Health Care

The U.S. Economy does Differ from Europe’s: a less regulated labor market, but also an economy that is more hemmed in than might be expected. By European standards, America has hardish-working people, a state that collects fewer tax dollars, and workers who are paid well even if their holidays are short. In social policy, the contrasts are more moderate. Europeans commonly believe that the United States simply has no social policy—no social security, no unemployment benefits, no state pensions, and no assistance for the poor. As Jean-François Revel, the political philosopher and académicien, summed up French criticism, the United States shows “not the slightest bit of social solidarity.” Will Hutton similarly assures us that “The structures that support ordinary peoples’ lives—free health care, quality education, guarantees of reasonable living standards in old age, sickness or unemployment, housing for the disadvantaged— that Europeans take for granted are conspicuous by their absence.” And, in fact, the United States is the only developed nation, unless one counts South Africa, without some form of national health insurance, which is to say a system of requiring all its citizens to be insured in one way or another. This lack of universal health insurance is the one fact that every would-be comparativist working across the Atlantic knows, and the first one to be hoisted as the battle is engaged. One of the first attempts to quantify and rank health care performance, by the World Health Organization in 2000, gave the American system its due. Overall, it came in below any of our comparison countries, three notches under Denmark. In various specific aspects of health policy, it did better. For disability adjusted life expectancy, it came in above Ireland, Denmark, and Portugal; on the responsiveness of the health system, it ranked first; on a composite measure of various indicators summed up as “overall health system attainment,” it ranked above seven Western European countries. Even on the measure of “fairness of financial contribution to health systems,” where we might have expected an abysmal rating, the United States squeaked in above Portugal. That is, of course, damning with faint praise, especially given that in this particular aspect of the ranking—a well-meaning but other-worldly attempt by international bureaucrats to rake the entire globe over the teeth of one comb—Colombia came in first, outpacing its close rivals, Luxembourg and Belgium, while Libya beat out Sweden.