What experts say about who has the world's best health-care system | Opinion

- I want to start
with a simple question. Which country in the world
has the best health care system? - Yeah, so,

I hate that question. Here's where you should ask me

Why do I hate that question? 

- I knew you were gonna start

with that question. I think it's a question

that a lot of people ask -- which country has
the best health care system? - I don't think there's

a correct answer to it. - It depends on what it is

that we value. 

- I'll give you an answer,

but then I'll tell you why the answer

might not be applicable. If you look at the world

health rankings, the country that

France came out on top. I think, in general,

starting from France 

and working northern, you tend to get

the best health care systems. But the reason why it's not

entirely applicable is that what works

in one country may not work in another country. - So, just a few years ago, 

I wrote a piece

in "The New York Times" with my colleague,

Aaron Carroll. We actually did a tournament

of health systems. It was like a bracket tournament

the way March Madness

is a bracket tournament, or a tennis tournament. And we had me and Aaron,

Uwe Reinhardt, Ashish Jha -- 

a physician,

now Dean of Brown -- and Craig Garthwaite --

an economist at Northwestern. And we each voted

in each of the brackets -- in each of the pairings -- for which system

We liked it better. And we ultimately got a winner,

but one of the important 

take-aways

from that whole process is that in no pairing

did any country win 5 to 0. There were five of us, right? We were not unanimous

in any decision. There was always at least

someone who disagreed, and in many cases,

it was 3 to 2. 

And we each had

different reasons. Someone was very big

on the cost, equity, access, or the quality. Look, this is five people

who know health care pretty well and know these systems

pretty well, 

and we couldn't even agree. So, there's just no

clear winner, actually. - But the one thing

that stands out is that among all major developed nations,

it's pretty clear 

that the United States

comes in dead last. - On the other hand,

I think everyone -- especially experts -- should be skeptical

that they know "the" answer. Because what works in

one country or one setting doesn't necessarily

work in another. 

- So, there are aspects

of the Australian system I like. There are aspects

of the English system I like. But I don't think that

there's a system we could just bring over here

and install a new fridge. - So, maybe the better

question is, 

what would the best system

for what the US looks like? - And what would that look like? - So, a good healthcare system

or a good -- Yeah, let's just call it

a health care system. A good healthcare system has,

to me, several attributes. 

One is -- -How does it affect our health
as a country? - How long is it that people

are you living? What is the infant

mortality rate? What is the rate

of certain types of diseases, and how well are they doing

in prevention? 

- And the second question

I'd want to know the answer to is, were the benefits

of the treatment greater than the cost of the treatment? - A bad health care system

could have overspending on care that's of really questionable

health benefit at the same time 

that it has under-spending

on health care that's of vital importance

to people. So, when people say, "Do we

spend too much on health care?" We spend way too much

on some things and way too little on others, so a good system

would fix both problems. 

- And the third dimension

for a health care system is, how well does it reflect
our values as a society? - And by values, I mean -- What are the rich

willing to do for the poor? 

What are the healthy
willing to do for the sick? The answer to that doesn't

I come from economics. It's an answer that

we all have within us. But that answer profoundly

effects how you answer questions 

about what's good and bad

about health care. - And I would hope that,

going forward, as we think about the learnings

from other countries, we can take a hard look

at what it is that we have and whether they align

with our core principles 

that we otherwise hold so dear. - So, my goal is,

have a health system that does the most it can

to improve our health, that protects people

from financial ruin, and that conforms to our values

as a society. 

- So, yeah, that would be the

right thing to do in principle. The next question should be,

Can we get there from here? And I just don't see it. - What we've seen over time

is that the costs of healthcare 

if you look back to 1976 --

-All of these countries -- the US, Germany, Canada --

look similar in terms of what share of GDP

goes to health care. - And people are living about

35 years after age 40. Okay.

- Fast forward 20 years, 

and the US is spending a lot

more of its GDP on health care, and its life expectancy

increases have not kept up with the life expectancy

increases in other countries. - So, the US becomes

increasingly an outlier 

both in terms of outcomes -- that is, life expectancy --

and in terms of spending. - Now, you can put the two

on the same graph, but that doesn't mean

that they're related in any way. I think we're simplifying

the other health care system 

to the point

of getting it totally wrong. But a lot of it depends on

who you're talking to, right? I think there's a view

that some Americans have that, in other systems,

care is terrible. There's very long waiting lines

and waiting lists; 

that the latest

medical technologies are routinely not available. I think for a lot of other

Americans, there's this view

that other countries have just figured it out, and what we should be doing

in the United States is copying what

they've already figured it out. 

And I think both those views

are not right at all. - So, I think people mix up

this term called "socialized medicine" with what I would call

"universal health care." - One is the insurance part --

that is, who runs the insurance. 

And you can have socialized

insurance -- where the government

is running the insurance or private insurance

or private companies, or both -- and then, second, there's

the providers of medical care, who could be either

government-run employees or private employees. - There are some methods

that one could classify 

as being socialized medicine, meaning that the government

is the single payer. The government operates

all the health care, and people belong to

a single government system. - So, Britain has socialized

medicine, 

because the hospitals

are government institutions, and the physicians and nurses

are government employees. - And France has yet a different

kind of a system, also not government-owned. And Switzerland, Netherlands,

Germany -- 

these are places that have

universal health insurance, but they have active

and important private health insurance companies

that administers it. So, very different structures

of these systems. The thing that they share

In common is that they're universal. -

So, I think, coming full circle, 

my great worry with health care

reform in America is that it has collapsed

to the level of fighting and arguing about these slogans, and the slogans have nothing

real behind them. 

- These slogans have become

so politically charged and tied to a particular candidate

or a particular viewpoint that has become

completely partisan and will shut down

constructive debate. - And if you go back to what

I was talking about -- 

how do you evaluate

a good health care system -- you don't evaluate it by the share of government

in the system. You evaluate it

by whether patients want the care that they get and whether the care

The patients get it. 

I think that other countries

have great hospitals, cover a lot

of medical treatments, have fantastic doctors. And at the same time,

they have not figured out a bunch of things

that we have not figured out. So, if you are the kind

of person who's going

without health insurance 

in the United States --

-I hate to say it, but I think they are better off in many other countries

than here in the US. - But for a lot of diseases --

for a lot of people, 

regardless of income --

this is probably the country where you would like
to get your health care.