CARVILLE: National fitness |

CARVILLE: National fitness

Fitness is a comprehensive topic. We talk about personal fitness which involves the basics of diet and exercise. Follow the basics and you will be in good health, unless you get ‘sick.’

By sick, I mean struck down by some event such as diabetes, cancer, car wreck, other physical accident or more recently … the coronavirus. Since 78% of American workers live paycheck to paycheck, getting ‘sick’ dramatically increases the likelihood of bankruptcy and financial ruin.

‘Sick’ System

When we look objectively at our national health care ratings, we find a situation that is a disgrace.

According to the World Health Organization, the United States is rated 37th in the world regarding health services … right behind Costa Rica rated 36th. Canada is rated 30th while France and Italy are rated No. 1 and No. 2.

Nationally, we spend more per person on health care than other developed countries, yet we are last in health care performance. We spend three times more than Sweden, Germany or Japan, yet we have poorer results. As a nation, we spent $10,739/person/year on health care. France, which is No. 1, spent $4,902/person/year or 54% ‘less per person’ than we do, but with better results in 2018.

Compared to the other developed countries of the western world, the United States comes out last. Yes, last. Something is very wrong here.

Politics or Passion

Too often politics, not compassion, dominates the health care debate. France (rated No. 1 in the world) spends about 12% of its GDP (Gross Domestic Product, which is the total of all goods and services) on health care. The United States (rated No. 37) spends 18% of GDP on health care. Estimates are that in 2020 it will be 20%… which means that one of every five dollars spent in America will be spent on health care.

Unless something changes, the estimate for 2050 American health care costs is 28% of GDP … leaving even less for national security, education, housing, food et cetera. What kind of a nation will we have then?

Brains not Bombast

It is time to apply reason and compassion to solve the situation. If other nations in the world can do it, why can’t we?

The arguments such as ‘it’s socialism’ or ‘we can’t afford it’ or ‘we have the greatest health care in the world’ are all bogus. They are obfuscations which do not lead to clear thinking and real solutions.

There are 36 countries in the world which have higher rated health care systems than we have. Some are ‘single payer’ but most have a combination of national health care coverage and some form of private insurance. France, for example, has a national health insurance program, but the physicians are in private practice. Supplemental coverage may be purchased from private insurers.

Switzerland and Taiwan have single payer models with high-quality care at stunningly low costs. Switzerland spends 11% of GDP on health care while Taiwan spends only 7% of GDP on health care.

Germany has a universal, multi-payer system which is a combination of 77% government funded and 23% private insurance. The German health care system has a record reserve of 18 billion Euros which makes it one of the ‘healthiest’ health systems in the world.

It is clear that a health care system doesn’t have to be ‘either or’ – totally government run or an unchecked free market. But whatever the system, we must start working on real solutions now.

Future of America

We live in a highly competitive world. Success in that world depends upon an educated and healthy populace. We need healthy, young people educated in STEM subjects (Science, Technology, Engineering and Mathematics). We are currently failing in both health and education.

China graduated 4.7 million students in STEM subjects last year while India graduated 2.6 million. Russia (a population of only 144 million and a GDP of only $2.01 trillion) graduated 561,000 STEM students. The United States (population of 331 million and a GDP of $15.68 trillion) graduated only 568,000 STEM students.

So, Russia, with a population 56% lower than the United States and with a GDP of only 13% the size of the United States, graduated almost as many STEM students as the United States.

National Fitness

National Fitness depends upon the same issues as personal fitness: education and commitment.

We must dedicate ourselves to finding solutions to America’s broken health care system and to its broken educational system. They are linked together.

If we are to have a vibrant, healthy democracy in the 21st Century, we must have an informed, educated and healthy population.

If we don’t start solving our major problems today, the future will not be as good as the past. Maybe it’s time that you got involved in the solution. Time is not our friend!

Phil Carville is a co-owner of the South Yuba Club. He is happy to answer questions or respond to comments. He can be reached at

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