the United States, but there is evidence that differences in cancer treatment effectiveness between the United States and other nations actually rise when considering senior citizens and sometimes fall to zero for younger folks.

When discussing the American health care system, then, we need to realize that it's a split system. Almost half of all expenditures in the US system are paid for by government, including roughly a third that fund Medicare and Medicaid. The least disputable successes of the US health care system apply mostly to the Medicare eligible age group, and may actually be lessened or even in some cases nonexistent outside it. While this is not an attempt to state that US single payer health care is completely responsible for seniors' high cancer survival rates, the facts do make it impossible to argue that for-profit health insurance is the driving force. Given the split system of the US, we need to be very careful when arguing that health data either supports or detracts from single payer health care, because we might just find it supporting the exact opposite conclusion.