Phil Carville: National fitness |

Fitness is a broad topic. I usually talk about personal fitness, which includes the basics of diet and exercise. Follow the basics and you will be in good health unless you get “sick”.

By ill, I mean being struck down by an event such as diabetes, cancer, a car crash, or a physical accident. With 78% of American workers living paycheck to paycheck, “getting sick” dramatically increases the likelihood of bankruptcy and financial ruin.


Health assessments include doctors, hospitals, dentists, psychology, nursing, physical therapy and more. If we look objectively at our national health care assessment, we find a situation that is disgraceful.

According to the CEOWorld Health Care Index, the United States ranks 30th in the world for health care services. South Korea is #1, Taiwan is #2, Denmark is #3, and Austria is #4.

Nationally, we spend more per person on healthcare than any other country, yet we rank #30 in terms of healthcare performance. South Korea spends $3,500/person/year on healthcare, or 8.41% of gross domestic product (GDP). We spend $12,931/person/year, 19.7% of GDP or 3.24 times more/person, but have much worse results. Healthcare in South Korea is provided to all citizens and funded through a combination of payroll taxes, government subsidies, tobacco surcharges, and external contributions. Denmark spends $6,003/person/year or 50% “less per person” than us, but with better results.

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Compared to the other developed countries of the western world, the United States is almost last…yes, last. Something is wrong here.


Too often, politics, rather than compassion, dominates the healthcare debate. Denmark spends around 10% of its GDP and the average for the European Union (EU) is 9.9%. The 19.7% of GDP we spend means that every fifth dollar spent in America goes on health care.

Barring changes, the estimate for America’s healthcare costs in 2050 is 37% of GDP… leaving even less for national security, education, shelter, food, and so on. What kind of nation will we have then?

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It is time to use common sense and compassion to resolve the situation. If other nations of the world can do it, why can’t we?

The arguments like “it’s socialism” or “we can’t afford it” or “we have the best healthcare in the world” are all wrong. They are obfuscations that do not lead to clear thinking and real solutions.

There are 29 countries in the world whose healthcare systems are rated higher than us. Some are “single payers,” but most have a combination of government health insurance and some form of private insurance. France, for example, has a national health insurance program, but doctors work in private practices. Additional insurance can be purchased from private insurers.

In Switzerland and Taiwan there are single-payer models with high-quality care at surprisingly low costs. Switzerland spends 11% of GDP on healthcare, while Taiwan only spends 7% of GDP on healthcare.

Germany has a universal multiplier system, which consists of 77% state-funded and 23% private insurance. The German healthcare system has a record reserve of 20 billion euros, making it one of the “healthiest” healthcare systems in the world.

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A healthcare system does not have to be “either or” – fully government-run or an uncontrolled free market. But whatever the system, we need to start working on real solutions now!


National fitness depends on the same factors as personal fitness: education and commitment.

We must devote ourselves to finding solutions to America’s broken healthcare system. If we are to have a vibrant, healthy democracy in the 21st century, we need an informed, educated and healthy population.

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

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

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