May 17, 2007 — The U.S. health care system is "a dysfunctional mess," and politicians who insist otherwise look ignorant, according to a medical journal essay by a prominent ethicist at the National Institutes of Health.
"If a politician declares that the United States has the best health care system in the world today, he or she looks clueless rather than patriotic or authoritative," Dr. Ezekiel Emanuel wrote in Wednesday's Journal of the American Medical Association.
Emanuel, who supports sweeping health care reform, said the U.S. spends $6,000 per person per year on health care, an amount that is more than 16 percent of the nation's gross domestic product and more than any other country.
He also said Americans' average life expectancy of 78 ranks 45th in the world, behind Bosnia and Jordan. And the U.S. infant death rate is 6.37 per 1,000 live births, higher than that of most developed nations.
President Bush frequently has said Americans have the world's best health care system, but Emanuel stopped short of calling Bush clueless in his essay and during an interview with The Associated Press.
"I work for the federal government. You can't possibly get me to make that statement," Emanuel said in the interview.
Emanuel's proposal involves phasing out Medicaid, Medicare and employer-sponsored health insurance. Under his plan, all Americans would get a basic package of insurance, would choose their insurance carrier and could buy upgraded coverage. The program would be funded by a value-added tax of about 10 percent on businesses.
Democrats and Republicans alike have made the "world's best" claim. Democrat John Kerry did so when he ran for president in 2004, as did Republican Rudy Giuliani on the presidential campaign trail this year.
David Hogberg, senior policy analyst at the National Center for Public Policy Research, said a strong case can be made that the U.S. health care system is the best.
"It depends on what measures you use," Hogberg said. Life expectancy is influenced by many factors other than health care, he said, and nations measure infant death rates inconsistently. Other measures show the United States performing well, he said.
October 23, 2025 
