Nick McClary (copy) (copy)

Nick McClary

Over the past two columns, I’ve reviewed a recent study covering the United States health care system. While health care can become divisive and political very quickly, my aim has been to provide an unbiased perspective of objective scientific evidence.

For those who haven’t read the previous two articles, I’d highly recommend checking them out on For a quick recap, the study we’re covering was published in 2018 in the Journal of the American Medical Association. The study compared the U.S. health care system in terms of costs, outcomes, structure, and more to 10 other developed, high-income countries. So, what were the findings?

While many Americans will proudly pronounce U.S. health care as the best in the world, the study found quite the opposite. Compared to other high-income countries, the U.S. spends nearly double per person on health care than the next closest country, and we have the WORST population health outcomes. That’s right. The U.S. ranked dead last in every health outcome except for two in the study (one of which we were second to last) despite spending nearly twice as much on health care. These health outcomes included things such as life expectancy, quality adjusted life expectancy, infant mortality (death rate), maternal mortality, and more.

I previously described three reasons why we spend so much more. First, we spend far more on administrative costs than other countries (8 percent versus 1 to 3 percent in the other studied countries). Second, we spend twice as much for the same pharmaceuticals as other countries. And lastly, doctors and nurses simply make more in the U.S. than in other countries. It’s not fair to say that they should make less, however, because other countries have more extensive social programs that cover education, health care, and more, which makes it hard to draw exact comparisons regarding pay.

Since we’ve covered the three areas of significant various costs in U.S. health care compared to other high-income countries, let’s now look at why we have some of the poorest outcomes.

The first thing that stands out is our population health insurance rate. All other countries in the study had an insurance rate of 99.8 percent or higher. Seven of the 20 had 100 percent of their population covered. The U.S. only had 90 percent. All other countries had mandatory or compulsory national health insurance requirements, meaning some countries require health care by law while others require a steep penalty (much steeper than Obamacare originally set) if you do not have coverage.

While we can assume that the 10 percent who were uninsured likely went without needed health care at some point during the study period, that doesn’t tell the whole story. The U.S. also led all countries in “unmet need” metrics such as missing a health care appointment because of cost. In addition to the uninsured population, there’s a high percentage of under-insured people in the U.S. who can’t afford their health care despite having insurance.

While not related directly to outcomes, it’s also interesting to note that the U.S. population had the least confidence in the health care system. When asked if their respective health care system “works well,” 60 percent of Germans surveyed agreed with that statement. Canada was the second lowest country at 35 percent. Of course, the U.S. was dead last at 19 percent. However, 55 percent of Canadians surveyed felt “fundamental changes” were needed to their health care system while 53 percent of Americans surveyed felt that way about ours.

Now, it’s also important to point out that the U.S. population is different than in other countries. The U.S. had the highest percentage of overweight people at 70.1 percent. However, Australia, the U.K., and Canada were all right behind the U.S. with 60 percent or greater of their respective populations being overweight. On the other hand, the U.S. had the second lowest smoking rate and was in the lower half of alcohol consumption, both of which swing in favor of the U.S. having better health. Yet the U.S. still ranked dead last on the majority of health outcomes.

Whether you agree with it, it appears the current system of the U.S. is simply outperformed on a population level by the other high-income countries with universal health coverage and single payer systems. However, does that mean the U.S. doesn’t have the best health care in the world? Well, it all depends on your perspective and who you are. Or perhaps more accurately put, it depends on how much money you have. Check back at my next column as I give my concluding thoughts on this study.

Nick McClary earned his doctor of physical therapy from the University of Tennessee. He also holds a masters in business administration. He was born and raised in Georgetown, lives in Pawleys Island, and works in Murrells Inlet. Send him your health and fitness questions at: