Paul Hipp has penned this little diddy celebrating the fact that the World Health Organization ranks the US healthcare system the 37th best in the world.  His lyrics are below the fold.

The United States devotes 17.6% of its GDP to healthcare. And we fail to cover some 47 million people making the US the only OECD country that does not even attempt to cover everyone. Mexico and Turkey aim for universal coverage but have yet to achieve it. On average, OECD nations spend $2,964 per person and 8.9% of GDP. In the US in 2007, we spent $7,290 per person. The next highest dollar spending (normalized for purchasing power parity) was in Norway, which spent $4,763 per person, in Switzerland spending $4,417 per person, in Luxembourg at $4,162 per person, and in Canada $3,895 per person. You can access the OECD Health Data for 2009 for a complete overview.

Beyond the fact that US simply spends more, the life metrics are inferior not just to OECD nations but to even some middle income countries. The United States is ranked 26th in infant mortality among industrialized nations but that's an overall number. While infant mortality is 6.7 deaths per thousand live births in the US in 2006, for African-Americans the rate 13.7 deaths per thousand live births. The infant mortality rate among blacks is actually rising in 16 states. Meanwhile a country like Brazil has reduced infant mortality by more than half between 1990 and 2006, from 48 deaths per thousand live births to 19.

In the United States, life expectancy at birth increased by 8.2 years between 1960 and 2006, which is less than the increase of almost 15 years in Japan, or 9.4 years in Canada. In 2006, life expectancy in the United States stood at 78.1 years, almost one year below the OECD average of 79.0 years. Japan, Switzerland and Australia were the three countries with the highest life expectancy. Costa Rica, a middle-income country, now has a life expectancy of 78.8 years. We are clearly not number one in life metrics. The only top ranking that we achieve is in the category of medical bankruptcies. In France, the number of medical bankruptcies is zero. In the US, over two million Americans annually file for bankruptcy because of medical bills. From Physicians for a National Health Program:

1. Illness and medical bills were linked to at least 62.1% of all personal bankruptcies in 2007. Based on the current bankruptcy filing rate, medical bankruptcies will total 866,000 and involve 2.346 million Americans this year – about one person every 15 seconds.

2. Most medically bankrupt families were middle class before they suffered financial setbacks. 60.3% of them had attended college and 66.4% had owned a home; 20% of families included a military veteran or active-duty soldier.

3. 78% of the individuals whose illness led to bankruptcy had health insurance at the onset of the bankrupting illness; 60% had private insurance.

4. 69% of debtor families had coverage at the time of their bankruptcy filing; 60% of families had continuous coverage.

Clearly, we are doing something wrong.

The WHO ranks the healthcare system in my native Colombia as the 22nd best in the world. Colombia spends 5.5% of its GDP on healthcare. Our current system dates to 1993 and believe it or not, the decision to implement it was spurred in part by the then on-going debate in the United States and by a collective decision to make universal basic healthcare a right guaranteed in the Colombian Constitution. Prior to 1993 Colombia had health insurance for about a fifth of the country with the rest of the country accessing the Instituto de Seguro Social (ISS) that ran a series of overburdened public hospitals and clinics.

Passage of Ley 100 (Law 100) in 1993 created a new system, modeled on the principle of managed competition. Ley 100 created two separate insurance programs and set forth the goal of universal coverage. The Contributory Regime (régimen contributivo ) is for the formal sector and self-employed workers, and is financed by employer and employee contributions. The employer pays about two-thirds of the cost and the employee the balance but no more than 12% of his or her salary. The Contributory Regime now covers about 65% of the population. The Subsidized Regime (el régimen subsidiado), a social insurance scheme, is for the poor and it is publicly financed. Enrollment in the subsidized health system means that the cost of health care is partially covered, on a sliding scale depending on one's level.  Those at Level Zero do not pay to see a doctor. As of 2008, insurance coverage either through the Contributory Regime or through the Subsidized Regime is at 90%. What the Colombian experience demonstrates that a social insurance approach (i.e. a public option) can close the gap and achieve universal coverage.

The aim is to cover everyone but services continue to lag in rural areas. Because the subsidized health care system does not have the capacity to meet demand, a third system has developed for those who are "linked" (vinculados) to the subsidized health care system but are not part of it. The vinculados are the approximate 5 million Colombians (Colombia has a population of 45 million) that are outside the system. The Uribe government has committed itself to achieving universal healthcare coverage by the time it leaves office in August 2010. It is doubtful that their target will be met.

Consumers choose from a set of health plans which act as purchasers for enrollees. Because the Colombian government mandated a strict benefit package (with an emphasis on primary and preventative care) for each insurance company to provide, competition in the sector is based mostly on quality and not on price. Colombia became the first middle-income nation that adopted the managed competition strategy to reform its health care system. The system is by no means perfect but there has been a vast expansion of healthcare services.  The International Development Research Centre found that "the main achievements of the Colombian health system reform has been an overall increase in health insurance coverage, resulting in improved equity, with significantly lower urban-rural and socioeconomic differentials and better targeting of subsidies to the poor."

When I reflect on the differences between my native land and my adopted one, I find that in Colombia we are actually trying to do much with little while here in the United States, a far wealthier country, there is a segment of the population that seems to view healthcare as a privilege for some. We have learned in Colombia that markets don't create fair access. Only the state can ensure reasonable coverage for all. In Colombia we have accepted that healthcare is by economic necessity rationed but we have given priority to children, pregnant women, elderly and handicapped persons. And the Colombian state has paid special attention to the rights of the neediest increasing the share of the national income spent on healthcare from just 2.2% in 1993 to 5.5% as of 2008.

The lyrics:

Come one, Come all
Down to the hall
We're gonna make noise
We're gonna bust balls
We're gonna disrupt
We're gonna jump in the fray
I got a list of all the things that were supposed to say
We're gonna get real rowdy
Have a barrel of fun
But we're the USA so by the way be sure to bring a gun
And buddy

We're Number 37
We're the USA
We're Number 37
And were so proud to say
We got old people crying at the pharmacy
Pay your deductible
This ain't the land of the f-f-f-free Grandma
We're Number 37
We're the USA

People of the town come on down
And if you got a crazy rumor you can spread it around
I kind of like my insurance and I like my health
The other 47 million can go treat themselves
To some prayer in chapel
Fold your hands and pray
Because we are a Christian nation and that is the Christian way
And brother

We're Number 37
We're the USA
The big Number 37
And were so proud to say
We're #1 one in tanks
We're #1 in planes
We're #1 in war with #2 for brains
We're Number 37
We're the USA

I drew a Hitler mustache on the president
Yea! Aint that neat
My brother had a hernia operation last year
And now he's living out on the street

We're Number 37
We're the USA
The big Number 37
And we want to keep it that way
Be sure to bring the kids
All of the boys and girls
Because the #1 health care system in the world.

Is in France???

We're Number 37
We're the USA
We're Number 37
And we got something to say
We pay more for less
40% in fact
Let's bite some fingers off
Shout at the handicapped
Cause buddy
We're Number 37
We're the USA

We're Number 37
We're the USA
We're Number 37
We're the USA