Each time I return to the United States, I am struck by how backwards my country seems in the field of health care. Backwards? You might wonder how I can make such a statement. After all, most Americans assume they have the best medical care in the world. Well, think about these two facts:

• The United States has the most expensive health care system in the world.
• Life expectancy and infant mortality statistics place the United States in the bottom quartile of industrialized countries.

Something is clearly wrong with the American health care system. We are not getting good value for what we spend. Politicians may argue why this is so, but if you have lived on the other side of the Atlantic, as I have for many years, the answer seems obvious. Here in Europe, governments make sure that health care is available to all their citizens, just as they provide adequate street lighting or good roads. It is taken for granted.

When I come back to America, I usually make a point of chatting with the driver of the airport shuttle bus that takes me into town, just as I habitually chat with London cab drivers. It helps keeps me in touch. One of the questions I have been asking the shuttle drivers on recent trips is what kind of medical insurance they have. Their answers trouble me.

On my most recent visit this week, the young man who drove me from Phoenix to Tucson told me he pays $250 a month for individual health insurance that has a huge deductible and so many limitations on coverage that he worries what would happen if he fell seriously ill. On a previous trip to America, my driver, an older man, said he had no health coverage at all. His employer did not provide it, and he could not afford to pay for it. His only access to a doctor was the emergency room. His predicament is not unique. Although the exact number is debatable, tens of millions of Americans are not insured.

How is it that European countries can provide universal coverage when the United States cannot? For one thing, health care in America has become a political football, endlessly debated but never resolved. For years, conservative politicians and some physicians have been campaigning against universal health care by telling us it is “socialized medicine.” That may sound frightening, but it's nonsense. If health care for all is “socialized,” so are universal roads and street lighting.

Moreover, the present American health care system (if you can call such a disorganized, inefficient, arrangement a “system”) is exceptionally expensive. According to Uwe Reinhardt, a Princeton economist who has studied health care costs, Americans spend nearly 40 percent more on health care per capita than other rich industrialized countries. Part of that excess spending is the administrative overhead imposed by the complex private health insurance system in the U.S. When Americans pay for private health insurance, they not only pay for the care they receive, but also for the company's marketing costs and profits. A recent McKinsey Global Institute study showed that public insurers have a much lower overhead. An earlier study comparing health care in Germany and the United States found that Americans spent more per capita on administration and received less per capita in actual health care.

How well do the European systems work? Fairly well, if you can judge by results. France has a system that mixes both public and private financing. Everyone is covered by national health insurance, to which both employers and employees contribute. The government picks up the tab for those who are not employed and are not covered by other family members. There are no exclusions for pre-existing conditions and the sicker you are, the less you pay; you pay nothing for chronic illnesses. The French system is in the red, but the World Health Organization ranks France number one in health care results.

Studies show the British are also healthier in many respects than Americans. Care under the British National Health Service is free at point of service, and is funded by taxes. Again, everyone is covered, but if you want, you can opt out of the system and pay for private care.

One of the arguments made by opponents of universal health care in America is that it would ration treatments, limiting the services that could be covered to those that government committees deem to be most efficient and effective. That happens to a limited extent in Europe, but far less than under most private insurance policies in America. And the United States imposes the most unfair form of rationing – by income and employment. Those who are not poor enough to qualify for state aid (Medicaid) or who do not have jobs that offer health insurance are not covered. In other words, the working poor get screwed.
The Obama administration has pledged to make health insurance affordable and available to all. If it can bail out the banks and rescue the home owners and auto makers, perhaps it can take care of the shuttle bus drivers.