Another political non-lie

I've been hearing an awful lot about health care reform in the US this summer - even from British outlets. It's all a bit disconcerting, especially the riotous town hall meetings and the arguments that seem unmoored from the facts.

FactCheck.org has a nice piece debunking seven falsehoods related to this debate, two from proponents of reform and five from opponents.

I'm interested, though, in a claim that is linguistically interesting because it is not actually a falsehood, though it is not unambiguously true, either. That is, the claim that the United States has the best health care system in the world. I've heard this claim made several times in the past few weeks; I've also heard it decried as a lie. But the claim is not really a lie in the sense of a deliberate recitation of an untruth with the intent to deceive. I think that most people who repeat the claim sincerely believe it, and most who call it a lie sincerely believe that it is untrue. The problem may be that there is no shared definition of either best or health care system.

On one hand, some of the most cutting edge medical care has been developed at US hospitals. The first successful heart-lung transplant was performed at Stanford University Medical Center; the first mechanical heart implantation was carried out at Texas Heart Institute. In terms of individual medical treatments, the United States has been on the cutting edge. In 1979 Mohammad Reza Pahlavi, the Shah of Iran, famously insisted that his gallbladder disease be treated in the United States. While that may be old news, the elite still seem to come to the US for treatment: according to Marketplace radio, wealthy foreign patients spend billions of dollars at US hospitals each year.

On the other hand, 28,000 infants die in the United States each year; that's a higher infant mortality rate than Hong Kong, New Zealand, Cuba, or most of Europe. According to the 2008 CIA Fact Book, overall life expectancy in the US is about 78.1 years. That's higher than in many poorer countries in Latin America or Africa, but lower than the EU, Japan, Korea, Canada, or Israel. The US ranks about 30th in overall life expectancy among United Nations member states.

So, if best health care system means "most cutting-edge in terms of treatments available," then the US may be near the top. If it means "best society-wide outcomes," however, the US is not at the top and may actually be below average.

[UPDATE: Writing in the Washington Post on August 23, T.R. Reid calls the claim that "America has 'the finest health care' in the world" a myth, and states flatly, "We don't." He goes on to point out that society-wide outcomes are better in most "advanced" countries.

In the next paragraph, though, he suggests that the US has "the best-educated doctors and nurses, the most advanced hospitals, [and] world-class research".

You would think that I should have something clever to say about that. Hm.]