At first blush you might think this is an easy question to answer: which is the best health care system? The American? Our own dearly beloved NHS? The French, Swedish, German, Canadian systems?

Then the real problem kicks in: best according to what criteria? Do we want a system which provides startlingly good care, like the US one, but patchily? One like ours that is a bureaucratic monstrosity but provides not all that terribly bad care to all? Do we go further with equality like the Canadians and near ban anyone at all from getting more than the government is willing to provide? Do we get the counties to run it, like the Swedes and the Danes?

We might even go further: part of the huge cost of the American system is that for those insured they’ve squeezed almost all of the waiting out of the system. The Rational Planner might not think that this cost is worth it but the Americans themselves seem very attatched to that part of their system. Is not having to wait a sufficiently desirable part of a health care system that huge amounts should be spent upon achieving that goal?

Your guess is as good as mine quite frankly: the criteria by which you judge these systems will depend upon your extant prejudices, little else.

But how are those international comparisons of health systems done then? What criteria do they use? The WHO for example, telling us that France is top, the UK 18 and the US 37? Glenn Whitman has done the work here. Only 37.5% of the index comes from actually measuring health care itself. The rest is one or another measure of how that care is distributed (ie, equally or unequally) and how it is financed.

When 62.5% of the weighting is given to the things we know that the US system is specifically bad at it’s a surprise to see it quite as high as 37 th actually. The level of treatment must be pretty good to get it that high.

But much more than that, when 62.5% of the weightings are given to the things that the NHS is supposed to be good at, was specifically designed to offer: financial fairness and equal care for all and still it only comes 18th? Well, it must actually be pretty bad at providing the actual health care, the health level and responsiveness, mustn’t it?

This might be a clue as to why no one has ever bothered to copy the British health care system for all we’ve been told for decades that it is the wonder of the world.