The Affordable Care Act is merely a small step in the direction of universal healthcare. One need only look at the data on life expectancy among Americans to realize how badly health care reform is needed in the United States. People in much of Europe are, on the whole, outliving residents of the U.S., which in some places, is looking more and more like a Third World country when it comes to life expectancy.

There is a considerable amount of data on life expectancy among Americans, much of it disturbing. According to the World Health Organization, the U.S. lags behind a long list of countries when it comes to overall life expectancy. WHO has reported that the U.S., factoring in both genders, has an overall life expectancy of 79 (76 for males, 81 for females) compared to 83 in Japan and Switzerland, 82 in France, Iceland, Spain, Italy, Australia, Canada, Israel, Luxembourg, Singapore and Sweden, 81 in Germany, the Netherlands, Austria, New Zealand, Finland, South Korea, the Republic of Ireland and Norway, and 80 in Belgium, Slovenia, the U.K., Malta, Kuwait and Portugal.

Those WHO figures for the U.S. take into account the country as a whole, and overall, Americans clearly aren’t living as long as Europeans. But the news becomes even more troubling when one examines a report that the Institute of Health Metrics and Evaluation at the University of Washington released in July 2013. That study broke down life expectancy for men and women in different parts of the U.S., showing a strong correlation between income levels and longevity. The report found that life expectancy is 81.6 for males and 84.5 for females in Fairfax County, Virginia (a very affluent area) and 81.4 for males and 85.0 for females in Marin County, California (another upscale area) compared to only 63.9 for males and 72.9 for females in McDowell County, West Virginia or 66.7 for males and 73.3 for females in Tunica County, Mississippi.

The fact that males in McDowell County are, on average, dying 18 years younger than males in Fairfax County or Marin County speaks volumes about inequality in the U.S. That type of disparity is more typical of a developing country than a developed country. Yet when one compares life expectancy in McDowell County to life expectancy in Guatemala, one of Latin America’s poorest countries, Guatemalans come out slightly ahead. WHO has reported an overall life expectancy of 69 for Guatemala (66 for men, 73 for women).

So in other words, the poor in Guatemala are outliving the poor in McDowell County. In fact, McDowell County is only slightly ahead of Haiti, Ghana and Papua New Guinea when it comes to life expectancy for males: according to WHO, life expectancy for males is 62 in those three countries.