Germany that is spending about 5.8,
but then we have the United States off
here in quite a different category,
spending roughly $12,000 per person.
So the US, this expenditure rate
is quite consistent across countries and across time.
So what are we getting for this additional expenditure?
Well, one of this couple of standard measures of
health well-being or life expectancy at birth,
and here the yellow line is
the OECD average and the red line is the US average,
and overtime life expectancy has been growing from 70,
just over 70 to almost 80
but it has consistently been lower in the United States.
Another very standard international measure of
health is infant mortality.
So what we're measuring here is
the conditions of children as they're growing,
and you can see here that infant mortality has been
falling for both the OECD countries
and the United States,
but here it's been consistently higher.
So now, let's move to some better news.
This one is cancer deaths per
100,000 people and you can see here
that the US has had
much lower cancer deaths per 100,000 people,
225 in 1970 and it gets down to about 182 by 2015.
So in our cancer management,
we've actually done better.
In coronary heart disease,
we started off doing considerably
worse than the OECD nations.
This probably had to do with the level of smoking in
the US and also our diet but we
have been fixing that over time and so we're converging
with the OECD here at
a fairly similar level of coronary heart disease.
This is really an outstanding slide
about the place of diabetes.
The US has substantially higher diabetes rates per
100,000 people than does the OECD nations,
and our rates are not falling as fast.
So here with a treatable disease largely
having to do with diet and exercise,
we're not doing nearly as well.
But for respiratory disease,
we were doing not so well compared to
the OECD and now we have surpassed the OECD.
So it's a mixed story,
to some extent the US is falling
behind especially in
these more general public health measures,
but in some of the specific disease measures,
it is at least catching up
and in some cases farther ahead.
So the US spends a lot more than other nations and why?
Well, we spend much more on research and
development than other nations,
we have many more labs, we develop treatments.
This is a major expense
in the United States and it's really
an American contribution to the whole world,
because as we find treatments for diseases,
these are used everywhere else.
We have very high medical malpractice costs and this
involves the cost of actually the insurance doctors buy,
it involves also but mostly,
the additional testing and procedures that have to
be done to defend against medical malpractice suits.
This is one way of regulating health care.
In other nations, it's typically done by fining and
removing doctors' licenses but
not by big malpractice settlements.
So in the United States, doctors and nurses,
and medical professionals earn substantially
more than they do in the other OECD countries,
it's a more lucrative profession
and if they're earning more,
we have to pay more and so that's
going to increase the cost of our health care.
By and large, most Americans think that
the quality of the treatment
we get is worth spending more.
Our system has very high administrative costs and
that is because we have all of
these different billing directions.
So you have insurance companies
with administration costs,
you have doctors offices,
you have hospitals, you have the federal government,
all trying to figure out who's responsible and who pays.
If you go into a Canadian doctor's office,
there'll be three doctors and one secretary.
You go into an American doctor's office,
and there's three doctors, a secretary,
and four people figuring out the insurance.
So this administrative cost that come from
multiple funders is pretty substantial.
Finally, we have higher poverty.
As a result of higher poverty,
we have higher levels of certain kinds of
diseases and diabetes is certainly one of those.
So these are choices that we've
seen as we've been talking through
the comparative situation and that
cause US health care to be much more expensive.
So overall, we would say that
US health care is not particularly the best in the world.
In fact, the World Health Organization
ranked it number 23 in 2009.
The criteria here is that we have
many more uninsured people.
So in 2013 before the Affordable Care Act,
we had 42 million uninsured people,
13 percent of the population and by the time we got
to 2015 with the passage of the Affordable Care Act,
we got this number down to 29 million,
9.1 percent, and this is
something of a change in the direction of our healthcare.
We have lower life expectancy,
we have higher number of low birth weight babies,
we have more premature baby mortality
from treatable illnesses.
All of these are pieces of what causes
our health care system to look
different than others in the world.
We'll come back later in a later course and
talk in more detail about our choices around health care.
So I want to introduce to
you a guest lecture who will be coming next,
Dr. Heidi Allen will be talking
about the cost of being uninsured in America.
This is a TED Med talk and so it's an interesting format.
So what comes next is Dr. Allen
talking about the cost of being uninsured in America.
