Ten Reasons Why America's NOT Number One (And Hasn't Been For A Long Time)

"America is number one!"

"U.S.A.!  U.S.A.!  U.S.A.!"

Such pride in a nation is not only common, but expected of every nation's citizens.  The trouble with having the pride blinders on is that we can rarely see beyond the rhetoric of "We're number one!," which makes us further unable to critically view where we actually stand in the rank of nations.

Now of course, I'm not suggesting that we, or any other nation for that matter, change our motto to, "We're number two!"  What nation in the world is okay with believing that they are less than any other nation?  I am instead asking that we begin to look upon our country and its history with a less idealistic eye, and pay more attention to how we can be better, rather than how we're better than everyone else.

This is not something that is unpatriotic - this is an exercise that will help us to realize our assertion that "We're number one" by actually rising to that claim, and proving that we mean what we say, that we live up to our promises, and that everyone in the country is treated equally, rather than continuing to pretend that we haven't created a class system based not on birth, but on income over the past 40 years.

Over the next week, or so, I will be enumerating these reasons, starting today with Number 10 - Our Healthcare System is Pretty Shitty.

If we want some good places to start, let's look at a few recent studies concerning the comparison of difference trends between the largest industrialized nations in the world:

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10.)  What we believe:  "America provides the most innovative and effective healthcare in the world!"

What's the reality?:  We are nowhere NEAR being the best by either of those measurements.

Efficacy in terms of health is generally measured by three factors - (a.) The per capita cost of healthcare; (b.) The incidence of preventable illnesses/long-term or chronic health conditions; (c.) The overall quality and effectiveness in comparison to other developed nations.

a.)  The per capita cost of healthcare is, perhaps, the easiest metric by which industrialized member nations of the Organization for Economic Cooperation and Development (OECD) can be most easily compared.  The OECD tracks and reports on more than 1,200 health system measures across 34 industrialized nations.  From the report from The Commonwealth Fund:


"This analysis concentrated on 2010 OECD health data for Australia, Canada, Denmark, France,
Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom,
and the United States. Health care spending in the U.S. towers over the other countries. The
U.S. has fewer hospital beds and physicians, and sees fewer hospital and physician visits, than
in most other countries. Prescription drug utilization, prices, and spending all appear to be
highest in the U.S., as does the supply, utilization, and price of diagnostic imaging. U.S. performance on a limited set of quality measures is variable, ranking highly on five-year cancer
survival, middling on in-hospital case-specific mortality, and poorly on hospital admissions for
chronic conditions and amputations due to diabetes."

By nearly every single comparison, the U.S. ranks at or near the bottom out of the top twelve industrialized nations in the OECD.  Despite this information being both empirically and quantifiably factual (read: TRUE), those who argue against other healthcare models continue to insist that our "free-market approach" to healthcare is working out great for us.

This goes beyond exhibiting "national pride," and proudly marches into the territory of "willful ignorance and stupidity."

Here are some easy-to-read charts from this report that clearly show how poorly the U.S. compares to other nations:

b.)  The incidence of preventable disease in the U.S. is higher than nearly every other nation in the world, and yet we still claim that our approach is working.  This high rate of incidence is likely the result of our problem with access to affordable care.  If every visit to a doctor costs more than half of your monthly rent/mortgage, how likely are you to deal with your health issues head on?

The reality of our situation is that Americans are the fattest people on the planet, and now we have the National Association for the Advancement of Fat Acceptance because fat people are tired of being persecuted and ridiculed for having a problem that is largely preventable, and then complaining that the world hasn't expanded in an effort to accomodate their often self-inflicted condition.

This is not to say that all fat people are fat because they just can't control themselves from being lazy or from overeating.  There are exceptions for those whose internal genetic issues render them unable to control their weight.  However...this is, by far and wide, not the case, and if it were, we would have generations of fat people dating back to the founding of our nation.  We do not.

Closely linked to our nation's high prevalence of adult and childhood obesity are the issues of heart disease, diabetes, and chronic pain.  Being obese generally comes paired with one or more of these conditions, along with a host of other serious medical issues that are largely preventable.  While these issues are not always the result of obesity, once again the majority of cases of these diseases are present in those who qualify as obese.

Here are a few charts providing comparative information between nations:

c.)  The overall efficacy and quality of health care in the U.S. ranks from poorest to middling when compared to other industrialized nations.  Despite spending nearly double the amount per capita than any other nation in the world, we rarely see those funds reflected in the results of said treatment.  Our healthcare model is mired in several issues, all of which go to negatively impact the cost and perceived quality and efficacy of our system.

Needless/Repeated/Extraneous testings and screenings are frequently employed as a manner that we're told is an "effective approach" to catching, controlling, and preventing the spread of disease...except for the fact that, with the sole exception of cancer survival rates, we rank far worst at preventing, treating, and curing those diseases.  The more likely purpose of forcing patients to undergo these tests and screenings is to drive up the cost of their visit, resulting in more payouts from insurance companies or out-of-pocket expenses.  Unfortunately, these procedures are accompanied by a suspiciously higher cost than in any other nation in the world - primarily because that's what insurance companies believe they should have to pay.

So, basically, our nation's "free-market approach" to healthcare actually results in fewer choices (due to cost), worse results, and long wait times for care.

Here is an overall ranking chart:

Overall, we're not "number one!"  We're not even in the top ten.  In order for us to get to "number one," we need to fundamentally reevaluate our concept of healthcare, and reexamine our belief that a free-market approach to healthcare is the best model for our nation's renewed success.  Capitalism has no place in the health market, and to those who believe it does, there's a large part of me that wishes an incurable, chronic illness upon them, along with a massive drop in income, so that they can learn how that approach to healthcare really affects "real Americans."

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Number 9 will address our issues with taxes, both individual and corporate, and how certain people in this debate obfuscate the difference between "established rates" and "what is actually paid."  Until then, if you can afford it, go to the doctor long enough to tell his collections people to go "fucking shove it!"