The American healthcare system is a mirror, reflecting the basic characteristics of America. To the extent this is true, it will take more than a new metaphor or a new frame to change our healthcare system. It will take a fundamental change in America itself, or at least in our perception of ourselves. George J. Annas, Worst Case Bioethics.

Some unsurprising results are published in the 2010 update of Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally: European countries lead the way with the best overall health care system performance but not with greatest amount of health expenditures per capita, while America protected the rear flank with the greatest expenditures and worst performance.

What I find surprising, however, is Canada’s performance. According to the report, Canada is second-last in overall rankings, followed closely by the United States. Furthermore, in a number of categories, such as effectiveness and timeliness of care, Canada comes in last place. On a positive note, Canada ranks second in having Long, Healthy, Productive Lives.

I was recently challenged to think about the factors that may contribute to America’s fractured health care system. My response — though brief and limited to 300 characters — is as follows (borrowed the second paragraph concept from Annas):

Among many factors that contribute to the discrepancy between America’s health expenditure per capita, quality of care, and quality of life, one which is of significance is the lack of collective will to address social inequities and guarantee health as a right.

Also, American health care is wasteful, technologically driven, individualistic, and death-denying. An better system would focus more on “upstream” factors such as the social determinants of health.

What about Canada? That’s a question worth thinking about.

Not long ago I became aware of the differences between health care reform and health system reform.

On a side note, I registered myself today as an organ donor. Can you imagine how many people die while waiting for organ transplants?