"America has the best health care system in the world, pure and simple." This ringing endorsement was served up by President Bush in the spring of 2006. It is an expression of national confidence and pride, and has long been an article of faith for many, regardless of political affiliation. "We're No. 1!" is our American mantra. In the arena of health care, however, this gold medal image is shattered by the facts. Compared to other industrialized nations, we are not the best - or even close - when it comes to basic standards of wellness and life expectancy. Despite that, we are by far the most expensive and inefficient.

 

Measures of quality

 

Let's look at a few accepted measures of public health. A country's infant mortality rate is a reflection of the health of its pregnant women and of the quality of care provided for both the women and their infants. While the United States has improved over the past 40 years, it still ranks only 27th among large industrialized nations. Shockingly, the infant mortality rate is climbing for the first time in decades in our Southeastern states. Average life expectancy is arguably the most reliable way to measure the health of a country's citizens. According to the World Health Organization, the average American lives until age 78, only 25th-best among nations. Our average number of years in good health is 69, also 25th among nations - and worse than Slovenia.

 

So repeat after me, "We're No. 25!"

 

One might guess that these other industrialized countries, to get their superior results, spend a lot more money than we do. In fact, they spend substantially less. The United States spends more than $2 trillion annually on health care, the most per capita of any country in the world. Germany, the United Kingdom and Canada, each with lower infant mortality and longer life expectancy, and each with universal coverage, spend roughly half of the U.S. total per citizen. Economist Paul Krugman calls this America's inverse medical miracle.

 

The evidence of a failing U.S. health care system is dramatic. In 2005, despite Medicare for seniors and Medicaid for the poor, 47 million Americans were uninsured the entire year and an additional 35 million for part of the year. The federal Institute of Medicine has determined that lack of insurance is responsible for 18,000 U.S. deaths annually. The same agency, in a study of the quality of care, concluded that "between what we know and what we do lies not just a gap, but a chasm." Institute officials estimate that at least 44,000 Americans die every year from medical errors. The National Committee on Quality Assurance estimates that an additional 57,000 Americans die each year because of "inappropriate" care - for example, inadequate treatment of hypertension or elevated cholesterol. If you combine the estimated annual deaths from lack of insurance, medical errors and inappropriate treatment, they are equivalent to a Sept. 11, 2001, disaster every nine days.

 

Crushing debt

 

While not as wrenching as the flesh-and-blood consequences of our health care crisis, the financial impact is profound. Uninsured and under-insured middle-class families often experience crushing hospital bills, which are responsible for half the country's personal bankruptcies. There is one bankruptcy filing due to medical debt every 30 seconds. America's employers, the principal purchasers of health insurance, bear the brunt of spiraling insurance premiums, compromising their profits and competitiveness. At General Motors, the first $1,500 received for every car goes for health care. Many employers are forced to pass ever-increasing portions of premiums on to employees, or to opt out entirely. And there is no end in sight. Recent projections indicate that the nation's health care bill will increase from its current $2 trillion (one-sixth of the gross domestic product) to $4 trillion (one-fifth of GDP) over the next 10 years.

 

There is an urgent need for fundamental change. While the Bush administration is buttressing the status quo with ideologically driven "reforms" such as medical savings accounts and "consumer-directed health care," individual states have taken the lead with authentic legislative efforts. In California, the bill by state Sen. Sheila Kuehl, D-Los Angeles (SB840 - universal coverage, single-payer, and this commentator's preference), and Gov. Arnold Schwarzenegger's plan (universal coverage, multiple-payer with limitations on insurance corporation profits) help define the landscape for real reform that cannot wait. Our country's health - physical and financial - is at stake.