Factfulness: Ten Reasons We're Wrong About the World – and Why Things Are Better Than You Think

The United States: The Sickest of the Rich
Which brings us to the United States. Just as Cuba is the poorest of the
healthy because of its commitment to a single idea, the United States is the
sickest of the rich.
Ideologues will invite you to contrast the United States with Cuba. They
will insist you must be for one or the other. If you would prefer to live in the
United States than in Cuba, they say, then you must reject everything the
government does in Cuba, and you must support what Cuba’s government
rejects—the free market. To be clear, I would definitely prefer to live in the
United States than in Cuba, but I don’t find it helpful to think like this. It is
single-minded and very misleading. If it is being ambitious, the United States
should seek to compare itself not to Cuba, a communist country on Level 3,
but to other capitalist countries on Level 4. If US politicians want to make
fact-based decisions, they should be driven not by ideology but by the
numbers. And if I were to choose where to live, I would choose based not on
ideology but on what a country delivers to its people.
The United States spends more than twice as much per capita on health
care as other capitalist countries on Level 4—around $9,400 compared to
around $3,600—and for that money its citizens can expect lives that are three
years shorter. The United States spends more per capita on health care than
any other country in the world, but 39 countries have longer life expectancies.

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Instead of comparing themselves with extreme socialist regimes, US
citizens should be asking why they cannot achieve the same levels of health,
for the same cost, as other capitalist countries that have similar resources. The
answer is not difficult, by the way: it is the absence of the basic public health
insurance that citizens of most other countries on Level 4 take for granted.
Under the current US system, rich, insured patients visit doctors more than
they need, running up costs, while poor patients cannot afford even simple,
inexpensive treatments and die younger than they should. Doctors spend time
that could be used to save lives or treat illness providing unnecessary,
meaningless care. What a tragic waste of physician time.
Actually, to be completely accurate I should say that there is a small
number of rich countries with life expectancies as low as that in the United
States: the rich Gulf states of Oman, Saudi Arabia, Bahrain, United Arab
Emirates, and Kuwait. But these states have a very different history. Until the
1960s when they really started getting rich on oil, their populations were poor
and illiterate. Their health systems have been built in just two generations.
Unlike the United States, these states are not constrained by a suspicion of
anything governmental and I would not be surprised if within a couple of

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years they all had higher life expectancies than the United States. Perhaps the
United States will then be less reluctant to learn from them than it is to learn
from Western European countries.
The communist system in Cuba is an example of the danger of getting
hooked on a single perspective: the seemingly reasonable but actually bizarre
idea that a central government can solve all its people’s problems. I can
understand why people looking at Cuba and its inefficiencies, poverty, and
lack of freedom would decide that governments should never be allowed to
plan societies.
The health-care system in the United States is also suffering from the
single-perspective mind-set: the seemingly reasonable but actually bizarre
idea that the market can solve all a nation’s problems. I can understand why
people looking at the United States and its inequalities and health-care
outcomes would decide that private markets and competition should never be
allowed anywhere near the delivery of public goods.
As with most discussions about the private versus the public sector, the
answer is not either/or. It is case-by-case, and it is both. The challenge is to
find the right balance between regulation and freedom.