10. U.S. Healthcare: Best in the World?

The United States spends more on medical care per capita than any other nation, by a wide margin. Does that mean that it has the healthiest population, measured by results?

No. The United States is clearly pre-eminent in cutting-edge medical research, in health-related technology, and in the quality of medical facilities. But in terms of life expectancy -- surely a critical measure of healthcare --it is 46th in the world in the latest UN Population Division ranking.

This is on a par with Estonia and Panama, and just below life expectancy in Cuba, which spends on healthcare less than ten percent as much, per capita, as the United States.

Don't trust life expectancy as a reliable measure of healthcare? The World Population Review has a more sophisticated index that adds in other measures such as preventive care and the patient experience. By this account the U.S. ranking improves slightly, but only slightly, to 37th.

For the many Israeli readers of this post, where does Israel come in? In comparison to the United States, Israel's performance is remarkably consistent. Healthcare spending per capita is 26th in the world, at 26 percent of U.S. expenditures, and the quality of healthcare in the World Population Review is ranked 28th. Israelis, apparently, get more or less what they pay for.

But Americans do not. How do the experts (I am not an expert) explain this? Well, there are some factors that have nothing to do with how healthcare is organized. Americans led the developed world in smoking until the 1970s, and that is still playing itself out decades later. They also take the lead in obesity, homicides, opioid overdoses, and road accidents. All this adds up.

But the United States also has striking inequality and poverty for a developed nation. A significant part of the population has limited access to the excellent facilities available. This is expressed in such facts as an embarrassing rate of infant mortality -- something that definitely lowers average lifespan.

Of the 37 nations in the Organization for Economic Cooperation and Development -- the club of developed nations -- all but one have universal healthcare coverage by one system or another. It might be a "single payer" system, or universal public insurance, or a combined public-private system, or a universal private insurance system (as in Israel). But everyone is covered.

Except in one nation.