Americans spend almost twice as much on health care as other developed countries, but generally have poorer health outcomes, according to a study released in the Journal of the American Medical Association. The analysis of data from 2013-2016 compared the U.S. with ten high-income countries: Australia, Canada, Denmark, Germany, France, the Netherlands, Japan, Sweden, Switzerland and the United Kingdom.

The study found that in 2016, the U.S. spent 17.8 percent of GDP on health care while other countries only spent 9.6 percent (Australia) up to 12.4 percent (Switzerland). All 10 of the other countries essentially covered every citizen (99 to 100 percent) with health insurance. The U.S. covered 90 percent of citizens with health insurance and had the highest proportion with private insurance.

Americans easily had the highest rate of overweight and obese citizens (70.1 percent) and the highest rate of infant mortality. U.S. life expectancy is the lowest of developed countries at 78.8 years and for the first time in modern history, future Americans will live shorter lives.

However, many pet theories for this rapid escalation of American health care costs were disproved. Some had blamed Americans for going to the doctor too often, but the U.S. has roughly similar rates of utilization as the other countries. With 2.6 doctors and 11.1 nurses per 1,000, our workforce was roughly equivalent to the other 10 countries. So why the higher cost?

Medical doctor salaries were much higher. U.S. general practitioners average over $218,000 per year while pay ranges from $86,607 to $154,126 in the other countries. Nurses in America are also paid more. Even more dramatic is in the cost of pharmaceuticals, where Americans average spending $1,443 per capita annually compared to $466 to $939 in other countries. A few procedures did emerge as perhaps over-used in America, mainly knee surgery and C-sections. We also use more MRI and CT scans.

But a really important difference was “administrative costs” that gobbled up 8 percent of the U.S. health care bill compared to only 1 to 3 percent in other countries. This points the finger at our bureaucracy of private insurance companies and at the complex electronic coding and added personnel required to manage continuously-updated digital record-keeping.

However, all of these measurable factors only accounted for 60 percent of the added cost of American health care, leaving 40 percent yet to be explained.

I propose that the majority of the remaining excess cost of American health care can be attributed to the steady decline in science literacy.

What was not measured — and admittedly, it would be hard to measure — is the average citizen’s understanding of anatomy and physiology, our owner’s manual. Across the United States, only a few states train high school teachers in biology. Instead, most train one-size-teaches-all science teachers who receive little or no coursework in anatomy and physiology. Even in Kansas where we do license separate biology teachers, the large research universities do not require human anatomy and physiology. As a result, you cannot teach what you do not know.

This is not the case in the other developed countries where science makes up far more of the K–12 curriculum. For instance, in Germany, an average citizen can self-refer to a medical specialist because they have studied human anatomy and physiology as well as basic microbiology and diseases. In China, a mere high school graduate has learned more science than U.S. elementary teachers learn by the time they graduate college.

The result is that we have a population that is profoundly ignorant about their health. This basic medical illiteracy in turn costs us in bad lifestyle choices and wrong health care decisions. In addition, medical illiteracy contributes to indirect costs in higher medical insurance due to ignorant jury decisions. Until we add a year of basic anatomy, physiology and microbiology to our high school curriculum, train enough biology teachers and start graduating knowledgeable patients, we will continue paying this stupidity tax.


Dr. John Richard Schrock is the editor of the Kansas School Naturalist and former chairman of the Biology Department at Emporia State University.