Alabama is not ranked highly regarding healthcare versus other states. One report has it ranked 48th based on cost, access and outcomes. another study of access, quality and public health has it ranked 45th overall. A third report has it ranked 43rd using the criteria of cost, quality and access. Based on these reports, Alabama’s healthcare needs improvement to just be average for the USA. 

However, another study has come out illustrating that US healthcare is very far from the best in the world. A March 2021 report in JAMA Comparing Health Outcomes of Privileged US Citizens With Those of Average Residents of Other Developed Countries contains some startling information showing that even  better off white citizens of the US (those living in the 5% richest counties) have worse healthcare outcomes versus the average citizen in the 12 other developed nations studied. The conclusion was “even if all US citizens experienced the same health outcomes enjoyed by privileged White US citizens, US health indicators would still lag behind those in many other countries.” 

At the same time, our expenditures per capita were much higher than any other nation. The United States spent $10,948 per capita in 2019. The average OECD nation spent $4,224.  France, with what many say is the best healthcare system, only spent $5,274 per capita. Italy spends $3,819, about the average for an EU nation, every one of which has health insurance coverage for all of their citizens. 

Other reports show the same problems with our US healthcare. I suppose being 37th is OK for a few Americans, but not for the overwhelming majority of us.  

As is true with some other studies, France is ranked first. We are ranked below less prosperous nations like Greece, Chile and Columbia. But slightly above Slovenia, Cuba, and Croatia. 

The US were ranked not quite as bad on other reports, but still not good. On the 2021 US News analysis, we rank 22nd. And on another 2021 survey, we rank 30th. We are only slightly better than Malaysia and Columbia. 

There have been a number of similar reports with the same sort of findings over the years. The most relevant question is why the US is ranked so low. A United Health Foundation report offers some clues.  

First, there is the rate of uninsured, which is still at over 9% nationally even after the ACA. And for many states and subgroups, it is much higher than that.  

For example, about a third of Latinos in Georgia are uninsured as opposed to a state rate of over 13%, one of the worst in the nation. The national insurance rate is lower for other groups- 14% of those not completing high school are uninsured as well as 19% of Latinos, and 21% of Native Americans nationally. 

Infant mortality is especially high among African Americans, 1% of all black births. So is the maternal mortality rate, which more than double the rate for white mothers. Further, chronic diseases (asthma, cancer, heart, and diabetes) are much more prevalent in the Native American and black communities.  

Life expectancy of black men is only 68 years, compared with an overall US life expectancy of 79 years. And some particular regions, like Appalachia, have higher death rates. Some of this discrepancy can be traced to mental health, drugs and alcohol illnesses. 

What’s the bottom line? As two national experts, Doctors David Himmelstein and Steph Woolhandler, stated- “US society and medical care are bad for almost everyone’s health.” (Health Justice Monitor, 7-8-21)   

We must leave ideology behind us, ignoring the politicians who incorrectly say that “our healthcare system is the envy of the world” (per George W Bush). It’s very clear that both the Alabama healthcare system and the US healthcare system needs major reform. The underlying question is how we go about it.  

In industry, the principle of copying “best practices” is well accepted. We must push for systemic healthcare reform based on the best practices of other nations like France. When that will actually happen is based on the people we elect to state and national office.

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Jack Bernard

Jack Bernard

Jack A Bernard is a retired SVP with a national healthcare corporation. He was Chair of the Jasper County, Ga Board of Commissioners and Republican Party. He was also on the Board of Health for Jasper County and is currently on the Fayette County BOH. Bernard has over 100 columns published annually, primarily in the South.