"Is American health care... the best or the worst of the First World?"

The first question posed by Dr. Doug Iliff, M.D. in this excellent article — Ten Key Questions Framing the Health Care Debate. The good doctor's answer to that first question:

It’s the best in the world if you have decent insurance, and among the best if you don’t. Nobody is denied care in America. Show up in the emergency room uninsured or undocumented, having just wrapped yourself around a light pole while operating a motorcycle drunk and exercising your constitutional right not to wear a helmet, and you’re in line for a million bucks of state-of-the-art free care paid for by the shrinking number of citizens still paying taxes. Nobody denies that. What they point to is a mediocre life expectancy, and a relatively high infant mortality. The first is due to slovenly lifestyles (36% of our Medicare costs, and 48% of Medicaid, are directed to the treatment and complications of obesity), and the second to a decadent underclass which refuses to act responsibly in the face of pregnancy. By the way, don’t forget that the vast majority of technological and pharmaceutical innovations in the world are provided and paid for by Americans. See Nobel, Alfred, Prize thereof. Don’t forget, either, that there are few queues in this country, except for organ transplants.

Click on the link for nine other quuestions and his conclusion that "only self-rationing– in the form of HSAs, or something similar– could fix health care in a way that acknowledges the unique American character and experience."