Health Care

Life expectancy in the United States has seen a “historic decline” since 2015, the biggest decrease in a century, partly due to the opioid crisis and party due to the COVID pandemic. In 2019, before the pandemic, life expectancy in the United States was 78.85 years; in 2020, in decreased to 76.98 years, and in 2021 decreased again to 76.44 years. Altogether, there was a net loss of life expectancy of 2.41 years. Hit the hardest during the pandemic were Hispanic, Black, Native American, and Asian populations. But in 2021, the largest decreases occurred in non-Hispanic white population.

Jessica Y. Ho found that “life expectancy in the United States lags well behind that of other high-income countries,” dropping from near the middle in the 1980s to near the bottom in the mid-2000s. Her study found that American men lived 5.18 years lower and American women lived 5.82 years lower than their peers in the world’s high-income countries. Young Americans, ages 25-29, have experienced death rates three times their counterparts.

In their study of early deaths in America, titled “Missing Americans,” Jacob Bor and his colleagues note that 1 million US deaths in 2020 and another 1.1 million US deaths in 2021 “would have been averted if the United States had the mortality rates of other wealthy nations.” They note that the number of excess US deaths relative to its peers is “unprecedented in modern times.”

In 2006, a report called the Eight Americas study examined the health inequities in the United States by separating out and analyzing eight distinct groups based on race, urbanicity, geography, income per capita, and homicide rates. In a November 2024 study, the Eight Americas groups were expanded to ten. The authors of the new study found the disparities “truly alarming,” with over a twenty-year gap in life expectancy between the highest group (Asian Americans, who lived an average of 84 years) and the lowest (American Indian and Alaska Native persons, who lived an average of 63.6 years). One of the lead authors, Christopher J.L. Murray, stated that "These disparities reflect the unequal and unjust distribution of resources and opportunities that have profound consequences on well-being and longevity, especially in marginalized populations."

What countries do better in life expectancy? First is Japan, with a life expectancy of 84.45 years; in second place is Switzerland (83.85); then South Korea (83.53), Australia (83.30), and Spain (83.18). The United States comes in 27th with an average life expectancy of 76.33.

Sources: Claire Klobucista, “US Life Expectancy Is in Decline. Why Aren’t Other Countries Suffering the Same Problem?” Council on Foreign Relations (September 8, 2022), https://www.cfr.org/in-brief/us-life-expectancy-decline-why-arent-other-countries-suffering-same-problem#:~:text=U.S.%20life%20expectancy%20was%20slightly,States%20have%20higher%20life%20expectancie. Ryan K. Masters, Laudan Y. Aron, and Steven H. Woolf, “Changes in Life Expectancy Between 2019 and 2021 in the United States and 21 Peer Countries,” MedRxiv, June 1, 2021, https://www.medrxiv.org/content/10.1101/2022.04.05.22273393v4. Jessica Y. Ho, “Causes of America’s Lagging Life Expectancy: An International Comparative Perspective,” Journals of Gerontology: SOCIAL SCIENCES, 2022 77 (S2), https://academic.oup.com/psychsocgerontology/article/77/Supplement_2/S117/6533432. Jacob Bor, Andrew Stokes, Julia Raifman, Atheendar Venkataramani, Mary T. Bassett, David Himmelstein, and Steffie Woolhandler, “Missing Americans: Early Death in the United States—1933-2021,” PNAS Nexus 2 (6) (June 2023), https://doi.org/10.1093/pnasnexus/pgad173. Laura Dwyer-Lindgren, Mathew M. Bauman, Zuochen Li, Yikaterina O. Kelly, Chris Schmidt, Chloe Searchinger, et al., “Ten Americas: A Systematic Analysis of Life Expectancy Disparities in the USA,” The Lancet, November 21, 2024, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01495-8/fulltext. The ten Americas are defined as: “America 1—Asian individuals; America 2—Latino individuals in other counties; America 3—White (majority), Asian, and American Indian or Alaska Native (AIAN) individuals in other counties; America 4—White individuals in non-metropolitan and low-income Northlands; America 5—Latino individuals in the Southwest; America 6—Black individuals in other counties; America 7—Black individuals in highly segregated metropolitan areas; America 8—White individuals in low-income Appalachia and Lower Mississippi Valley; America 9—Black individuals in the non-metropolitan and low-income South; and America 10—AIAN individuals in the West.” Murray quoted in Sara Moniuszko, “Life Expectancy Gap in US Widens to 20 Years Due to ‘Truly Alarming’ Health Disparities, Researchers Say,” CBS News, November 21, 2024, https://www.cbsnews.com/news/life-expectancy-gap-20-years/. “Life Expectancy at Birth, Total Years,” World Bank, https://data.worldbank.org/indicator/SP.DYN.LE00.IN).

In 2021, CEOWorld magazine published The Healthcare Index which looked at the overall quality of healthcare, ranking countries according to their health infrastructure, healthcare professionals, costs, availability, and government readiness (such as imposing penalties on risks such as tobacco use and obesity). Altogether, eighty-nine countries were ranked. The Index measured health infrastructure, professionals, cost, medicine availability, and government readiness to support healthcare.

The study determined that South Korea had the highest level of quality healthcare, scoring 78.72 (out of 100) in its Index. Second was Taiwan (77.70), Denmark (74.11), Austria (71.32), Japan (70.73), Australia (67.99), and France (65.38).

The United States came in 30th, with an overall quality healthcare score of 45.62.

Source: Sophie Ireland, “Revealed: Countries with the Best Healthcare Systems,” CEO World, April 27, 2021, https://ceoworld.biz/2021/04/27/revealed-countries-with-the-best-health-care-systems-2021/

The United States can rightly boast of having some of the finest hospitals, doctors, and specialty care facilities in the world; but at the same time, many rural hospitals in America have been forced to close, leading to a crisis in rural healthcare access. In 2021, Newsweek magazine and Statista compiled a list of the best specialized hospitals in the world. American hospitals garnered high marks in each of the specializations of cardiology, oncology, endocrinology, neurology, gastroenterology, and orthopedics. In the field of cardiology, for example, eight of the top ten hospitals were in the United States; American hospitals also ranked high in the other specialized fields of medicine.

At the other end of the spectrum are rural hospitals, many of which are in critical financial straits; and without federal or state assistance many will have closed their doors. The Center for Healthcare Quality and Payment Reform, a national healthcare policy organization, noted that more than 100 rural hospitals had closed over the past decade, 200 more are at immediate risk of closure, and that more than 600 additional rural hospitals (30 percent of all rural hospitals) are in precarious financial conditions. This is the dilemma for millions of Americans who live in rural areas: even if they have insurance to pay for medical care, their communities cannot provide the healthcare they need. These hospitals lose money delivering services to patients, and, especially in states withdrawing patients from Medicaid eligibility, the financial difficulties become even more challenging.

Another major concern, no matter where in the country, is the growing shortage of physicians. In October 2023, Jesse M. Ehrenfeld, president of the American Medical Association, warned that “there is an insidious crisis going on in medicine today that is having a profound impact on our ability to care for patients, and yet isn’t receiving the attention it deserves. This crisis is physician burnout.” Physicians everywhere, in every part of the country and every medical specialty, Ehrenfeld noted, “continue to carry tremendous burdens that have us frustrated, burned out, abandoning hope. . . and in increasingly worrying numbers, turning our backs on the profession we’ve dedicated our lives to.” The American Association of Medical Colleges has projected a national physician shortfall over the next decade of at least 37,000, perhaps even 100,000. Covid burnout, the administrative and bureaucratic health care system drowning physicians in paperwork, the attack on science undermining the trust in physicians, the government intrusion into health care decision and aggressive efforts to criminalize health care, the widening healthcare disparities suffered by marginalize communities, the increases in gun violence and drug overdoses, and the shrinking Medicare reimbursement that has pushed many small, independent medical practices to the brink of financial collapse—all these have contributed to the loss of doctors and the consequent repercussions for millions of patients.

Ehrenfeld noted that some 83 million Americans do not have sufficient access to primary care physicians; 90 percent of counties in the US do not have access to pediatric ophthalmologists, 80 percent of counties do not have infectious disease specialists, and “more than 30 percent of Black Americans live in cardiac deserts.”

Sources: “World’s Best Specialized Hospitals,” Newsweek, n.d., https://www.newsweek.com/worlds-best-specialized-hospitals-2021. Cardiology, hospitals and world ranking: Cleveland Clinic, Ohio (1); Mayo Clinic-Rochester, Minnesota (2); Brigham and Women’s Hospital, Massachusetts (3); Massachusetts General Hospital, Massachusetts (4); Mount Sinai Hospital, New York (5); The Johns Hopkins Hospital, Maryland (6); Cedars-Sinai Medical Center, California (7), New York-Presbyterian Hospital-Columbia and Cornell (8).Oncology, hospitals and world ranking: MD Anderson Cancer Center, Texas (1); Memorial Sloan Kettering Cancer Center, New York (2); Dana-Farber Cancer Institute, Massachusetts (3); Mayo Clinic-Rochester, Minnesota (4); The Johns Hopkins Hospital, Maryland (8). Endocrinology, hospitals and world ranking: Mayo Clinic-Rochester, Minnesota (1); Cleveland Clinic, Ohio (2); Massachusetts General Hospital, Massachusetts (3); Johns Hopkins Hospital, Maryland (5); Brigham and Women’s Hospital, Massachusetts (10). Neurology, hospitals and world ranking: Mayo Clinic-Rochester, Minnesota (1); Massachusetts General Hospital, Massachusetts (5); Cleveland Clinic, Ohio (7); The Johns Hopkins Hospital, Maryland (9). Gastroenterology, hospitals and world ranking: Mayo Clinic-Rochester, Minnesota (1); Mount Sinai Hospital, New York (2); Massachusetts General Hospital, Massachusetts (4); The Johns Hopkins Hospital, Maryland (9). Orthopedics, hospitals and world ranking: Hospital for Special Surgery, New York (1); Mayo Clinic-Rochester, Minnesota (2); The Johns Hopkins Hospital, Maryland (7); and Massachusetts General Hospital, Massachusetts (8).

“The Crisis in Rural Healthcare,” Saving Rural Hospitals, n.d., http://ruralhospitals.chqpr.org;Press Release, “AMA President Sounds Alarm on National Physician Shortage,” American Medical Association, October 25, 2023, https://www.ama-assn.org/press-center/press-releases/ama-president-sounds-alarm-national-physician-shortage.

Every member country of the OECD has a system of national health care, except the United States. The programs vary widely, some relying on market mechanism to provide medical services while others rely mostly on public provision of services and public insurance. Here are how the OECD countries break out.

Reliance on private insurance and market mechanisms:

• --Germany, Netherlands, Slovak Republic, and Switzerland rely on private insurance for basic health care coverage.

• --Australia, Belgium, Canada, and France use public insurance for basic health coverage and permit private insurance beyond basic coverage.

• --Austria, Czech Republic, Greece, Japan, Korea, and Luxembourg use public insurance for basic health coverage but permit little private insurance.

• Mostly public insurance and public provision of medical services:

• --Iceland, Sweden, and Turkey have no gate-keeping and ample choice of providers for users.

• --Denmark, Finland, Mexico, Portugal, and Spain have limited choice for providers and soft budget constraints.

• --Hungary, Ireland, Italy, New Zealand, Norway, Poland, and the United Kingdom have ample choice of providers and strict budget constraints.

Source: Health Care Systems: Efficiency and Policy Settings, OECD (2010), 15, https://www.oecd.org/economy/growth/46508800.pdf