WHO on health care - the US ranks 37th, but why?

The WHO assessed the world's health systems and found that the US ranked 37th. This number has been bandied about a great deal, and my fellow blogger at "What the Hey", after hearing this number on "Sicko", followed her curiosity to find out where it came from. The result is a thought-provoking post that I hope will be followed by a post of her own thoughts on the WHO assessment.

Please read the WHO article on the assessment for yourself. Once you do, read on to hear my own thoughts on the article.

The main thing I want to draw attention to is this paragraph:
"In designing the framework for health system performance, WHO broke new methodological ground, employing a technique not previously used for health systems. It compares each country's system to what the experts estimate to be the upper limit of what can be done with the level of resources available in that country. It also measures what each country's system has accomplished in comparison with those of other countries." (emphasis mine)

The bolded part is confusing and inappropriate, unless this explanation of the measurement gets passed along every time someone quotes the ranking of a country from this report. When we hear that the US is ranked 37th, we expect that the US is being ranked against only the other countries, not also against the level of resources available in that country. We automatically say, "With our resources, why aren't we #1?" The answer is, it is because of our resources that we are so very low. Because we have much, much is being expected of us. This fact needs to be made clearer when people pass these facts along. Even better, the WHO should focus on a ranking based on just the italicized (by me) portion, and give the other ranking as a supplementary statistic.

My other issue is that there was no mention of weighting the indicators. Overall health and distribution of health were only two of five indicators - were they also only 2/5ths of the weight? In my opinion, these indicators are far more important than the others. These indicators represent the goal of a health care system: healthy people. The other indicators - responsiveness, distribution of responsiveness, and distribution of cost - seem to me to be fundamentally different, more ways to reach both overall health and a good distribution of health than actual ends in and of themselves. I also do not think distribution of cost should be included, but rather that the WHO should measure people's ability to attain healthcare at all after meeting their other necessities. Otherwise, they are measuring not the health care system itself, but people's access to luxeries after buying health care - which is not the sole perogative of the health care system.

I thought this statement was a bit strange: Dr. Frank said, "What we are seeing is that in many countries, the poor pay a higher percentage of their income on health care than the rich." Why is this, specifically, a problem? The poor also pay a greater portion of their income on food and on housing, I would guess. It is no surprise to me that the poor spend a higher portion of their money any given necessity than the rich. As long as the combination of necessities (including taxes) does not exceed 100% of the amount of money a person / family can reasonably earn, I think that there is no moral obligation to fix the situation. While I would be thrilled to support a national policy that seeks to free up, say, a minimum 5% of EVERYONE's income for luxeries after necessities like health care, food, utilities, and shelter (assuming the person is making a reasonable effort to earn the cost of necessities + 5%) - I don't feel we have a moral obligation to do so.

I guess that my question is, why does health care get preferential treatment over food and shelter, such that all *should* pay a flat portion of their income? Why don't we tax to provide all with basic food, as well? And shelter? How many countries give tax-supported food and shelter universally? I'm skipping the standard discussion of socialism here. My point is that, while I support universal health care in the US, I do not think that a health care system that results in the poor paying a higher portion of their income to health care is innately less fair - and therefore, the WHO should not be measuring this "indicator". I believe that universal health care is better, but that is more because I believe that improving quality of life for the poor in general benefits all of society greatly. There are many ways we can spend money improve the quality of life for the poor to get closer to achieving the maximum net benefit for society; universal health care simply seems to be the easiest at the moment. However, we could instead provide universal food and housing vouchers, freeing up money to be spent on healthcare instead - just as one example, I'm not seriously proposing we do this.

I am also suspicious about other hidden values (beyond the clear bias towards universal health care / evenly portioned health care costs), although this one article doesn't have the information I need to assess this. I want to know what "respect for persons (including dignity, confidentiality and autonomy of individuals and families to decide about their own health)" includes, for example, under responsiveness. I want to know if that includes things like easy-access abortion "rights" for women (at the expense of the fetus' right to live, and the doctor's right to keep his job without performing what he may believe is murder, etc.) - as just one example of a possible innapropriate attempt to measure healthcare quality that might fall under this bucket, but is based on a set of health values that is not universally shared. I personally would argue that enabling abortion decreases health, since it ends many human lives that could have lived, if only there were a better support system for the woman's pregnancy and the child's care after birth. The WHO assessment may not include such non-universal ideas of health under responsiveness; however, I want to find the time to track the information down so I can know for sure.