Sharp readers have pointed out that this statistic means different things to different people. Conservatives think the U.S. health care system needs reform because there is too much government involvement in health care; liberals because there is not enough.

So allow me to clarify this survey with a few others. Americans are the most dissatisfied with the quality and quantity of their health care. Of the 10 largest industrialized nations, the U.S. ranked dead last in health care satisfaction, with an approval rating of only 11 percent.1 There's no putting a positive spin on this statistic; any president with such a low approval rating would be impeached!

Most of this dissatisfaction stems from the high expense and unavailability of U.S. health care. During the 1993 debate on health care reform, polls consistently showed that two-thirds of all Americans supported the idea of universal coverage.2 Polls also showed that Americans didn't want to pay the higher taxes to achieve this goal, which many pundits took to be an amusing example of public inconsistency. Actually, the public was entirely consistent. Other nations manage to cover everybody, and at lower cost.

Nor is America's international reputation in health care as high as many Americans boast it to be. "Ask anyone you know from a foreign country... which country is the envy of the world when it comes to health care," wrote Rush Limbaugh in See, I Told You So. But according to a Gallup poll published in the September 13, 1993 edition of The Toronto Star, only 2 percent of all Canadians believe that the U.S. has a better health care system than their own.3

The fact is that America does not have the finest health care system in the world; it has the finest emergency care system in the world. Highly trained American doctors can summon Star Wars-type technology in saving patients who have fallen seriously injured or critically ill. But as far as preventative medicine goes, the U.S. is still in the Stone Age. It should be no surprise that in America's health care business, entrepreneurs will take a pound of cure over an ounce of prevention every time.

But in reality, what affects the health of Americans lies more outside the formal health care system than within it. In Europe during the last century, life expectancy nearly doubled after nations purified their drinking water and created sanitation systems. In America during this century, the highest cancer rates are found in neighborhoods around the chemical industry.4 A healthy diet and exercise provide better health than most medicines in most circumstances. Other nations have figured this principle out, and have used it to lower their health care costs.

But perhaps the greatest reason why Europeans are healthier than Americans is because they have reduced poverty, especially child poverty. The link between poverty and poorer health has long been proven. One survey reviewed more than 30 other studies on the relationship between class and health, and found that "class influences one's chances of staying alive. Almost without exception, the evidence shows that classes differ on mortality rates."5 The American Journal of Epidemiology states that "a vast body of evidence has shown consistently that those in the lower classes have higher mortality, morbidity and disability rates" and these "are in part due to inadequate medical care services as well as to the impact of a toxic and hazardous physical environment."6

Many reasons contribute to the worse health of the poor. Political scientist Jeffrey Reiman writes: "Less money means less nutritious food, less heat in winter, less fresh air in summer, less distance from sick people, less knowledge about illness or medicine, fewer doctor visits, fewer dental visits, less preventative care, and above all else, less first-quality medical attention when all these other deprivations take their toll and a poor person finds himself seriously ill." 7 And this is not to mention that the poor work and live in more polluted, hazardous and strenuous environments.

These deprivations are especially hard on infants in their critical development years. The U.S. has tried to combat this problem by offering universal prenatal and postnatal health care, much like Europe does. But the U.S. is fighting against a head wind because it has levels of poverty that Europe does not. Again, a person's health is affected by more factors outside the formal health care system than within it.

"When I look back on my years in office," says C. Everett Koop, Reagan's former Surgeon General, "the things I banged my head against were all poverty."8

If America is to improve its health statistics, it must not only pass universal health care, but reduce poverty as well.

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1 Health Affairs, vol. 9, no. 2, cited by Steven Randall, Jim Naureckas and Jeff Cohen in The Way Things Aren't: Rush Limbaugh's Reign of Error (New York: W.W. Norton & Company, 1995), p. 65.
2 Jeff Cohen and Norman Solomon, Through the Media Looking Glass: Decoding Bias and Blather in the News (Monroe: Common Courage Press, 1995), p. 81
3 The Way Things Aren't, p. 66.
4 This was the finding of a county-by-county national survey conducted by the National Cancer Institute in 1975. Cited in "N.J.'s Chemical Belt Takes Its Toll: $4 Billion Industry Tied to Nation's Highest Cancer Rate," Washington Post, February 8, 1976, p. A1.
5 Aaron Antonovsky, "Class and a Chance for Life," in Inequality and Justice, Lee Rainwater, ed., (Chicago: Aldine Publishing Company, 1974), p. 177.
6 S. Leonard Syme and Lisa Berkman, "Social Class, Susceptibility and Sickness," American Journal of Epidemiology 104, no. 1 (July 1976), pp. 1,4.
7 Jeffrey Reiman, The Rich Get Richer And the Poor Get Prison (New York: MacMillan Publishing Company, 1990), p. 75.
8 Quoted in Stephanie Coontz, The Way We Never Were: American Families and the Nostalgia Trap (New York: HarperCollins, 1992), p. 270.