Results of a recent British-American study of health outcomes among white citizens of the United Kingdom and the United States have surprised a lot of people. These show that the British are healthier than the Americans at every income level.

Of course, the bad results may not be due to deficiencies in health care. Discussion of the British result has focused on general environmental determinants of health, notably stress, rather than differences in the health care systems. But with tens of millions of Americans lacking any insurance, and health care costs spiraling, we need to look long and hard at how health care is delivered and paid for in the United States.

We flatter ourselves that our health care system is cutting edge. Yet our health outcomes are not only worse than Britain’s, they look bad in a global context.

The United States spends more of its income on health care than any nation on earth, nearly $6,000 per person per year, more than 15 percent of our total income. In contrast, the countries of the European Monetary Union spend about $2,500 per person per year, less than 10 percent of their income.

What do we get for our money? One simple test is to see where the United States stands in a comparison of the most basic health statistic of all: life expectancy at birth.

The answer is that the United States appears to be doing badly, not just compared to Britain but compared to every advanced country in the world. Taking into account the overall standard of living and spending on health care, we should expect a newborn in the United States to live 81 years. [1] In fact, life expectancy at birth is 77 years. Of 25 high-income industrialized countries, the United States is in last place, both in life expectancy at birth and in the gap between actual life expectancy and predicted life expectancy given the standard of living and spending on health care. The next worst outcome, behind U.S. life-expectancy deficit of four years, is a deficit of 2.7 years in Denmark. In contrast, a Japanese newborn is predicted to live about 79 years but actual life expectancy in Japan is nearly 82 years. A Japanese newborn can be expected to live two and a half years more than Japanese living standards and medical spending would lead one to expect, while an American lives four years fewer.

The four year deficit in life expectancy in the United States is one of the worst outcomes anywhere outside Sub-Saharan Africa. All the other countries with life expectancy outcomes substantially worse than predicted are developing countries or part of the former Soviet Union.
Countries with the Biggest

Life Expectancy Deficits (years)
1 Haiti -13.3
2 Papua New Guinea -10.1
3 Lao PDR -8.8
4 Russian Federation -6.8
5 Guyana -5.2
6 United States -4.1
7 Kazakhstan -4.1
8 Trinidad and Tobago -3.7
9 Dominican Republic -3.6
10 Turkey -3.5

No other G7 country has such a large gap between actual life expectancy and that predicted on the basis of its standard of living and medical expenditures.

The United States is very rich and we spend the most in the world on health care. We have a right to expect more for our money than a life expectancy outcome that places us thirtieth in the world, behind Singapore, Chile, and Costa Rica as well as Australia, New Zealand, Japan, and every Western European nation.

Our health care system certainly delivers innovations in pharmaceutical and other technologies. It leads the world in Nobel Prizes for medicine and physiology. But it does not deliver medical care equitably to all Americans. Those who can pay have access to the best health care in the world. Those with good insurance plans—a decreasing fraction of the population—get good, life-extending health care. The rest must make do. And the result is that enough people fall through the cracks to place us at the bottom of the rich country life expectancy tables.