America fares badly in a comparison of health measures in rich countries

IT IS hardly news that America spends more on health care than any other country. Nor is it news that this money fails to make Americans healthy. But a new report from America’s Institute of Medicine and National Research Council illuminates the many ways in which America’s health lags that of other rich countries and tries to explain why. Health spending reached $2.7 trillion in 2011, equal to 17.9% of America’s GDP (and more than the entire GDP of Britain). Yet America performs poorly on nearly every measure. Life expectancy has risen, but not as quickly as among America’s peers. In a ranking of 17 rich countries, America’s death rate from non-communicable diseases is higher than any country except Denmark.

The statistics are particularly bleak for the young. America has the highest infant-mortality rate of the 17 rich countries examined. Its teenagers are more likely to become pregnant or die from a car accident or violence. Shockingly, deaths among under-50s account for roughly two-thirds of the gap in life expectancy between American men and those in comparable countries. The old fare better. If an American is lucky enough to reach 75, he can expect to live longer than his peers elsewhere.

America is obviously doing something wrong. But what, exactly? That is the $2.7 trillion question. The report offers a few tentative answers. The structure of America’s health system is partly to blame. Different types of care are siloed, which is inefficient. Doctors are paid for providing lots of services, rather than keeping patients well. There are fewer general practitioners. More citizens lack insurance and more find care unaffordable. The gap might also be explained by behaviour. Americans may smoke and drink less than people in other countries, but they tend to eat more, take more drugs, own more guns and are more often in drunk-driving accidents. They have sex younger, with more partners, using protection less frequently. But circumstance and behaviour cannot explain all. Interestingly, even rich, insured, non-smoking, normal-weight Americans are less healthy than adults with similar traits in similar countries.

How all these factors relate to one another is difficult to untangle. Even harder is getting politicians to agree on which problem to tackle first. Barack Obama’s health reforms, which will take full effect in 2014, expand insurance and start to tweak doctors’ perverse incentives. This new report is a reminder of how much is left to be done.