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By Ira Sharkansky
 JERUSALEM—I do not know what surprises me more. That the debate over health care in the United States has provoked such extreme expressions, or that individuals I have known for a long time as well as some new internet acquaintances have trouble accepting my criticism of American health care.
As a mature social scientist I should not be surprised at either. I learned long ago that the intensity of ideology may know no limits; and that smart people can be parochial, admire what they have, and think it superior without looking elsewhere.
I have received messages claiming that Americans have the best medical care in the world, that severe criticism against the president's proposal is deserved, that the most extreme reflect a small undercurrent of unpleasant Americans, that data showing low American life expectancy does not reflect medical care but the sizable number of American untermenschen (an unpleasant German term used for Jews and other undesirables), that free enterprise is the essence of American society, and is prominent among the factors that explains the country's opportunities for medical innovations and medical care.
Where to start?
The World Bank is a source of measurements that are reliable for well-to-do democracies that make suitable comparisons with the United States. Its World Development Indicators show that among 23 countries from Europe, North America, Japan, Australia, New Zealand and Israel the United States scores lowest in life expectancy and highest in the incidence of infant deaths. At the same time, it scores highest in overall medical expenditures per capita. On government expenditures for health as a percentage of GDP it is middling, on the incidence of hospital beds it is the lowest, in the incidence of physicians it scores 15th out of 23, and it is middling in the incidence of children immunized against diphtheria, whopping cough, tetanus, and measles.
It is reasonable to conclude from these indicators that the United States as a whole is not getting high medical value for its expenditures. In American hospitals affiliated with university medical schools, it may be possible to find care as good as any in the world. However, indicators for life expectancy and infant mortality suggest that the average American falls below comparable populations in access to the best--or even good--care.
My own impressions of the current debate are similar to what appears in the Economist.
Americans may not realise how horrible their health-care debate looks to outsiders. . . . The partisan nature of today’s Congress looks mad to Europeans brought up to value consensus. Europeans also know that “European-style” health
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care does not include death panels prescribing euthanasia for grannies and are offended by the way such tosh is alleged in America.
Is it only a small underclass that is most extreme in attacking the president's proposal?
The most recent vice presidential candidate of the Republican party is among those pushing the envelope.
A great deal of attention was given to my use of the phrase 'death panel' in discussing such rationing . . . Despite repeated attempts by many in the media to dismiss this phrase as a 'myth', its accuracy has been vindicated. . . .The fact is that any group of government bureaucrats that makes decisions affecting life or death is essentially a 'death panel,
Attacks on socialism and claims that free enterprise is the secret of high quality American health care and medical innovations?
There already is a great deal of socialism, in one form or another, in American medical care. The National Institutes of Health are world leaders in the support of research. Research by drug firms relies on tax benefits. Overall, the United States does better in government expenditures for health than other indicators: it scores 13th out of 23 countries. Moreover, decisions about medications and medical devices by the Food and Drug Administration provide an international standard.
Many medical innovations come from American companies. However, there are also leaders among French, Swiss, and German companies. And it is an Israeli firm (Teva) that is a world leader in the production of generics that provide the low cost work horses of health care in numerous countries, including the United States.
In short, one can find excellent medical care in the United States. But health indicators strongly suggest that most American have no access to it. To date, free enterprise has not been the hero but the villain, in the form of insurance companies and HMOs that show more concern for profits than the public's health.
It is too early to predict what, if anything, will emerge from the congressional response to the president's proposals. The proposals and the debate are complex. That is the nature of health care. Individuals may lose some benefits currently enjoyed. That may be inherent in any legislation about social policy.
Americans' love of free enterprise shows itself in stinginess toward other Americans. The United States scores 21 out of 23 countries on the percent of Gross Domestic Product taken in taxes. It also scores lowest on a measure of income equality. The rich do well in the United States, on health care as well as other amenities. More than in other well-to-do countries is the high incidence of Americans who do not do well.
Americans condemn extremism, even while they score extremely low in the provision of health care, and are extreme in the rhetoric directed against health reformers.
It is Succoth. Build a succah and invite the neighbors. Chag sameach.
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