This ranking is curious because the actual life expectancy of the average American differs very little from that of the average European. At birth, average life expectancy in the European Union is 78.7. For the average American it is 78. And this doesn’t adjust for factors that can affect the averages which are unrelated to health care, such as lifestyle choices, accident rates, crime rates, and immigration. Health isn’t entirely about longevity but it certainly is a major component. 

What is not mentioned by Moore, or others citing the WHO report, are the measures being used to rate the various countries and who is doing the measuring. There are many ways to nudge ratings in one direction or another that are not directly related to the actual item being measured.

For instance, one might produce a study on transportation. The purpose of transportation is to get people from where they are to where they wish to be. You might rate how quickly people can move, how cheaply they can move relative to their income, how conveniently they can move, and how free they are to move. 

You would think the United States would rate high in such a study. Americans tend to be wealthier than the rest of the world. There is widespread ownership of cars. Gasoline prices are lower than in most other countries. On average, the typical American can travel quicker, cheaper, and more conveniently than people in most parts of the world. But what if this index included other factors as well? For instance, if a major component was the percentage of commuters who use public transportation, that would push the United States far down in the ranking. A larger percentage of the people in other countries have no other option but public transportation. 

In 2000, when the report was issued, WHO was run by Gro Harlem Brundtland, a former prime minister of Norway and a socialist. She doesn’t think the results of a health system alone are important. Rather, she wants to know if the system is “fair.” In introducing the WHO report she wrote that while the goal of a health system “is to improve and protect health,” it also has “other intrinsic goals [that] are concerned with fairness in the way people pay for health care.” She is clear about the ideological factors she thinks are important: “Where health and responsiveness are concerned, achieving a high average level is not good enough: the goals of a health system must also include reducing inequalities, in ways that improve the situation of the worst-off. In this report attainment in relation to these goals provides the basis for measuring the performance of health systems.”

True to her ideological roots, Brundtland prefers socialized medicine over private care. Drawing her first conclusion about what makes a good medical system, she declares: “Ultimate responsibility for the performance of a country’s health system lies with government. The careful and responsible management of the well-being of the population—stewardship—is the very essence of good government. The health of people is always a national priority: government responsibility for it is continuous and permanent.”

One WHO discussion paper states, regarding “fairness” in financing, “we consider only the distribution, not the level, as there is no consensus on what the level of health spending should be.” Equal results, not necessarily good results, are the focus. 

When Moore or others refer to the WHO index as proof that private health care doesn’t work, they aren’t being totally honest because they fail to disclose that the index lowers the scores of systems that don’t satisfy socialist presumptions.

A Second Rigged Study

The New York Times in August editorialized that American health care “lags well behind other advanced nations.” The newspaper relied in part on the WHO rankings as proof. For the rest, it relied on a more recent study by the Commonwealth Fund. But that study, which compared the United States to five other wealthy countries, has weaknesses similar to the WHO study.

The Commonwealth Fund marked down the United States partly because “All other major industrialized nations provide universal health coverage, and most of them have comprehensive benefits packages with no cost-sharing by the patients.” Again the American system loses points because it doesn’t provide socialized medicine. And the Times neglected to note that “no cost-sharing” means the people have paid through taxes whether they receive the care or not. 

Non-Emergency Visits

The United States also was penalized because seeing a physician for non-emergency reasons is harder to do on nights and weekends than in the other five nations. The Fund said “many report having to wait six days or more for an appointment with their own doctors.” 

The survey didn’t look at the treatment of serious conditions. Waiting weeks or months for chemotherapy is not held against a health-care system, but waiting a few days to have a check up is. Waiting time for “elective” surgery is counted (the United States was a close second to Germany), but waiting time for non-elective, serious surgery did not count, though that is precisely where socialist systems do the worst.

This issue is not unknown to the Commonwealth Fund. In 1999 it published The Elderly’s Experiences with Health Care in Five Nations, which found significant delays for “serious surgery.” Only 4 percent of the American seniors reported long waits for serious surgery. The rate was 11 percent in Canada and 13 percent in Britain. For non-serious surgery the differences were more obvious: 7 percent in the United States, 40 percent in Canada, and 51 percent in Britain. 

In the latest survey, the United States came in dead last for health “safety,” but many of the scores were only a few points apart. For instance, 15 percent of American patients said they “believed a medical mistake” had been made in their treatment within the last two years. Notice this is merely patient perception and nothing objective. But the best score was in Britain, where 12 percent said this.

The United States is also marked down because 23 percent of patients report delayed or incorrect results on medical tests they took. That is far worse than the best country, Germany, at 9 percent. But what constitutes a delay? If a result is expected in a week but takes two, that is a delay. But if it is expected in three weeks and arrives then, that isn’t a delay. Thus what constitutes a delay depends on expectations, leading to counter-intuitive results.

The United States also lost credit because fewer Americans report having a regular doctor for five years or more. But Americans are more mobile than many other people. CNN reports that Americans move every five years on average. In comparison, Britain has a moving rate of 10 percent a year, or an average of once a decade. And 60 percent of those move about three miles.

Freer to Change Doctors

Americans are also freer to change doctors if they wish. Britain requires patients to sign up with physicians, and once they do so, they are pretty much stuck unless they want to end up on the waiting list of another physician. Patients often have to wait to get on the books of a physician and only then can they be treated; that is, they wait to get on a wait list. This is true even for heart transplants. The inevitable waiting is a disincentive to change doctors.

Another measure used by the Commonwealth Fund is centralization of medical records. If a country has a system that allows doctors anywhere to tap into the patients’ records, it is rated higher. The United States has no centralized database and so is rated lower. Many Americans may prefer to have their records private and dispersed. When the Clinton plan was proposed in 1993, one of the rallying points that helped defeat it was the centralization of health records.

Out-of-pocket expenses were counted against a system as well. In socialized health care these expenses are zero or very low but are replaced with taxes. Taxes, however, don’t lower a country’s score because the care “is free.”

Countries were also judged on the number of patient complaints. But different cultures have different attitudes toward complaining. Jeremy Laurance wrote in the Belfast Telegraph recently that the National Health Service needs “a healthy dose of American belligerence.”

Finally, the United States is ranked last among the six nations surveyed  in infant mortality. What is not discussed is that nations define infant mortality differently. Any infant, regardless of size or weight or premature status, who shows sign of life is counted as a live birth in the United States. Germany, which ranks number one in the Commonwealth Fund survey, doesn’t count as a live birth any infant with a birth weight under 500 grams (one pound). How valuable is a comparison under those circumstances?

One could easily design a survey that would rank American health care high and other nations low. But this does not mean the American system is what it should be. Its successes and innovation can be attributed to the vestiges of freedom, but government has saddled the system with so much intervention that it is far from market oriented. Instead of worrying about irrelevant international rankings, we should be working toward freeing the medical market.

This observation is not limited to economics. It can be applied to all areas of human study, including political philosophy. Once learned, that lesson can prevent a great deal of human hardship. Take, for instance, a concept promoted by left-wing environmentalists, “sustainable development.” The term itself actually sounds rather pleasant. Most of us—oddly, excepting those who use this term most often—support development, and we want it to last.

But to understand this concept we have to look beyond the short term. We have to ask ourselves what are the ramifications and logical conclusions of this theory. First, we have to be clear about what is usually meant by the term. It most often means the preservation of resources for future generations. The concept originated with the United Nation’s World Commission on Environment and Development, the Brundtland Commission, named after its socialist chairwoman, Gro Harlem Brundtland. The commission members said sustainable development “meets the needs of the present without compromising the ability of future generations to meet their own needs.”² The more vocal proponents refer to the consumption of resources today as “stealing” from future generations.

The advocate of individual rights immediately has problems with this theory. It not only postulates that rights belong to a collective but to a collective that doesn’t even exist. By definition, a future generation is a group of people not yet born. As the saying goes, “Tomorrow never comes.” The reason is simple: when tomorrow does arrive it ceases being tomorrow and becomes today. So it is with future generations. Once an individual is actually born he ceases to be a potential member of a future generation and becomes the actual member of the current generation.

If we accept the theory that resources must be preserved for future generations, then we assume that groups of unborn individuals have a right to those resources. But, strangely, this right vanishes the moment those individuals are born, because each future generation, once born, is saddled with the same obligation to yet-still-unborn generations. Moreover, while advocates of sustainable development argue that the unborn have a right to a resource, they also argue that many members of the same future generations should be prevented from coming into existence—that is, they tend to support government intervention meant to reduce the size of future populations. Apparently, unborn generations have property rights but no right to life.

Another problem for the sustainable development theory is that we don’t know what resources will be needed in the future. A hundred years from now people might still be using petroleum to heat their homes or power their cars. But they might not.

As a boy I often visited my grandmother in Chicago. She had a large old house not far from Lake Michigan. On one side was a trap door with a metal slide leading to the basement. Periodically, a truck would pull up and drop a large load of coal down the slide to the basement. There was always a massive pile of dirty, smelly coal down there. The basement was covered in fine coal dust. A large furnace, which required constant maintenance, generated steam for the radiators and for hot water. Every so often my grandmother would have to shovel coal into the furnace—otherwise there would be no heat.

A policy in my grandmother’s day to save coal for future generations would have required her to use much less. She would have been colder—but no one would have been better off. If that old house still exists, I doubt it is heated with coal. Her children don’t use coal today. Coal conservation would have been a lose-lose situation.

Similarly, if we had made policies 20 years ago based on consumption patterns then, we would have worked hard to preserve copper supplies for telephone use. Yet today few phones use copper wires for transmission. They use fiber-optic cables. A huge percentage use no transmission wires at all.

Why sacrifice the well-being of living people for the sake of nonexistent possibilities? Why make sacrifices when we know for certain that much of what is used today will be unwanted tomorrow? Certainly there are resources used today that will still be required in the future, but demand may be significantly less relative to supply. In fact this is precisely what has been happening with virtually every natural resource.

Impossible Projections

In just a short time the resource needs of our generation have changed dramatically. It is unlikely that any of us would have correctly projected today’s resource requirements. Yet sustainable-development advocates project future consumption over generations, centuries, perhaps millenniums.

To complicate matters even more, whether something is or is not a resource depends entirely on human ingenuity. Once, oil on one’s property devalued the land. It killed the cattle, made agriculture difficult, smelled bad, and had no useful purpose. The negative value turned positive when someone figured out how to use it. A bane became a resource. As human knowledge increases, more and more substances become resources.

The basic premise of sustainable development theory is that the supply of all resources is limited across time. While this has been challenged, let’s accept the premise for the sake of argument.

The goal of sustainable development is to preserve “enough” of a resource for future generations. But how much is enough? And for how many generations? While a meteor, or some other catastrophe, may wipe out the human race, we must assume infinite future generations.

But this assumption leads to problems. If we figure that resources are finite and consumption is not, then we have to recognize that any level of consumption will eventually mean that some future generation will have to do without. Logic would seem to demand that we consume nothing at all. And this would apply not only to our generation but to every one that follows. Thus the very people for whom we would be preserving the resource are themselves required not to use it. But if they have no right to use the resource, then our consumption of it today could not possibly be considered “stealing” from them. (The advocates of sustainable development, coming from the apocalyptic Green movement, never consider the role of prices and market incentives, which prevent any needed resource from being depleted.)

Would we actually improve the life of future generations? As illustrated by my grandmother’s use of coal, this may not be true. In fact, we could diminish the well-being of future generations by limiting consumption today. Coercive limiting of petroleum consumption would no doubt make us poorer than we would have been. It would also reduce the well-being of our children and their children. Yet technological changes will no doubt reduce our need for petroleum, as it has been doing for decades. In other words, forced conservation would lower our living standards, and that of following generations, in order to preserve a resource that we’ll need less and less of in the future—and maybe not at all.

Moreover, forced reduction in consumption today may well stifle the very technological innovations that would eradicate the need for petroleum. Innovation requires investment, and investment requires wealth. If we reduce wealth we reduce investment and, in all likelihood, innovation. We may actually increase the consumption of a resource over the long term by reducing its usage in the short term.

The “right” set of environmental regulations just a couple of decades ago could have prevented development of fiber-optic, cellular-telephone, and Internet technology. As a result, vast quantities of copper, paper—and trees—would still be required today for communication.

Of course, no one misses a technology that never was. It is only by looking backwards that we can see what effect such policies would have had on us had they been foolishly implemented by our parents or grandparents.

Other Stifling Effects

Sustainable development would stifle innovation in other ways as well. It is supposed to guarantee “equal” access to resources today, tomorrow, and a hundred years from now. The idea is to prevent resource crises. Yet crises often bring new technologies into existence. Price controls in the United States artificially stimulated demand for oil during the 1970s and caused shortages. When deregulation later increased prices (temporarily), consumers demanded new technologies to reduce consumption. Cars built before the crisis consumed more fuel per mile than those built since. (Higher prices also summoned new supplies.)

Thus, in a free market, crises contain the seeds for their own solutions. Often the solution dramatically reduces demand for the resource in question and sometimes eliminates demand entirely.

But the ebb and flow of markets cannot be allowed to operate under sustainable development, which requires state control. This inevitably means that price and profit signals will become distorted, causing both consumers and producers to miscalculate the availability of resources and forcing them into patterns contrary to their actual well-being.

Sustainable development is one of the most perilous theories around. It can’t even answer the basic questions it raises. It can’t tell us what resources to sustain. It can’t tell us for whom they should be sustained. It can’t tell us how long such sustainability should be maintained. It merely makes unsupported assertions and calls for centralized state control of economic resources, preferably on a global scale.

Apparently, small is beautiful to the Greens, except when it comes to government. Then “the bigger the better” is the rule. While “sustainable development” sounds good, it actually is a hollow phrase with little or no meaning but with some dubious, if not dangerous, implications.

Notes

1. This, of course, is the “one lesson” immortalized by Henry Hazlitt: “the art of economics is looking not merely at the immediate but at the longer effects of any act or policy: it consists in tracing the consequences of that policy not merely for one group but for all groups.” Economics in One Lesson (San Francisco: Laissez Faire Books, 1996 [1946]), p. 5.
2. World Commission on Environment and Development, Our Common Future (Oxford: Oxford University Press, 1987), p. 8.