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Thinking Differently About Health Care

by John de Graaf

IV%20Drip.jpg There’s a problem with today’s health care debate in America. It’s way too focused on health care.

It’s true that the American health care system is on life-support. Priced at nearly $8,000 a year per American, and soon to be 20 percent of our GDP, it’s more expensive by 40-60 percent than health care systems in any other industrial country and totals nearly half the health care budget of the entire world. Yet it leaves 48 million Americans uncovered by health insurance and produces remarkably poor results.

Americans rank 45th in life expectancy, right there with Albania. After age 50, they are nearly twice as likely as western Europeans to suffer from chronic illnesses. Even in the hospital, US patients face unusual dangers. As many as 275,000 of them die each year from “healthcare” itself--errors or infections during treatment. So the system is broken. But fixing it will require a far more holistic approach than has been discussed in the health care debate.


Let’s consider American health as a house. Health care is the roof, the final protection against illness. In our case, it’s an expensive roof, gold plated yet with 48 million holes.

In some ways—vaccinations, for example—it’s a preventive system, but mostly it’s sickness care.

In most other countries, the roof is a simpler affair, asphalt shingles on a fiberglass mat but with hardly any leaks. These health care systems rely more on prevention; less on high tech treatment. Yet the people in the house live longer, healthier lives. That’s because in those other countries, the foundation and the walls of the house are stronger, with fewer cracks to let in the cold.


Let’s start with the foundation. That’s the head start toward health that children in most other rich countries receive. There’s a stronger focus on pre-natal care, for example. In part because of this, infant mortality in all other industrial countries is lower than in the United States, which ranks 42nd in the world, according to the CIA. Every other rich country does better.

In every country in the world except, believe it or not, the United States, Liberia, Swaziland and Papua New Guinea, mothers, and often, fathers, are guaranteed paid time off from work to take care of newborns. In many cases, such “family leave” extends for up to a year or more. In the US, by contrast, parents often return to work when children are only a few weeks old.

Paid family leave, and the parental bonding it ensures, pays off in terms of children’s health—fewer childhood illnesses, fewer problems with attention-deficit disorder, less obesity. Most countries find that such a taxpayer investment in early childhood results in lower health costs and other problems as children grow up.

A recent UNICEF study ranked the United States 20th out of 21 rich nations regarding children’s welfare. While our rich enjoy a marble floor, and our middle class, a wooden one, poor Americans have a dirt floor, with rain leaking through the holes in the roof and puddling up in the corners.


If Democrats talk almost exclusively about universal health care as the solution to our health problems, Republicans tend to focus on wall number one—lifestyle choices. It’s a matter of personal responsibility, they say. Americans should simply stop smoking, eat properly, avoid over-eating, and excessive alcohol consumption, exercise regularly and sleep enough. Of course, this is sensible advice.

But it isn’t all a matter of personal responsibility. Policy changes would help here as well. Our tax system subsidizes producers of sugars and fats and our marketing system relentlessly advertises unhealthy foods. At the same time, Americans tend to work longer hours than people in other rich countries. Europeans, for example, work 300-350 fewer hours each year on average. Laws guarantee them sufficient time off, including a minimum of four weeks of paid vacation a year, and shorter weekly working hours. This leaves them more time to select foods carefully, eat more slowly—and, as a result, eat less—while exercising and sleeping more.


It’s no secret in the field of public health that stress is a killer. Several factors make American life particularly stressful. We are among the most competitive of wealthy capitalist countries and have the widest gap between rich and poor. Fewer people on top; more on the bottom. Studies clearly show that whether it’s humans or baboons, the lower your status, the higher your stress levels. More economically egalitarian societies, like Sweden or Japan, for example, are clearly less stressful and more healthy.

Stress is also the result of insecurity. As the American social safety net has been gutted in recent years (with more of us losing health and pension benefits, for example) and job protections have been reduced, life in America is far more insecure than in other rich countries, where strong social safety nets remain in place. Danes, for example, can be fired as easily as Americans, but they receive generous unemployment benefits, job training and government jobs if they are unable to find a position in the private sector. Insecurity also leads to anxiety, a mental illness. American rates of anxiety are double or triple those in western European countries. Europeans say their social safety net gives them a feeling of peace of mind. It’s certainly good for their health.

Finally, stress is the result of time pressures and overwork. More breaks from a stressful workplace are seen by Europeans as yet another way to improve health. It’s unlikely that we will be able to quickly change the levels of hierarchy and inequality in the US, or that our safety net will be suddenly strengthened. But policies offering shorter work time and longer vacations, clear stress reducers, could be enacted more easily and quickly, and they should be.


It’s a given in the field of public health that social connection strengthens immune systems and improves physical well-being. In fact, it may be the most important single factor in health outcomes. One of the worst things you can do for your health is to be lonesome. Yet America is an increasingly lonely country. More and more people, and especially older Americans, live alone, far more than in other rich countries. A recent study found that the average American has only two close friends he or she can turn to. A quarter of us have none at all. Loneliness quickly turns into depression. As with anxiety, Americans are two to three times as likely to suffer from depression as western Europeans.

A National Institutes of Health study comparing frequency of chronic illness in the United States and the United Kingdom found that Americans are nearly twice as likely to suffer from chronic illnesses such as heart disease in old age. Such diseases account of a huge part of our health care costs. The study found, surprisingly, that poor Britons are as healthy as rich Americans. It didn’t find that eating fish and chips makes you healthier. The major reasons for the difference were related to the fact that the British had more security and more free time, which they used to exercise more, but especially to socialize more.


Americans, according to the UNICEF study, rank at the bottom in child safety, with the highest rates of accidents among children. Partly, time pressure on American parents leave them less able to supervise their children. Other studies show extremely high rates of accidents in the workplace compared to other nations. Preventable death rates in the US, including deaths from automobile accidents, are the highest among industrial countries. Moreover, the European Union has stricter controls on the release of toxic chemicals into the environment. On average, Americans breathe in air pollution at double the levels of western Europe.

Finally, and this is no small matter, every other industrial country guarantees its workers paid time off from work when they are sick; only the US does not. In many cases, as much as a month of leave is allowed. These countries know that without paid time off, workers will come to work sick, as many American workers do. They will get others sick and stay sick longer, often requiring more expensive treatment for their illnesses. This is not rocket science. Most Americans get this immediately. That is why more than 80 percent of them favor a law that would guarantee paid sick days for workers.


To achieve better health outcomes, Americans must begin to see health as a holistic matter, like the house I describe. Right now that house has a foundation that is part marble, part rotting wood and part dirt. It has four walls that are a mixture of teak, balsa wood and bamboo, all of them in sorry shape. And finally, it has a gilded roof with millions of holes.

It is not enough to talk of making the roof all gold and eliminating the holes, though we do need to eliminate the holes. We need to eliminate the gold as well, taking the profit and costly complexity from the system and expanding a program like Medicare to cover everyone, potentially at less cost. Such a system must rely more on preventive methods than high tech cures.

If we also pay attention to the foundation and the walls, we can assure better outcomes also at lower cost, as is the case in other rich nations. We can:

Strengthen the foundation by improving pre-natal care and providing at least three months or more of paid leave to all parents of babies or very young children. Make the Family and Medical Leave Act a paid provision and extend it to all workers.

Strengthen the wall of lifestyle by encouraging consumption of whole grains and vegetables, teaching children the value of eating healthy foods, eliminating subsidies to the purveyors of sugars and fats, and especially, reducing working hours to give Americans more time for exercise, sleep and healthy eating.

Strengthen the wall of stress relief by re-instituting tax policies that narrow the gap between rich and poor, re-building our social safety net and adopting policies like paid vacation time (the US is the only industrial nation without a law guaranteeing paid vacations) that can assure Americans periodic relief from the stress of our hyper-competitive and long-hour workplaces.

Strengthen the wall of connection by reducing working time and by stimulating, through programs like national service, greater volunteer involvement with our neighbors and communities.

Strengthen the wall of safety by improving OSHA and other protections for workers, building more pedestrian and bicycle friendly cities, and regaining the environmental zeal of the early 1970s, which led to much cleaner water and air for all Americans. Pass the Healthy Families Act, guaranteeing seven paid sick days to American workers.

All of these changes, taken for granted in other nations, will make the United States healthier, and almost certainly at less cost than our current system. Improving our health outcomes is less a matter of better science and more money than of political will and an ability to see the connections between things.

Many business leaders (though certainly not all!) will object to these ideas on the grounds that they will cost too much and make us less competitive in the world economy. But the cost of poor health will be far greater than the price tag for such reforms. If there is one thing more than any other which makes it harder for American businesses to compete, it’s the escalating cost of health care.

We can do better. We owe it to ourselves and our children to make these changes without delay.

John de Graaf is a documentary filmmaker, Executive Director of Take Back Your Time and co-author of Affluenza: The All-Consuming Epidemic.

Photo credit: Flickr/kden604, Creative Commons license

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This is an excellent article, containing reasonably simple ideas that would go a long way towards improving the quality of life for many Americans.

We face similar issues in Australia, though to a lesser degree. Western healthcare seems to lack the wholistic approach that reaps benefits from preventative health care.

Posted by: Dan on 3 Oct 08

Very interesting and some good ideas. Thank you.

Posted by: Elizabeth on 3 Oct 08

The reason we are 42nd has much more to do with America's interpretation of death. In most countries severe birth defects that will not result in a living child are considered stillbirths. In the United States, we take every measure to save the lives of children who don't have a chance. These children are then counted as part of the infant mortality. I agree that we need more accessible healthcare, but the statistics on this issue are greatly skewed.

Posted by: Shane on 5 Oct 08

Something has got to give. My God, premiums have doubled in the last year alone, co-payments have tripled, its getting OUT OF CONTROL. and enough is ENOUGH.


Posted by: John Woods on 5 Oct 08

Love this article.
I am from Sweden, I lived for a year in Portland, ME, and I have experienced firsthand the differences between the systems.

Here I never even thought about health care and what would happen if I got sick or injured. Then I broke a leg and had to fix it. Didn't even get to sign a single paper, they asked my name och social security number and that was it, they told me to come back in a few weeks to remove the casque (spelling?). Oh, and I did not have to wait in line for hours because of a beuraucrat standing in the way of me and the doctor as most politicians in the states wants you to believe.

Then I went to Portland, ME, (Ps. I love the states! I love the people there, friendlier folks are hard to find. Here in sweden we are a lot more rigid and boring I can promise you) had a pizza at some local place and ended up at the ER with food poisoning. Once there I had to wait for four hours, vomiting my guts out until I got to a nurse that took my blood pressure, said it was ok, took my information. Later I received the bill for $300 and the hassle to let my insurance company take care of it ensued.

Americans; You are a wonderfull people and I love you all, but you need to stop trusting the politicians that tells you that "socialized healthcare" is something bad. It is not.
And yes, we have higher taxes, but we can afford it because we have a minimumwage that is about twice that of the states. I can go to norway and staple boxes and earn $20 an hour.
I for one is an uneducated kid of 23 years and I live well in a nice house, I work my 38 hours a week and then enjoy my 5 week paid vacation during the summers. I earn about $37,700 a year as a government employee (I take care of depressed kids) and from that I get to keep $25,000 after 33% income tax.

What does that high tax burdon get me?

Free health care throughout (better then free, I get paid even if sick)

Free school throughout (better then free, If I were to study I would receive almost 400$ a month that I would NOT have to repay. We see it as a job to study, we are building future wealth. It's a national investment that we will reap the benefits from later)

All the examples mentioned above in the article apply here as well, in many/most cases even better then in the article.

My pension is guaranteed. A big part of it is through the government so that I will not loose my retirement if my company goes out of business.

If I become unemployed I will keep 80% of my salary until I find a new job.

If I were in to bad a position to be availible to work I would receive social securities of up to $15,500 a year taxfree. (not combinable with unemployment benefits)

If my child gets sick (If I had one) I am allowed to stay home with that child with 100% salary.

If I need to lend money in order to afford school ($400 is not enough to live on) I can lend from the government to extremely subsidized levels up to $750 a month. It is not until I get a job with a certain salary that i have to repay that in a manner that is appropriate for my income. That debt follows you until it's re-payed or I turn 65.

When I become 65 I will not have to worry about anything either.

If anyone read this far you have probably realized that those 33% gives you a heck of a lot of good things to the society. It is well worth it and I don't believe that there are to many people here that will tell you that our system does not work (although there are always things to improve of course, even here (arrogance? ;) )

Americans use the word wellfare as a slur word, it is as bad as a nation can get.
Here we use the exact same word (Välfärd) in the direct translation but it has a completely different inheret meaning to us. We see wellfare as a direct synonym to the word prosperity.

Thanks for your time

Posted by: Oskar on 5 Oct 08

Um... I'm pretty sure just about nobody has a dirt floor in the U.S. I think you made that one up. The vast majority of U.S. citizens in "poverty" live well above the poverty lifestyle of other countries.

Metaphor or not, I agree that more preventative measures are certainly the way to go. However, our government is not a European government. You say we need universal coverage like Medicare but look what the government did to Medicare. It's all but bankrupted. Besides, you also have to concede that both democrats and republicans will continue to be elected in the future. Do really think that the leftist universal coverage concept will survive another Bush-type administration and/or a republican congress without being ruined or destroyed?

I also noticed you didn't post much specific info on these other rich countries. If you dig a little deeper you'll find that every single one of their health care systems are either already operating at a loss (and thus will implode sooner or later) or will be bankrupted withing one or two decades. There's no reason to think such a system is actually sustainable.

I'll end by saying that sure, I would love it if I could get "free" and preventative health care. However, I have no trust in this government to be able to do it. You would have to assume them to be better/smarter than every European system. Are you ready to make that assumption?

Posted by: Sam on 5 Oct 08

Oskar, what a fascinating post. For a single American making 37,700 a year, by the time they paid Federal tax, State Tax, Medicare, Unemployment insurance, and social security they would only take home 1 or 2 thousand dollars more than a Swede. And then most likely, he/she would have to pay a portion of their health care insurance from their take home pay.

My mother is German so I have long heard of the benefits my German cousins receive (living in Germany). I am so frustrated with the decreasing standard of living we experience here, not financially, but socially with more work hours, decreasing health benefits, less job security.

Thank you for sharing your comparison. I think most Americans just don't realize that we don't have it that great after all. Our propaganda machine seems to be as great as the old Soviet Unions.

Posted by: Valerie on 5 Oct 08

Valerie: You are more then welcome. I feel that I should try to give back to a nation that welcomed me as affectionately as the states did me, and I feel that this is a good place to start.

To Sam; I don't really know where you get your data that the medicare systems in place in the rich european countries are doomed to fail. Yes, we in Europe to are experiencing that the costs are rising, sometimes faster then the inflation and faster then the general growth of the BNP, that in itself is not sustainable I agree. But there are always adjustments. Recently here in Sweden for example the costsexpansion has slowed down and is now very sustainable.

As for your claim that the healthcare here are running on defecits... That is not an especially relevant point. Healthcare is to cost as much as it needs, the governments lays out a budget on the prospect of how much of the taxpayers money they will spend. (currently 15% i believe..) And it is the nature of a healthy economic policy to always strive to have a restrictive budget so that the local hospitals for example don't let their budgets run wild. In effect perfecting their expenditures.
So to say that the healthcare is operating at a loss is just not attributing to the discussion.

Actually, I can't really see how the healthcare, in a theoretical way, can operate at a loss when the system is built like ours... There is no special tax that is supposed to only go towards the healthcare and if they spend more money then that they will eventually go bankrupt.

Either way Sam, I do trust that america has good politicians that are to be trusted with real issues (Ron Paul for economics for example) but it is up to the people to actually vote for those kind of people that knows their subject instead of people like Palin and McCain who does not understand economics for example.
You don't need to like politicians as people, it is a voters duty to look past the exterior and see what they will deliver. That is why our politicians are so much duller. (Although the French president Sarkozky is kinda fun, appearing drunk at the G8 meeting, sleeping around with supermodels, having a good time ;) )

Posted by: Oskar on 5 Oct 08

What we have in the uSA is more accurately described as 'health marketing' than healthcare. When HMOs began buying up non profit hospitals in the 1980's and the Big Pharma companies began controlling all the 'FDA' studies and releasing only the 'positive' data the slide down the slippery slope started. Now we have the most drugged population in the world which merely treats/blocks symptoms rather than treat actual causes. This results in decreased quality of life, lifelong addictions to prescriptions with no real health benefit. The big question is why are we first in costs and so low in results? Greed, mismanagement and stupidity. When presidential candidates say 'everyone has coverage, go to the emergency room' they are stating their ignorance and contempt for the average working American. For me its taken 5 years, the loss of job, insurance, house, 401k and living on food stamps/prescription assistance to get a diagnosis of Trigeminal Neuralgia. Severe pain precluding majority of activity with disability benefit denied and no hope of affording treatmnet. They would quite rather we imply die off if we cannot work. If I could get treated I could return to work. Our Congress should be stripped of health benefits so they could better understand the reality they have created. My only choices are starvation or suicide. We need MAJOR change with control taken away from those who have put us where we are.

Posted by: theo on 5 Oct 08

This is an excellent article. It draws attention to the enormous health gap in driven by social inequality and the associated stresses in the US, with only part of the gap attributable to differential access to health care between the insured and uninsured.

In light of the article's emphasis, it's interesting that many of the commenters nonetheless focus on the health-insurance gap and the crisis in US health care (critical issues but not really the main point of the essay).

In addition, I draw partial exception to the comment by Shane regarding the supposed non-comparability of the US Infant Mortality Rate. The underlying source for this re-characterization of poor US comparative health performance is an analysis by American Enterprise Institute Nicholas Eberstadt. Eberhard concludes that under standardized measurement, "America might move from the bottom third toward the middle, but it would be unlikely to advance into the top half." There is a scholarly discussion of differences in measurement in "International infant mortality rankings: a look behind the numbers" (Liu, et al., Health Care Financing Review, 1992).

Poor comparative life expectancy obtains in the US at higher ages as well, which suggests that the poor US performance is more than a figment of the data.

Posted by: Michael Ash on 5 Oct 08

Americans are brainwashed about the evils of "socialized medicine". You don't hear about the evils of "socialized defense" or "socialized air traffic control"? So what's the problem with having some national minimum standard of health insurance and basic entitlement for ALL citizens? Americans currently pay vastly more and get considerably less for their money than anyone in any civilized democracy. But to even suggest that another country does it better is "communist."

North Koreans are also told that they live in the greatest country on earth, day in and day out, and they put flags on their porches and wear flag pins their lapels etc. ... and close their minds. Only they don't have access to the Internet so they can't really be blamed.

From a European perspective the popular attitude to healthcare in much of the US is about as informed, objective and rational as a North Korean's belief in the superiority of his or her way of life. In other words it's driven by dogma, cant and the propaganda of special interests with lots of money and power.

There are more than a few published comparisons. Here are a couple

Posted by: Paul Joseph on 5 Oct 08


Books in all classes / schools are kept or a teacher doesn’t explain properly the education for a child will be meaningless. The same way is Shastra / Ethics for a child, which is very vast & confused in INDIA. True and proper education & simple automatic law known to everybody can save a child to be slaughtered in remote area by a wrong educator / Guru even EDUCATIONAL TEACHERS /EDUCATIONAL BOARDS OF WORLD CAN EDUCATE CHILDREN.

Page No.24 (18th line) To-day the Education given to females is not good. We should
give progressive & truth education and it is not only from the books.
Page No.68 (12th line) If we think & ask them, they have nine lives in INDIA like
Cats and boys are dying like houseflies.
Above written in Hindi Book ----- Bhartiya Nari
Written by Swami Vivekananda
Above is the reason INDIAN SAINTS don’t marry, Wife is so kind to her Criminal Guru / Educator who is thirsty for blood of males & children are slaughtered in remote areas.

In the World all religion has females & male i.e. every type of peoples is there. How to identify peoples by religion????? A debate can be organized to know from a child by whom he wants to die by a criminal / God. If no please think what is all religion & Shastra / Ethics or this is only the harmful way for child.

Please reach to a simple Shastra / Ethics by competitions on above which is best for everybody & simple to known by everybody & to save a child from the wife / Guru who is thirsty for blood of males & child are slaughtered in remote areas.

Page No.18 (10th line) If you think like Christ, you will be Christ or if you think like
Buddha, you will be Buddha.
Page No.47 (10th line) The pride of man is due to his thinking and man are different
from animals due to his thinking power only.
Above written in Hindi Book ----- Vedanta In Practical Life
Written by Swami Vivekananda

KISHAN, INDIA—033-2259 7321 & 7429 / 0651-2200166 & 3279 / 0-98318 22701

Posted by: kishan on 8 Oct 08

Thank you for this great article! This is the first time that I've seen the connection made between long work hours, fewer vacation days, and health. Finally someone makes it! If you work 40+ hours and commute 2 hours per day, how are you supposed to find time to cook healthy and work out?!? Oh, and get enough sleep, too.

Posted by: RachelAB on 15 Oct 08

I am an American who's angry and tired and burned out. It's too bad that more Americans are not even aware that there are sites like this. There are not nearly enough of them and their voices are not being heard. Maybe this financial crisis will shock Americans out of trying to follow the herd towards working more jobs and more hours to maintain their standard of living. The article above made a point about America being one of the most competitive capitalist countries, with one of the widest gaps between rich and poor. The "American Dream" has become distorted and values have gone by the wayside as people blindly put themselves hopelessly in debt to buy a bigger house, a fancy car, etc.

I have tried to keep up and have now given up. Fundamental change, such as that advocated by Mr. De Graaf, simply has to happen here. Europeans have always known how to live better than Americans, and I think it's tragic that our way of life has poisoned European capitalist ideology. Vive la revolucion!

Posted by: Miriam Gordon on 16 Oct 08

Thank you for this site and reading materials. I especially enjoyed the comments on Health Care...very enlightening.

Posted by: Grace on 16 Oct 08



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