Republican Minority Leader Mitch McConnell, in a floor speech yesterday, insisted that Americans won't stand for a health care system such as those in Great Britain, Canada, or New Zealand. Since he picked the allegedly terrible health care systems of those three countries as the ground upon which he wants to fight this battle, I think Democrats should join the fight with him on precisely that battleground. And if our Senators can find the courage to do so, we should win. Frankly, it wouldn't matter WHAT three countries he had picked, since in every other developed country in the world, health care spending is lower than it is here, and results (not only per dollar spent, but in absolute terms) are better than they are here. But since he picked the three countries, let's show that we're not afraid to join the fight on the battleground of the Republicans' choosing.
First, let's look at per capita health care spending in those three countries, and in the United States:
United States: $5,274
Canada: $2,931
United Kingdom: $2,160
New Zealand: $1,857
Let's look at the figures from a slightly different standpoint, total health care spending as a percent of GDP:
United States: 15.4%
Canada: 9.8%
New Zealand: 8.4%
United Kingdom: 8.1%
On the theory that you get what you pay for, our health care system certainly SHOULD be the best in the world, as the Republicans keep telling us that it is. So the next question is, what is the objective evidence of the results obtained by the health care systems in those three countries, compared to the United States.
I hope that even Mitch McConnell thinks that babies dying before their first birthday is a bad thing, so surely our massive health care spending gives us a lower infant mortality rate than those countries, right? WRONG. Here are the number of children, per thousand live births, who die in their first year of life in these same four countries:
United States: 6.3
Canada: 5.08
New Zealand: 4.99
United Kingdom: 4.93
Well, maybe you're more likely to stay alive as a baby if you're born in one of these countries with such terrible health systems, but surely we have a longer total life expectancy, right? WRONG! Here are the years of life expectancy at birth for the total population (in all cases, the average woman lives a little longer than this, and the average man a little less than this):
Canada: 80.18 years
New Zealand: 79.62 years
United Kingdom: 78.95 years
United States: 77.71 years
Personally, I care a lot less about how many years I live than how many years I live in reasonably good health. Here are the years of heathy life expectancy in these three countries and the United States:
New Zealand: 70.3 years
Canada: 69.9 years
United Kingdom: 69.6 years
United States: 67.6 years
Here are the figures on the average man's probability of making it to age 65 in those three countries and the United States:
Canada: 82.3%
United Kingdom: 81.5%
New Zealnad: 80.9%
United States: 77.4%
I don't know about anybody else, but as a 60 year old man, those countries' health care systems don't look so terrible to me. As a matter of fact, they look pretty good. I don't really know any New Zealanders, but I've known a number of Brits and Canadians, and I have yet to meet the first one who would trade their health care system for ours.
But Senator McConnell is right on at least one thing. Government health care spending, as a percent of total health care spending, IS higher in those three countries than it is here. Here is the public health care spending as a percent of the total in those three countries and the United States:
United Kingdom: 83.4%
New Zealand: 77.9%
Canada: 69.9%
United States: 44.9%
This suggests to me that perhaps government is more effective at limiting costs and improving results in the health care field than is the vaunted private sector, and that increased government involvement in health care would be a good, rather than a bad, thing.
The Republicans' game is clear. They want to focus on a handful of specific examples of the worst things that happened in these countries' heath care systems, and compare them to the best of our system. We can of course play that game, and compare the horror stories from our system (which are replete) with the best examples from their system, and we should do that. But I think most people intuitively understand that what a high school social studies teacher of mine many years ago described as a "My Aunt Emma" argument really doesn't make much sense as a basis for public policy, since both sides can invariably come up with such examples. What DOES make sense is to compare the overall outcomes of one system with another, and on that basis, it is simply impossible to deny that New Zealand, Canada, and Great Britain have health care systems that deliver better results, at far lower cost, than the system we have here in the United States. There is no reason that Democrats should be afraid to join the battle on the ground that the Republicans have chosen. In fact, we should welcome the opportunity to do so.
When will we see Harry Reid, or some other prominent Democrat, stand up on the floor of the Senate and say, in essence, "OK, Senator McConnell, if you want to make speeches about the health care systems of Canada, New Zealand, and Great Britain, let's talk about what those systems cost, and the results that they deliver."