Healthcare Coverage for All: We’re Last in the OECD
Every member country of the OECD has a system of national health care, except the United States. The programs vary widely, some relying on market mechanism to provide medical services while others rely mostly on public provision of services and public insurance. Here are how the OECD countries break out.
Reliance on private insurance and market mechanisms:
--Germany, Netherlands, Slovak Republic, and Switzerland rely on private insurance for basic health care coverage.
--Australia, Belgium, Canada, and France use public insurance for basic health coverage and permit private insurance beyond basic coverage.
--Austria, Czech Republic, Greece, Japan, Korea, and Luxembourg use public insurance for basic health coverage but permit little private insurance.
Mostly public insurance and public provision of medical services:
--Iceland, Sweden, and Turkey have no gate-keeping and ample choice of providers for users.
--Denmark, Finland, Mexico, Portugal, and Spain have limited choice for providers and soft budget constraints.
--Hungary, Ireland, Italy, New Zealand, Norway, Poland, and the United Kingdom have ample choice of providers and strict budget constraints.
Source: Health Care Systems: Efficiency and Policy Settings, OECD (2010), 15, https://www.oecd.org/economy/growth/46508800.pdf
Every member country of the OECD has a system of national health care, except the United States. The programs vary widely, some relying on market mechanism to provide medical services while others rely mostly on public provision of services and public insurance. Here are how the OECD countries break out.
Reliance on private insurance and market mechanisms:
--Germany, Netherlands, Slovak Republic, and Switzerland rely on private insurance for basic health care coverage.
--Australia, Belgium, Canada, and France use public insurance for basic health coverage and permit private insurance beyond basic coverage.
--Austria, Czech Republic, Greece, Japan, Korea, and Luxembourg use public insurance for basic health coverage but permit little private insurance.
Mostly public insurance and public provision of medical services:
--Iceland, Sweden, and Turkey have no gate-keeping and ample choice of providers for users.
--Denmark, Finland, Mexico, Portugal, and Spain have limited choice for providers and soft budget constraints.
--Hungary, Ireland, Italy, New Zealand, Norway, Poland, and the United Kingdom have ample choice of providers and strict budget constraints.
Source: Health Care Systems: Efficiency and Policy Settings, OECD (2010), 15, https://www.oecd.org/economy/growth/46508800.pdf
Spending on Public Primary and Secondary Education: We’re Number 4 and We’re Number 5
The United States spends a considerable amount of money on public primary and secondary education, both in terms of per student expenditures and percentage of GDP. In terms of public spending on education, per student in both primary and secondary schools, the United States ranks 4th among selected OECD countries. The most recent data available is from 2019 and shows that the US spends $13,780 per pupil in Primary grades and $15,538 in Secondary, Post-Secondary Non-Tertiary grades and programs, for a total of $29,318. Norway, South Korea, and Austria spend more per pupil.
On a per capita basis, the United States ranks 5th, spending 8.3 percent of its GDP on primary and secondary education. Chile, Israel, South Korea, and the United Kingdom invest a higher percentage of their GDP on education than the United States.
Source: Statista, https://www.statista.com/statistics/238733/expenditure-on-education-by-country/; “How Do Governments Allocate Public Spending on Education?” OECD, July 12, 2022, https://www.oecd.org/coronavirus/en/data-insights/how-do-governments-allocate-public-spending-on-education
The United States spends a considerable amount of money on public primary and secondary education, both in terms of per student expenditures and percentage of GDP. In terms of public spending on education, per student in both primary and secondary schools, the United States ranks 4th among selected OECD countries. The most recent data available is from 2019 and shows that the US spends $13,780 per pupil in Primary grades and $15,538 in Secondary, Post-Secondary Non-Tertiary grades and programs, for a total of $29,318. Norway, South Korea, and Austria spend more per pupil.
On a per capita basis, the United States ranks 5th, spending 8.3 percent of its GDP on primary and secondary education. Chile, Israel, South Korea, and the United Kingdom invest a higher percentage of their GDP on education than the United States.
Source: Statista, https://www.statista.com/statistics/238733/expenditure-on-education-by-country/; “How Do Governments Allocate Public Spending on Education?” OECD, July 12, 2022, https://www.oecd.org/coronavirus/en/data-insights/how-do-governments-allocate-public-spending-on-education
Social Security Benefits: We’re Number 29
Social Security has become the Grand Contract, keeping millions of Americans out of poverty and providing a modicum of financial security for millions more. A report from the Center on Budget and Policy Priorities, based on the March 2022 Current Population Survey, noted that “Without Social Security, 21.7 million more adults and children would be below the poverty line.” Social Security benefits are especially important for older women and persons of color. Women “tend to earn less than men, take more time out of the paid workforce, live longer, accumulate less savings, and receive smaller pensions.” Social Security brings 8.8 million older women above the poverty line, 1.7 million African Americans, and 1.3 million Latinos. Without Social Security benefits, older women would have a poverty rate of 40.5 percent; with Social Security, that rate drops to 11.6 percent. Similarly, the poverty rate for African Americans would be 50.2 percent without Social Security but is 17.5 percent when it is included. Elderly Latinos would have a poverty rate of 44.5 percent without Social Security, but with it, the poverty rate drops to 18.7 percent. In addition, more than 8 million children are lifted above the poverty line. The average Social Security recipient receives about $21,384 per year, or $1,782 per month. This sum hardly puts a recipient on Easy Street.
Social insurance programs have a long history in Europe, with the first adopted by Germany in 1889. By the time that the United States created the Social Security Act in 1935, thirty-four nations were already operating some form of social insurance programs. Today, there are a wide variety of social security programs worldwide, some similar to those found in the United States (Old-Age, Survivors, and Disability), some with cash sickness benefits, cash maternity benefits, worker injury, unemployment benefits, or family allowances. When comparing the American programs, as vital, expensive, and necessary as they are, to programs in other countries, they fall quite short. As the Center on Budget and Policy Priorities noted, “Social Security benefits are . . . modest by international standards.”
Sources: Kathleen Romig, “Social Security Lifts More People Above the Poverty Line Than Any Other Program,” Center on Budget and Policy Priorities, June 2, 2023, https://www.cbpp.org/research/social-security/social-security-lifts-more-people-above-the-poverty-line-than-any-other; “Historical Background and Development of Social Security,” Social Security Administration, https://www.ssa.gov/history/briefhistory3.html; “Social Security Programs Throughout the World: Europe 2018,” Social Security Administration, September 2018, https://www.ssa.gov/policy/docs/progdesc/ssptw/2018-2019/europe/ssptw18europe.pdf; “Policy Basics: Top Ten Facts About Social Security,” Center on Budget and Policy Priorities, April 17, 2023, https://www.cbpp.org/research/social-security/top-ten-facts-about-social-security; “Pensions at a Glance, 2021: Retirement Systems in OECD Countries.
Social Security has become the Grand Contract, keeping millions of Americans out of poverty and providing a modicum of financial security for millions more. A report from the Center on Budget and Policy Priorities, based on the March 2022 Current Population Survey, noted that “Without Social Security, 21.7 million more adults and children would be below the poverty line.” Social Security benefits are especially important for older women and persons of color. Women “tend to earn less than men, take more time out of the paid workforce, live longer, accumulate less savings, and receive smaller pensions.” Social Security brings 8.8 million older women above the poverty line, 1.7 million African Americans, and 1.3 million Latinos. Without Social Security benefits, older women would have a poverty rate of 40.5 percent; with Social Security, that rate drops to 11.6 percent. Similarly, the poverty rate for African Americans would be 50.2 percent without Social Security but is 17.5 percent when it is included. Elderly Latinos would have a poverty rate of 44.5 percent without Social Security, but with it, the poverty rate drops to 18.7 percent. In addition, more than 8 million children are lifted above the poverty line. The average Social Security recipient receives about $21,384 per year, or $1,782 per month. This sum hardly puts a recipient on Easy Street.
Social insurance programs have a long history in Europe, with the first adopted by Germany in 1889. By the time that the United States created the Social Security Act in 1935, thirty-four nations were already operating some form of social insurance programs. Today, there are a wide variety of social security programs worldwide, some similar to those found in the United States (Old-Age, Survivors, and Disability), some with cash sickness benefits, cash maternity benefits, worker injury, unemployment benefits, or family allowances. When comparing the American programs, as vital, expensive, and necessary as they are, to programs in other countries, they fall quite short. As the Center on Budget and Policy Priorities noted, “Social Security benefits are . . . modest by international standards.”
Sources: Kathleen Romig, “Social Security Lifts More People Above the Poverty Line Than Any Other Program,” Center on Budget and Policy Priorities, June 2, 2023, https://www.cbpp.org/research/social-security/social-security-lifts-more-people-above-the-poverty-line-than-any-other; “Historical Background and Development of Social Security,” Social Security Administration, https://www.ssa.gov/history/briefhistory3.html; “Social Security Programs Throughout the World: Europe 2018,” Social Security Administration, September 2018, https://www.ssa.gov/policy/docs/progdesc/ssptw/2018-2019/europe/ssptw18europe.pdf; “Policy Basics: Top Ten Facts About Social Security,” Center on Budget and Policy Priorities, April 17, 2023, https://www.cbpp.org/research/social-security/top-ten-facts-about-social-security; “Pensions at a Glance, 2021: Retirement Systems in OECD Countries.
Personal Time Off: We Have Far Less Vacation Time
American workers have far less vacation time than do their counterparts in OECD countries. In a 2024 study, New View Strategies found that 81 percent of Americans had four weeks or less in paid time off, and on average American workers took just thirteen days of vacation. By contrast, 70 percent of European workers receive four weeks or more of paid time off and took an average of twenty-one days of vacation. Americans also took fewer sick days, nine compared to thirteen for Europeans. But for Americans, there is more feelings of guilt for taking time away from work. When taking more than a week off, 41 percent of Americans feel guilty; just 28 percent of Europeans feel some pangs of guilt.
The United States is also the only OECD country that does not provide a statutory minimal annual leave policy for employees. In most European countries, workers are entitled to twenty days of leave per year. When public holidays are included, that figure increases to thirty to thirty-five days a year of vacation time. The United Kingdom has a statutory minimum of twenty-eight days annual leave, along with eight public holidays. Austria, Denmark, Finland, France, and Sweden provide twenty-five days. The US has ten public holidays and zero days of federally mandated days of paid leave.
Sources: Kerry (Rosvold) Peters, “Vacation Guilt: Americans vs. Europe PTO,” New View Strategies, June 22, 2022, https://getyournewview.com/vacation-guilt-america-vs-europe-pto/; Kerry (Rosvold) Peters, “Vacation Guilt: Americans vs. Europe PTO,” New View Strategies, June 22, 2022, https://getyournewview.com/vacation-guilt-america-vs-europe-pto/.
American workers have far less vacation time than do their counterparts in OECD countries. In a 2024 study, New View Strategies found that 81 percent of Americans had four weeks or less in paid time off, and on average American workers took just thirteen days of vacation. By contrast, 70 percent of European workers receive four weeks or more of paid time off and took an average of twenty-one days of vacation. Americans also took fewer sick days, nine compared to thirteen for Europeans. But for Americans, there is more feelings of guilt for taking time away from work. When taking more than a week off, 41 percent of Americans feel guilty; just 28 percent of Europeans feel some pangs of guilt.
The United States is also the only OECD country that does not provide a statutory minimal annual leave policy for employees. In most European countries, workers are entitled to twenty days of leave per year. When public holidays are included, that figure increases to thirty to thirty-five days a year of vacation time. The United Kingdom has a statutory minimum of twenty-eight days annual leave, along with eight public holidays. Austria, Denmark, Finland, France, and Sweden provide twenty-five days. The US has ten public holidays and zero days of federally mandated days of paid leave.
Sources: Kerry (Rosvold) Peters, “Vacation Guilt: Americans vs. Europe PTO,” New View Strategies, June 22, 2022, https://getyournewview.com/vacation-guilt-america-vs-europe-pto/.
Voter Turnout: We’re Number 31
Voter turnout in US presidential elections has generally hovered a little above 50 percent of eligible adults. The relatively high turnout in the 2020 presidential election was an outlier. In response to COVID, many states adopted mail-in balloting for the first time. Further, the partisan and ideological turmoil of the Trump versus Biden election along with the concerted efforts of the political parties to get out the vote meant a record high percentage of eligible adults cast their votes. In 2020, 81 million citizens voted for Biden; 74 million voted for Trump; 3 million voted for third party candidates. Yet 80 million people did not vote at all. In the 2020 presidential election, despite record numbers of voters, there was a significant racial disparity in voter turnout. The Brennan Center reported that 70.9 percent of white voters cast their ballots, while only 58.4 of non-white voters did so (62.6 percent for Black voters; 53.7 for Latino voters; and 59.7 percent for Asian voters).
In 2024, voter turnout decreased, especially for Democrats. The biggest decrease came in urban areas, with approximately 1.9 million fewer votes for Harris than voted for Biden four years earlier. By contrast, approximately 1.7 million more votes were added to Trump’s campaign than voted for him in 2020. Analysis by the New York Times noted that “the drop-off spanned demographics and economics. It was clear in counties with the highest job growth rates, counties with the most job losses and counties with the highest percentage of college-educated voters. Turnout was down, too, across groups that are traditionally strong for Democrats—including areas with large numbers of Black Christians and Jewish voters.”
During off-year elections for members of Congress, the percentage of those voting usually drops substantially. Again, the 2018 and 2022 mid-term elections were exceptions, drawing higher than usual percentage of voters. At the local level, voter turnout in the United States drops significantly, often below 20 percent of eligible voters.
In recent national elections, the United States ranked 31st in voter participation.
How Did They Do It? The Affirmative Right to Vote. Several countries, including Canada and Germany have a guaranteed affirmative right to vote or require voting.
Source: Drew DeSilver, “Turnout in US Has Soared in Recent Elections but by
Source: Some Measures Still Trails That of Many Other Countries,” Pew Research Center, November 1, 2022, https://www.pewresearch.org/short-reads/2022/11/01/turnout-in-u-s-has-soared-in-recent-elections-but-by-some-measures-still-trails-that-of-many-other-countries/
Voter turnout in US presidential elections has generally hovered a little above 50 percent of eligible adults. The relatively high turnout in the 2020 presidential election was an outlier. In response to COVID, many states adopted mail-in balloting for the first time. Further, the partisan and ideological turmoil of the Trump versus Biden election along with the concerted efforts of the political parties to get out the vote meant a record high percentage of eligible adults cast their votes. In 2020, 81 million citizens voted for Biden; 74 million voted for Trump; 3 million voted for third party candidates. Yet 80 million people did not vote at all. In the 2020 presidential election, despite record numbers of voters, there was a significant racial disparity in voter turnout. The Brennan Center reported that 70.9 percent of white voters cast their ballots, while only 58.4 of non-white voters did so (62.6 percent for Black voters; 53.7 for Latino voters; and 59.7 percent for Asian voters).
In 2024, voter turnout decreased, especially for Democrats. The biggest decrease came in urban areas, with approximately 1.9 million fewer votes for Harris than voted for Biden four years earlier. By contrast, approximately 1.7 million more votes were added to Trump’s campaign than voted for him in 2020. Analysis by the New York Times noted that “the drop-off spanned demographics and economics. It was clear in counties with the highest job growth rates, counties with the most job losses and counties with the highest percentage of college-educated voters. Turnout was down, too, across groups that are traditionally strong for Democrats—including areas with large numbers of Black Christians and Jewish voters.”
During off-year elections for members of Congress, the percentage of those voting usually drops substantially. Again, the 2018 and 2022 mid-term elections were exceptions, drawing higher than usual percentage of voters. At the local level, voter turnout in the United States drops significantly, often below 20 percent of eligible voters.
In recent national elections, the United States ranked 31st in voter participation.
Source: Some Measures Still Trails That of Many Other Countries,” Pew Research Center, November 1, 2022, https://www.pewresearch.org/short-reads/2022/11/01/turnout-in-u-s-has-soared-in-recent-elections-but-by-some-measures-still-trails-that-of-many-other-countries/
Population: We’re Number 3
Based on 2022 Census estimates, the United States had 339 million people.
India is the most populous country, with 1.425 billion people, followed very closely China, also with 1.425 billion. India and China each have 18 percent of the world’s population.
A full 40 percent of all people on Earth live in Southeast Asia (China, India, Pakistan, and Bangladesh).
The most populous country in Africa is Nigeria (ranking 6th, with 216 million people).
Brazil is South America’s largest country, ranking 7th with 215 million people.
Europe’s most populous country is Germany (ranking 19th, with 84 million people).
Source: World Population Review, 2022, https://worldpopulationreview.com/countries; “Countries by Percentage of World Population,” World Atlas, https://www.worldatlas.com/articles/countries-by-percentage-of-world-population.html; updated in 2023 with estimates of China, India, and the United States.
Based on 2022 Census estimates, the United States had 339 million people.
India is the most populous country, with 1.425 billion people, followed very closely China, also with 1.425 billion. India and China each have 18 percent of the world’s population.
A full 40 percent of all people on Earth live in Southeast Asia (China, India, Pakistan, and Bangladesh).
The most populous country in Africa is Nigeria (ranking 6th, with 216 million people).
Brazil is South America’s largest country, ranking 7th with 215 million people.
Europe’s most populous country is Germany (ranking 19th, with 84 million people).
Source: World Population Review, 2022, https://worldpopulationreview.com/countries; “Countries by Percentage of World Population,” World Atlas, https://www.worldatlas.com/articles/countries-by-percentage-of-world-population.html; updated in 2023 with estimates of China, India, and the United States.
Adult and Child Obesity:We’re Number 1!
Fatty America!
The OECD ranked the United States Number 1 in both child and adult obesity in 2010; since then we haven’t improved, but other nations are catching up with us.
The Global Obesity Observatory ranks the Polynesian islands and some Caribbean countries higher than the United States in both adult and childhood obesity. But among the industrialized democratic countries, the United States has the highest percentage of overweight adults and overweight children.
How are we doing fighting against obesity? In its 2021 Report, “Obese and Overweight Population,” the OECD found that the US ranked 34th (out of 34 member countries reporting); https://data.oecd.org/healthrisk/overweight-or-obese-population.htm.
Sources: “Ranking, % Obesity by Country,” Global Obesity Observatory, https://data.worldobesity.org/rankings/?age=a&sex=t;
“Obese and Overweight Population,” OECD, https://data.oecd.org/healthrisk/overweight-or-obese-population.htm.
Fatty America!
The OECD ranked the United States Number 1 in both child and adult obesity in 2010; since then we haven’t improved, but other nations are catching up with us.
The Global Obesity Observatory ranks the Polynesian islands and some Caribbean countries higher than the United States in both adult and childhood obesity. But among the industrialized democratic countries, the United States has the highest percentage of overweight adults and overweight children.
How are we doing fighting against obesity? In its 2021 Report, “Obese and Overweight Population,” the OECD found that the US ranked 34th (out of 34 member countries reporting).
Sources: “Ranking, % Obesity by Country,” Global Obesity Observatory, https://data.worldobesity.org/rankings/?age=a&sex=t; “Obese and Overweight Population,” OECD, https://data.oecd.org/healthrisk/overweight-or-obese-population.htm.