gwhit715 wrote:
All the industrialized nations of the world provide this vital health care at FAR less per capita that we do. In fact, last year we passed 15% of our GDP in health care expense alone ... and we do NOT lead the world in outcomes or in life expectancy or in birth survival.


Thus, the only rational question is why we spend nearly twice as much per person to achieve less - and how quickly we can alter our system to more closely approximate THEIR systems. Our medical care system is a failed experiment in any economic analysis. Let us admit that and move on.
The problem with using life expectancy is that many things outside the purview of health care effect how long a person may live. A 19 year old  gang-banger getting shot and killed in a drug deal gone bad or an automobile accident killing a young family with three children is totally unaffected by how good your health care system works.

Birth survival works only if every country classifies a live birth using the same criteria. The World Health Organization has defined a set of criteria for what should be considered a live birth and what should be considered stillborn. The U.S. is one of the few countries that follows the full WHO guidelines.

Infant Mortality and Premature Birth

Myth: The U.S. infant mortality rate is higher than that of other countries

Fact: The U.S.’ infant mortality rate is not higher; the rates of Canada and many European countries are artificially low, due to more restrictive definitions of live birth. There also are variations in the willingness of nations to save very low birth weight and gestation babies.

The ethnic heterogeneity of the U.S. works against it because different ethnic and cultural groups may have widely different risk factors and genetic predispositions.

Definitions of a live birth, and therefore which babies are counted in the infant mortality statistics very considerably. The U.S. uses the full WHO definition, while Germany omits one of the four criteria. The U.K. defines a still birth “a child which has issued forth from its mother after the twenty-fourth week of pregnancy and which did not at any time after being completely expelled from its mother breathe or show any other signs of life.”1

This leaves what constitutes a sign of life open and places those born before 24 weeks in a gray area. Canada uses the complete WHO definition but struggles with tens of thousands of missing birth records and increasing numbers of mothers sent to the U.S. for care.2 France requires “a medical certificate [that] attests that the child was born ‘alive and viable’” for baby who died soon after birth to be counted, which may be difficult to obtain.


Myth: The U.S. premature birth rate is higher than that of other countries.

Fact: In the Netherlands, babies below 25 weeks gestation are no longer resuscitated, but rather given only palliative treatment. Those at 25 to 26 weeks are generally resuscitated and kept alive, but the decision depends on the facts of each case.3 The result is underreporting the number babies that may be live-born but who are not offered aggressive treatment.

Switzerland only uses two of the four WHO criteria, respiration and heart beat, and does not aggressively treat very premature babies. In some cantons, the baby must be 30 cm long to be registered as a live birth. Switzerland also requires registration of still births only from 6 months gestation and has no rule regarding registration of live births. Studies have found significant underreporting of premature births in Switzerland, which can alter the overall mortality rate by more than a percentage point.4

  1. 1 Births and Deaths Registration Act 1953, paragraph 41, modified by Still Birth Definition Act 1992.
  2. 2 Lisa Priest, “Canada’s U.S. baby boom,” The Globe and Mail, 5 May 2008; Caroline Abraham, “Red tape denies baby Sonja her brief life; To the dismay of parents, thousands of births go undocumented in Ontario,” The Globe and Mail, 22 July 2006.
  3. 3 From the newsletter of the Dutch Paediatric Association, quoted in “The Dutch Policy,” BBC News, 22 September 2004, http://news.bbc.co.uk/go/pr/fr/-/2/hi/programmes/panorama/3677278.stm.
  4. 4 Martina Müller, Gero Drack, Christian Schindler, and Hans Ulrich Bucher, “Live and Stillborn very low birthweight infants in Switzerland: comparison between hospital based birth registers and the national birth register,” Swiss Medical Weekly, vol. 135, (2005).



"To take from one, because it is thought his own industry and that of his fathers has acquired too much, in order to spare to others, who, or whose fathers, have not exercised equal industry and skill, is to violate arbitrarily the first principle of association, the guarantee to everyone the free exercise of his industry and the fruits acquired by it." --Thomas Jefferson