The national health debate, centered for the past several years on the efficacy and later the constitutionality of the Affordable Care Act, has been characterized by passionate discussions and diatribes focused on the controversy regarding the obligations of government to manage the health of its citizens even to the extent to which it intrudes on individual freedom of action. What an affluent society-one that can provide the wherewithal to improve healthcare-should be most concerned with ought to frame the content of the conversation about what kind of system do we need and what and how are we to pay for it. The means and mechanisms by which we should promote health, prevent disease, cure or at least treat illness and provide rehabilitation is by contemporary rhetoric often lost in the shuffle, at least in my view.

So if you will allow me, I would like to acquaint you with the health indices of other countries, most of which are similar to ours with respect to per capita income. Extensive information about the components of their health care is readily available from the files of the Organization for Economic Co-operation and Development (O.E.C.D.). Two years ago it had made available statistics for each of its member countries, providing an opportunity to scan a scorecard, if you will, comparing the American experience with others. It allows us to redirect our attention towards the transcendent concern of long term trends with enduringly relevant data focusing beyond immediate political issues and certainly beyond radiology and even organized medicine as a whole. This information offers an assessment over a 50 year span. In this two part evaluation, I will compare all 34 nations first and then in the second part concentrate on Japan as a counterpoise to the US.

The O.E.C.D. currently consists of 34 member countries. It includes Switzerland, Norway, Iceland and nearly all nations in the European Union, excluding Malta, Cyprus, Latvia, Lithuania, Bulgaria and Romania. Also not on its roster are all the countries resulting from the dismembering of Yugoslavia, except Slovenia, and the 15 nations who once constituted the Soviet Union. The ten other members include two from North America, the U.S. and Canada, two from Latin America, Mexico and Chile, two from Oceania, Australia and New Zealand, two from East Asia, Japan and South Korea and two from West Asia, Turkey and Israel. Other noteworthy non-members include Brazil, Argentina, Indonesia, Taiwan, Singapore, India, Pakistan and China. The population of its constituent countries varies from 300,000 in Iceland to more than 300 million in the U.S.

Since 1960, the O.E.C.D. has accumulated annual national health statistics. Not every country is represented by an uninterrupted skein of contributions to all of these indices. Not everyone has contributed yearly data, but by and large, especially in the last 15 years, the data are extensive even if not exhaustive. For most of the categories and for most of the countries the long term, and particularly, the recent records are robust.