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I’ll try to answer honestly with a minimum of snark. Health care systems around the world are often judged by three criteria:AccessCostQualityThe American health care system does poorly against the first two and against the third depending on who you ask and what you are measuring.Access is fine if you are employed and receive health care via your employer or you can otherwise afford it. From a cost perspective, America has the most expensive health care system in the world per capita and, remarkably, still has over 28 million people without insurance, a number expected to grow over the next few years. The quality of the American health care system fails on many measures of basic health outcomes such as mortality, infant mortality, preventative medicine, etc. Some legitimate criticisms of some of these measures are offered by defenders of the American system. It is likely that American failure on many of these measures is unrelated to the quality of health care.Arguments made in defense of the American system are usually measures related to:Quality of care for certain diseasesAccess to non-emergency medical careInnovation.Although American’s fare poorly on many basic health measures, in the treatment of certain diseases such as heart disease, stroke care and cancer care, American outcomes are among the best in the world. In fact, according to data from the Commonwealth Fund and the NBER, the United States, ranks at the top for most cancer screening measures. American patients have the highest survival rates in the world for colon, rectum, lung, breast, and prostate cancer according to data from the Robert Wood Johnson Foundation. So if you are an American with good health insurance with one of these medical conditions, then America is a great place to be. And in fact, wealthy foreigners travel to the United States for treatment of many of these diseases. But access to this care is limited among those 28 million people in the United States without health insurance.In addition, wait times for elective or non-emergency procedures in the United States are among the best in the world according to data from the Commonwealth Fund. In the United States, 80% of patients are able to get in to see a specialist within 4 weeks, the best among the measured countries. 68% of patients are able to have elective surgery within 4 weeks in the United States, the second best among measured countries behind France. Wait times very widely from country to country and in some countries, wait times are generally very good even as they provide universal coverage. The wait times in other countries are now being measured and, in some cases, guaranteed, and the gap in wait-times between countries with universal coverage and the United States is shrinking.Lastly, the United States is the leader in the development of new medical innovations, technologies and therapies. According to data from SciVal Analytics, about 40% of articles published in medical journals occurred in the United States. In addition, a study by the libertarian Cato Institute demonstrates that in three of four categories of innovation, “basic science, diagnostics, and therapeutics — the United States has contributed more than any other country, and in some cases, more than all other countries combined”. Nicholas Kristoff claims here, without citation, that “The top five American hospitals conduct more clinical trials than all the hospitals put together in any other country in the O.E.C.D”. Innovations have led to treatments and technologies that extend life and improve quality of life. Our profit motivated system provides the incentives for innovation and these innovations are exported all over the world. But they are also one of the reasons that health care in the United States is so danged expensive. And it’s not clear whether the positive trade-offs for innovation are worth the cost.So in summary there are good things about the United States health system. There are always trade-offs and the US does okay by some measures. But we cannot forget that most of the benefits mentioned here are accrued to those that have good health insurance. We have the most expensive system in the world and yet manage to fail to provide insurance coverage to over 28 million American’s. I think, despite some of the strengths, we need a system of healthcare that will provide access to care regardless of ability to pay and that will allow people with pre-existing conditions to be covered.I favor a market-based approach to universal or near- universal coverage such as those offered by Avik Roy with the Foundation for Research on Equal Opportunity or my own modest proposal which you can read about here.NOTE: I initially had a fourth bullet point related to the quality of the medical education system in the United States. Many people claim that the United States has the most well trained physicians in the world which is why so many from other countries apply to come to the United States for their training. Interestingly, most recent data dispels this notion. Foreign trained doctors perform very well in both standardized testing and in clinical outcome measures. Frequently, they out-perform US trained physicians. This is encouraging and should lead to policies to allow many more foreign trained physicians to come to the United States to help keep the cost of care down as well as to help overcome the critical shortage of physicians, only expected to get worse over time, in the United States.

First, a bit of a deep dive into global numbers is necessary to properly contextualize US infant mortality rates; not high per se but certainly higher than expected compared to several countries with similar or even much lower GDP per capita.Specifically, the 2018 US neonatal* mortality rate of 3.5 deaths per 1000 live births is higher compared to not just Japan but also several less wealthy countries. These numbers become even more interesting when examined in light of rates back in 1990 when the US rate was 6 (table below using data from 1).*Neonatal mortality rate: probability of dying between birth and 28 days of age, expressed per 1,000 live births.Similar trends apply to infant mortality rates which typically include mortality of neonates, under-5 and children (5 to 14 year olds). The upshot is less wealthy countries such as Poland and Slovakia that spend far less per capita on healthcare than the US and which had much higher infant mortality rates in 1990 could nevertheless reduce their rates by 2019 to such an extent that the US ranked below them at an embarrassingly low 33 out of 36 OECD countries (below from 2).In light of such data, the question needs to be modified to 'Given how wealthy it is, why does the Unites States continue to have such unexpectedly high infant mortality rates?'.Obviously only one factor couldn't possibly explain such a complex issue. Instead, many stubborn structural and cultural idiosyncrasies set the US healthcare system apart from practically all others, especially in ways that adversely impact the outcome of birth even as it is by now well known that US healthcare spending per capita far outstrips all other countries by an increasingly wide margin. Here are some factors that contribute to less than optimal maternity and birth-related outcomes in the US.Perverse incentives make US workplaces hostile to maternity needsCurrent incentives make US workplaces singularly hostile to pregnancy and childcare. Being lackluster to say the least, current US regulations are unable to effect beneficial social and cultural changes in this regard.The US is the only developed country without mandatory paid maternity leave.~25% of new US mothers return to work within 2 weeks of giving birth (3).It's telling that the few big US and multinational corporations that do offer maternity leave to US workers do so in the form of short-term disability (4). Surely, giving birth isn't a disability! Such a mindset only serves to emphasize that the US is a long way away from considering birth in a more humane and natural fashion.For example, France has a maternity care system where nurses make house calls after a baby is born (3).Consider the UK where new mothers can avail themselves of at least 6 months time off (4).As things stand today, only the very affluent could realistically consider such options in the US.Stark and steep racial, geographic and inter-state disparities in socioeconomic status and access to good quality healthcare further conspire to help ensure that both maternal and infant mortality rates stay relatively high in vulnerable US communities.A 2017 comparison of black versus the rest showed a shockingly high average of >11 neonatal deaths per 1000 live births for black women, >2X higher than for babies born to white women (5). No wonder then that black mothers and their babies are in crisis mode in various American communities (6, 7). Not just black women, infant mortality rates are also higher among American Indians, Alaska Natives and Pacific Islanders (8).Deepening rural versus urban divide in accessing adequate healthcare. With profit making the dominant idea in US healthcare, no surprise that hospitals and healthcare clinics continue to close down across the rural US as its population empties out. Since medicalized births dominate US maternity, this means women living in rural areas often have to travel further, sometimes even 100s of miles, to even access pre, peri and antenatal care (9, 10).In 2019, Mississippi had the highest infant mortality rate of 8.6 deaths per 1000 live births, >2X the rate compared to Massachusetts at 3.8, which had the lowest (2).Giving birth is more expensive in the US than anywhere else in the worldAlready back in 2013, a New York Times article reported that US hospital birth costs an average of ~$3400 out of pocket (11). News reports suggest that many American women and families are even now forced to declare bankruptcy after giving birth (12, 13).Contrast this state of affairs to Finland's average of just ~$60 (14). And yes, Finland has universal healthcare coverage.Thailand and Rwanda's examples show that universal healthcare coverage can help bring about a steep drop in neonatal mortality (from 21 and 41 per 1000 live births, respectively, in 1990, to 5 and 15.9 in 2018), with an unprecedented abolition of historic disparities between poorer and richer regions in Thailand, according to Amartya Sen (15).In his book Pathologies of Power, Paul Farmer contrasts Cuba's healthcare, a country with universal healthcare coverage, to the US, a country famously lacking such coverage (16),That Cubans say, “We live like poor people, but we die like rich people”.And that Cuba's infant mortality rate is lower than even that in the Boston neighborhood of the prestigious Brigham and Women's hospital!Good quality US childcare is increasingly out of reach for many new parentsAt an average of ~$10000 per year, cost of full-time childcare for 0 to 4 year olds is so expensive in the US (17), it's becoming increasingly out of reach for many new mothers.Trustworthy data on US maternal mortality is also increasingly out of reachUS maternal mortality rates are perhaps the highest among OECD countries and in some states such as Texas, they appeared to be actually increasing and not the other way around; appeared because according to a 2017 ProPublica investigation (18), “Data collection on maternal deaths is so flawed and under-funded that the federal government no longer even publishes an official death rate”. Mind-boggling, that conclusion.The Texas example underscores the extent of this data collection crisis. After numbers showed that Texas maternal mortality rates doubled over just a two year period from 2010 to 2012 (19), a task force established to figure out what was going on found such “sloppy and erroneous data collection”... “that more than half of the deaths that were recorded as pregnancy-related that year were recorded that way in error” (20).CodaFor far too long, emphasizing the importance of American families has become an empty rhetorical tool cynically deployed to whip up primeval passions during US political campaigns even as in recent decades, actual US government policies and regulations have become increasingly hostile towards them.As long as the politically dominant thought in US society continues to pretend against all evidence to the contrary that childbearing, birth and child rearing are optional luxuries among a smorgasbord of consumer choices instead of common social goods necessary for human society to truly flourish, the US will continue to outspend other countries and yet get worse outcomes from healthcare spending on the natural processes of pregnancy and birth.Bibliography1. Every Child ALIVE2. 2019 Annual Report3. The Guardian, December 5, 2017. The Mother Load: America is failing mothers. Help us change that4. The Guardian, December 14, 2017. Your stories about motherhood in America: 'There are no social safety nets'5. 2017 Annual Report6. The Los Angeles Times, Ann M. Simmons, October 26, 2017. The quiet crisis among African Americans: Pregnancy and childbirth are killing women at inexplicable rates7. The Guardian, Leslie Casimir, June 26, 2018. Why are so many of San Francisco's black mothers and babies dying?8. What do we know about infant mortality in the U.S. and comparable countries? - Peterson-Kaiser Health System Tracker9. The Politico, Lisa Rab, October 3, 2017. Rural Hospitals Are Dying and Pregnant Women Are Paying the Price10. The New York Times, Jack Healy, July 17, 2018. It’s 4 A.M. The Baby’s Coming. But the Hospital Is 100 Miles Away.11. The New York Times, Elisabeth Rosenthal, June 30, 2013. American Way of Birth, Costliest in the World12. The Guardian, Jessica Glenza, January 16, 2018. Why does it cost $32,093 just to give birth in America?13. The Guardian, January 16, 2018. Bankrupted by giving birth: having premature twins cost me everything | Jen Sinconis14. The Cut, Gabriella Paiella, March 21, 2019. What It’s Like to Live in the Country Where Giving Birth Costs $6015. The Guardian, Amartya Sen, January 6, 2015. Universal healthcare: the affordable dream16. The Atlantic, James Hamblin, November 29, 2016. How Cubans Live as Long as Americans at a Tenth of the Cost17. The Guardian, Emma, December 16, 2017. How new moms are supported – or not – in France v the US: a feminist cartoon18. ProPublica, Robin Fields and Joe Sexton, October 23, 2017. How Many American Women Die From Causes Related to Pregnancy or Childbirth? No One Knows. — ProPublica19. The Guardian, Molly Redden, August 20, 2016. Texas has highest maternal mortality rate in developed world, study finds20. The Washington Post, Meagan Flynn, April 11, 2018. https://www.washingtonpost.com/news/morning-mix/wp/2018/04/11/texas-maternal-mortality-rate-was-unbelievably-high-now-we-know-why/Other references consulted for this answer:Papanicolas, Irene, Liana R. Woskie, and Ashish K. Jha. "Health care spending in the United States and other high-income countries." Jama 319.10 (2018): 1024-1039. https://www.oregonlegislature.gov/committees/hhc/WorkgroupDocuments/staff%20-%20(report%2005-23-2018%20meeting).pdfhttps://www.unicef.org/reports/levels-and-trends-child-mortality-report-2019Hug, Lucia, et al. "National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis." The Lancet Global Health 7.6 (2019): e710-e720. https://www.sciencedirect.com/science/article/pii/S2214109X19301639Thanks for the R2A, Gabriel Guzman.

Myth? Debunked? The question is framed to elicit a certain incorrect assumption and a pre-set ideal, while referencing just 1 article source. Admiration for the Canadian health care system is misguided. The Fraser Institute has documented for 2015, 55,000 cases of Canadians traveling to USA facilities, mostly for life-saving treatment. Allow me to jump in and clarify why 10’s of thousands of Canadians indeed flock to the USA for health care:Canada’s Health care system is ranked a lowly 30th according to WHO. Just think of that for a second. There’s 29 better countries. USA is also ranked low, but only because of its expense - not because of its quality, which is world class.Canada’s Universal healthcare system has created unfathomable line-ups, even for critical conditions. More people die from cancer and heart failure whilst waiting for procedures than any other developed countryThe sale of Critical Illness Insurance to 100’s of thousands of Canadians have given them the opportunity to seek immediate care ($$$ in hand) in the USA from their superior facilities.Remember, Canada only has 37 million people, so relatively speaking, no, you are not going to see the massive system in USA overwhelmed by CanadiansThe Canadian healthcare industry suffers from very low morale. There are a plethora of reasons why - which cannot be covered here.The Commonwealth Fund, a think tank, placed Canada last in timeliness of care. (last)Healthcare in Canada is not free. I live in BC, and mandatorily pay more than 130/mth for basic services. Ambulances, drugs, bloodwork etc.. etc.. are all charged to you personally.In summary, most Canadian that are faced with life-threatening conditions immediately look south of the border for treatment. When the average wait in Canada for a blood transfusion is 9 months - your choice is to either die in Canada or live because we have the option to go and pay for the treatment immediately in the great US of A.