Reviewed by Robert Milburn

Thorough works of scholarship are not usually good reads, especially when accompanied by footnotes, figures, and tables. This one is an exception, both because of the intrinsic fascination of its subject and the clarity of the author’s prose.

Hoover Institution fellow and physician Scott W. Atlas, author of a medical textbook, methodically demolishes the myth that the U.S. health-care system ranks low among those of industrial nations. He simply asks, If you could choose anywhere in the world, where would you want to receive health care? His answer: the U.S.

Atlas compares countries’ treatments of heart disease, cancer, stroke, chronic lung disease, Alzheimer’s, and diabetes on the basis of quality of care, access to care, and medical innovation. He finds that Americans have better treatment rates, greater survival rates, and access to better screening procedures with state-of-the-art medical technology and drugs.

In Excellent Health: Setting the Record Straight On America’s Health Care

by Scott W. Atlas, M.D.
Hoover Institution Press

The author points out, for example, that in “France, Germany, Italy, and the United Kingdom, patients are subjected to more invasive surgery because…access to interventionist radiology” such as MRIs and CT scans is “less than half that of the United States.” Not only do an estimated 80% of health-care innovations originate in the U.S., but also “the vast majority of new drugs for diseases like cancer are first available in the United States.”

Just how U.S. health care has gotten an unjustifiably low world rating makes for a grimly amusing excursion into the use and abuse of data. Take the two most commonly cited points of comparison: life expectancy and infant mortality. As the author reports, in October 2008 presidential candidate Barack Obama declared that “29 other countries have a higher life expectancy and 38 other nations have lower infant mortality rates,” figures that later gave his “transformative health-care legislation a seemingly data-driven argument.”

Obama was citing a 2000 World Health Organization report that gave the U.S. system a low ranking. But many factors influence length of life that have nothing to do with the state of medical care. One study cited by Atlas, using data from the Organization for Economic Co-operation and Development, shows that the U.S.’ poor rank in “overall life expectancy” was partly attributable to such obvious culprits as murder, motor-vehicle accidents, and suicide. Once these and similar factors were accounted for, the U.S. advanced to No. 1 in life expectancy.

As for infant mortality, the abuse of those figures is tinged with dishonesty. It’s hard to know precisely where the U.S. ranks because the available data are not comparable. The U.S. maintains vigorous live birth recording procedures and follows the WHO’s definition of live birth: “expulsion from its mother… irrespective of duration…[which] breathes or shows any other evidence of life.” It is estimated that European countries have reported a false reduction of infant mortality rates by up to 17%, owing to inadequate recording procedures. One example: Switzerland decrees an infant must be at least 30 centimeters long to be considered living.

Atlas is hardly uncritical of the U.S. system. But his problem with Obamacare is that it “does not address the single issue of highest importance: cost.” Under Obamacare, “Americans will be forced to buy insurance they may not want or value; businesses will be fined unless they acquiesce to government dictates about the composition, structure, and breadth of health-insurance benefits; [and]…the plan calls for significant tax increases, including ones on the very sources of innovative medical technology [an excise tax on the devices] that have improved and prolonged the lives of Americans so dramatically over the past half-century.”

In Excellent Health is a good read that provides a helpful balance to today’s health-care debate.

ROBERT MILBURN is a research associate at Barron’s.


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