In the last video, we talked about the comparison of education between the United States and comparable OECD countries, and in this video, we're going to do the same comparison looking at health care. The differences are actually much darker looking at healthcare. So when we take a look at health care, we'll see here that health care costs have been growing for both the OECD nations and the United States from 1970 until 2017, and we have some projections of the US beyond 2017 that we don't have for the OECD. In 1970, the OECD was spending about 4.8 percent of its GDP of everything is spent in the country, on health care and the US was spending just about 6 percent. But as time has gone on, the US healthcare costs have risen much more rapidly than have OECD health care costs. So now, the OECD is spending about 10 percent of GDP and the US is spending about 17 percent of GDP on healthcare. So we are spending substantially more than other nations. So you've seen a slide like this before, and this is comparing OECD nations and their health care expenditure per person in 2017. So I've highlighted Poland here which is spending about $2,000 per person, the United Kingdom which is spending about 4.2, Canada which is spending about 4.8, 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.
