International Health Care Comparisons: The WHO Numbers
That version of the claim is at best misleading. There is a measure, "Overall Health System Performance," on which the U.S. ranks 37. But it is a measure that takes expenditure into account, downrating the U.S. precisely because it spends so much. The rank is 37 not in spite of the level of expenditure but because of it.
There is another measure, "Overall Goal Attainment," which does not take account of expenditure; on that the U.S. ranks 15, still behind a fair number of other countries but not nearly as many. So a more accurate claim would be that the U.S. ranks 15 despite its large expenditures.
Even that is misleading, however, because if one actually read the notes explaining how the numbers are calculated it turns out that "Goal Attainment" is based on five different characteristics of a health care system, only one of which is an (imperfect) measure of how much health care the system provides.
That one, "Health level," is average life expectancy, adjusted to make a disabled year count for less than a healthy year. It is an imperfect measure because life expectancy depends not only on health care but on lifestyle variables such as smoking or obesity and on factors such as the death rate from murders and traffic accidents. And even to the extent that it depends on health, health is not entirely a matter of health care; some environments are more unhealthy than others.
A second variable, responsiveness, measures how good people in each country think their health care system is, as determined by questionaires. On that one, interestingly enough, the U.S. comes in first—a fact that ought to worry the President. If Americans think the current system works better than any existing alternative, as they apparently do, they may not look favorably on changes to it.
The other variables all have to do with distribution. "Health distribution" purports to measure how unequal the distribution of health care in each country is. The authors wanted to use distribution of life expectancy but didn't have the data to do it. Instead they used a measure, never clearly explained, of the distribution of infant survival, apparently of how many infants die at what point in their first five years. Even for that, the relevant data existed for only a minority of countries; for the rest the report substituted an estimate based on variables such as poverty level.
"Responsiveness distribution" was calculated from questionaires and apparently designed to measure the degree to which respondents believed that various groups in their country were disadvantaged with regard to health care.
Finally, we have "fairness in financial contribution," defined as how nearly health costs are distributed in proportion to income minus the cost of food. That measure is obviously biased in favor of state run health care plans, since in order for both health care and its cost to be distributed in the way the authors of the report want there has to be a sizable redistribution of cost from poorer families getting health care to richer families paying for it.
My conclusion is that the numbers produced by the report are very nearly useless for purposes other than propaganda, since they do not provide much information on how good the health care systems of different countries are at delivering health care.
In fairness, I should add that I don't have any proposal for doing a much better job of comparing international health care systems, given the data limitations when trying to look at 192 different countries. Ideally, one would want a value added measure, something like the difference between actual life expectancy in a country and what life expectancy would be if there were no health care system at all. But I don't see any practical way of generating such numbers. One could simply use life expectancy, but that has the problems I have already described. One can try to look at particular outcomes heavily dependent on health care; the U.S. apparently does very well measured by cancer survival rates. But neither approach really tells you what you want to know.