U.S. healthcare not best in world, study shows

David Heitz


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White privilege and wealth results in better health care when compared to average people in the United States, but the rich in this country don’t get the best health care in the world.

That’s the conclusion of an original investigation in the Journal of the American Medical Association. “This study suggests that privileged white U.S. citizens have better health outcomes than average U.S. citizens for six health outcomes but often fare worse than the mean measure of health outcomes of 12 other developed countries,” the researchers found.

“These findings imply that even if all U.S. citizens experienced the same health outcomes enjoyed by privileged white U.S. citizens, U.S. health indicators would still lag behind those in many other countries.”

The study’s lead author, Dr. Ezekiel Emanuel, comes from the Department of Medical Ethics and Health Policy at Perelman School of Medicine at the University of Pennsylvania, Philadelphia.

Where is healthcare better than in the U.S.?

The study looked at white U.S. citizens living in the 1 percent and 5 percent richest counties in the U.S. Health outcomes were measured based on infant and maternal mortality, colon and breast cancer survival rates, childhood acute lymphocytic leukemia survival rates, and acute myocardial infarction death rates.

The Americans’ outcomes were compared with those in a dozen other developed countries, including Australia, Austria, Canada, Denmark, Finland, France, Germany, Japan, the Netherlands, Norway, Sweden, and Switzerland.

Statistical analysis occurred between July 25, 2017, and Aug. 29, 2020. The study analyzed Organization for Economic Co-operation and Development data, CONCORD-3 cancer data, and Medicare data.

Infant mortality rate higher even among wealthy

The infant mortality rate for the top 5 percent of white, wealthy counties was 4.01 per 1,000. For the mothers, the death rate was 10.85 per 100,000 births.

Both those numbers are higher in the U.S. than in all the other countries studied.

For colon cancer, the five-year survival rate for whites in the top 5 percent richest counties was 67.2 percent, beating the average American survival rate of 64.9 percent. The numbers for the wealthy Americans mirrored those of average citizens for four of the other countries. The numbers were worse than the survival rates in two countries.

Breast cancer survivors fare best in U.S.

For breast cancer, the five-year survival rate among white U.S. women living in the wealthiest 5 percent of counties was 92 percent. That number was higher than any of the other countries.

The mean survival rate for wealthy white children with acute lymphocytic leukemia was 92.6 percent in the United States, comparable to the nationwide survival rates in all but one of the other countries.

The adjusted 30-day acute myocardial infarction case-fatality rate for white U.S. citizens in the wealthiest counties was 8 percent below the rate for all U.S. citizens. When compared to citizens in other countries, however, the fatality rate was about the same.

Less than stellar performance nothing new

According to the study, the U.S. has lagged other countries in healthcare for quite some time. “The U.S. health care system appears to underperform on nearly every metric,” the authors explained. “The U.S. spends more than $3.5 trillion per year on health care, 25 percent more per capita than the next highest-spending country. However, compared with other countries, the U.S. performs poorly on process, outcome, and patient experience metrics, as well as life expectancy.”

But that’s not all. “Compared with countries tracked by the Commonwealth Fund, the U.S. ranks behind every country on causes of preventable mortality that could have been addressed by health system interventions,” the authors reported.

Why breast cancer survival rate is high in U.S.

The reality of the United States healthcare system is not as rosy a picture as most Americans would believe, the authors explained. “Despite these well-known data, U.S. politicians, the public, and even physicians seem complacent, often proclaiming that the United States has ‘the best health care system in the world.’

“As a recent poll showed, ‘nearly 80 percent of Americans reflect positively on the health care they personally receive.’ Similarly, in a recent Gallup poll, approximately two-thirds of U.S. citizens said they were “completely or mostly satisfied with the U.S. healthcare system.”

But in reality, even for wealthy white Americans, “The outcomes for these individuals are no better than for average citizens in many other developed countries, and for infant, maternal, and AMI mortality, privileged white U.S. citizens often fare worse,” the researchers concluded.

“Privileged white U.S. citizens appear to have the best outcome in the world for breast cancer. That outcome is very likely due to the high rate of mammogram screening in the U.S., which is associated with higher rates of diagnosis of small cancers. “

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I have been in the news business more than 30 years, spending much of my career at some of the best newspapers in the country. Today, I specialize in Denver local news, health reporting, social justice issues, addiction/recovery/mental health news, and topics surrounding homelessness and human trafficking.

Denver, CO

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