What Do the U.S. and Turkmenistan Have in Common?

Foreign Policy came up with a list of “The World’s Worst Healthcare Reforms”. Keeping company with Russia, China, and Turkmenistan is the good old U.S. of A.: “The United States has the rare distinction of being both one of the world’s richest countries and having one of its least-functional health care systems. … [F]or the most part, the history of health reform in the United States has been a history of failure.” But it sounds like we still have a leg up on Turkmenistan: “In a frankly insane healthcare reform effort, [President Saparmurat Niyazov] restricted the public’s access to care by replacing up to 15,000 doctors and nurses with unqualified military conscripts. … He also implemented fees and created an ‘unofficial’ ban on the diagnosis of certain communicable diseases, like hepatitis.” [%comments]

Garrett Pendergast

Healthcare by fiat? Couldn't happen here of course.



I think it was diagnosis by fiat. Which of course does happen here already. It just depends on who is doing the "fiat-ing".


Putting the US in the same breath as the other countries is insane. It's obvious that the author is simply a cheerleader for a government takeover of health care.


The writer makes one of he dumbest points I've read when she notes that US lung cancer survival rates aren't much better than Europe. Lung cancer is extremely deadly and the US rate (15%) is only slightly better (10%). But there's not much you can do. that's like comparing the US to Europe in rates of bazooka blast survival.

Other US cancer survival rates, as well as survival rates for heart attacks and strokes, are significantly better than Europe.


from Foreign Policy, published by Slate, a property of the Washington Post. Of course they have an agenda.

U.S. health care bashers are all in need of treatment for their massive blind spots. They obvioulsy don't get annual optic field exams - as my private provider allows - but then if their untreated eyes dim, they can fall back on the french model - merde happens.


Note that cancer survival rates can be very misleading. Especially time survival rates (how many patients are alive after 5 years) are extremely skewed by the intensive screenings favored in the USA - if the cancer is diagnosed very early, the 5 year survival rate shoots up independantly of the quality of treatment and ultimate survival rate.

Cancer death rates are less susceptible to skews in this regard (but of course include influences of lifestyle) and don't show any clear superiority of the US health system:


The comments on the American reforms was just asinine. For example - "Since [the defeat of HillaryCare], costs and premiums have doubled, a lower percentage of employers offer coverage, and millions more are uninsured."

Don't they understand that one of the reasons that "costs and premiums have doubled" is precisely becaue the system is GOOD. Our health care system is so good that it leads to the creation of all sorts of cutting edge technologies that, yes, result in higher premiums. Moreover, the use of medical services is over-used which leads to the increase in premiums. We also keep people alive longer, which will also increase premiums.

The only way they can make their point is to assume their conclusion, cherry pick stats, and then assume those stats can only be interpreted to support their conclusion. There are several weaknesses along that chain.


I agree that the author is unfair in lumping the US with the likes of Russia, China, and Turkmenistan (seriously?) but she makes her point in that, dollar for dollar, Americans get poor value for for all the money we put in healthcare.

I don't understand why people have issue with her example about lung cancer deaths. She points out that many countries have the SAME death rates from lung cancer as the US, but spend less than half as much per capita on health care. Which begs the question: what is the other 50+% being spent on?

Cory your argument is makes no sense. A majority of insurers will refuse to pay for experimental/cutting-edge treatment because it is so expense. They would much rather you take the established (old) alternative that would cost a fraction as much to administer. And the medical services in ALL countries are overused. Show me a single developed country with idle doctors and empty hospital beds and I'll find you a couple thousand people who would be willing to move their in a heartbeat.
Cory does make one good point though, advances in medical technology have allowed us to keep people alive longer. Unfortunately this is why 25-40% of health care costs come from treatment during the 2-4 weeks of a person's life. Of course if we try to curb the costs by say, refusing to cover anything unless it extends your life for more than a month, then people start screaming "rationing!" life it is some four-letter word and all logical debate ceases.
Personally, if I was on my deathbed and knew I could save my family from paying 40% of my medical bills before I die, I'd tell them to just pull the plug.



I have lived overseas in a country that has socialized medicine (Greece). The public hospitals there are awful. Everyone who can afford it goes to private hospitals and pay for it themselves. The private hospitals are good but still not as good as the US. From my experience, it seems to me that the US still has the best healthcare in the world. I think that it is the best by a large margin. It is crazy to imply that the system in the US has anything in common with the other countries listed. If I get sick in the future, I hope that I am in the US. I agree that there needs to be some reform to the system in the US but I am afraid that our government will make it worse and not better.


A such "reform" happened in Turkmenistan years ago. Now the situation is quit different. The health care servise is one of the best in Central Asia.

Catherine Fitzpatrick

This sort of moral equivalency is disgraceful and discredits the Times and Foreign Policy. It's a frivolous comparison to make a political point that only leads increasingly to an inability of the left to persuade people that health reform is needed in this country.

It's a sign that the argument is being lost, and the debaters are finding that they aren't persuasive, that they must resort to this sort of shenanigans. That's a pity.

The grave institutionalized malpractice of the Soviet era still incorporated into Turkmenistan's health care system isn't remotely like anything in the U.S. People profoundly poor by contrast with affluent Americans have to pay for health insurance and also pay huge bribes to get sub-standard and even damaging care. There is little recognition of HIV/AIDS and rampant drug addiction in Turkmenistan, and high rates of maternal and infant mortality.

The high rates of infant mortality in this country come from the increasing use of in vitro technology and multiple pregnancies which lead to prematurity and often infant deaths -- the opposite of the problems of absence of prenatal care, lack of sanitation, poverty, etc. in a place like Turkmenistan.

The 47 million people in the U.S. without health insurance (I'm one of them) still obtain paid health care or throw themselves on the mercy of emergency rooms which usually (not always) care for them, adding to the medical expense burden.

The agitprop team for Obama's health care reform, which people like me supported, are losing this battle because they can't refrain from hysterical hyperbole, silencing and ridiculing of their critics and then resorting to all kinds of low tactics in this debate, like demonizing those who don't agree with them.



Here is the point of the healthcare debate to me: What good is world class healthcare if you do not have access to it?
I am so tired of hearing how great the U. S. Healthcare system is when I have had access to it only when I accidently got pregnant in college and had to go on Medicade. It was the last time I ever saw a doctor who had a file on me. Since then I have worked for small bussiness and have never been offered health insurance. I am 44 years old and pay $600 a month for catastrophic coverage for my husband, son and me. We have a family deductable of $5,000. Basically I pay $500 a month to keep from going bankrupt if any of us became seriously ill. I go to Planned Parenthood for my yearly exam. My peditrician takes a sliding scale, but my son ages out of pediatrics next year and I have not found a GP with a sliding scale ever. My husband and I make too much money to qualify for any clinics. I have chronic mental illness and pay a litttle over $100 a month out of pocket to treat that.

I have been denied treatment from lack of coverage. Doctors do not have to accept you if you don't have insurence. I know.

I pay the uninsured rate at my dentist which is higher than the insured rate because insurence companyies negotiate a lower rate.

Last year my husband got pneumonia. Because we don't have a GP we were sent to the outpatient clinic attached to the emergency room. He was supposed to be admitted, but since we had no money, they gave him IV drugs and sent us home.

This is not hysterical hyperbole, this is my life. Two college-educated homeowners who had only one child, who live in fear of a broken arm from playing sports. I already know that I will not have HRT when I go through the change, or any medical treatment. I can't afford it.



"Putting the US in the same breath as the other countries is NOT insane"
Is a practice necessary to see where we are. Those studies, uses lots of parameters that are being taking into account and while,of course, are not perfect, still the best thing we'd got. All serious studies on this, and by even using different algorithms agree on the same thing; the US health system is not good at all. I think it may be the only thing (well also the prison system) that no country want to imitate.

Someone mention that cancer rate is worse in Europe. That may be the case, i think the fact that the smoking rate here doubles the one in the US may be the biggest factor for that difference.


The forces of the AMA, malpractice lawyers, insurance companies, Big Pharma, and Government Entitlement Programs, and Americans on the obese rears have largely driven healthcare costs to roughly 16% of the economy.

Recommended treatment: outsourcing these ruthless forces' economic activity to places like the Philippines, India, in the form of medical tourism. And please people stop whining, reduce your caloric intake, and exercise.


The article also didn't mention the health care reform of Cambodia's Khmer Rouge, which was to close all the hospitals and kill all the doctors.


I have very low blood pressure, run 2 miles everyday and have low cholesterol, which Planned Parenthood tested because I have no GP. Thank God for Planned Parenthood.

I am not whining. I live in a great country; why should I not expect good health care? I held my first taxed job when I was 14 and have been gainfully employed ever since then. My taxes go to support many things I don't agree with, but I live in a democracy, so I go with the flow. Now I want my taxes to support the reduction in health care costs so that I can save a little bit for retirement, or donate to a worthy cause. I am in excellent health and intend to stay that way. That has not reduced my health care costs in any significant way.

BTW, the Indianapolis Star reported today that health insurence costs are expected to rise 42% in the next 12 months. This burden will affect small bussiness as well as individuals. Our current system inhibits capitalism because our employers are forced to seek new plans for employees every time there is a rate hike. It used to work. It no longer does.



I agree we do need reform, and we do have the best health care..emergency health care.. in the world and u can get it relatively fast (but its very expensive because the technology is highly superior then day to day stuff, the drugs needed are more advanced, and the medical training for the doctor is harsh)...

but before we reform health care we need to reform ourselves (healthier diets, exercise, less fast food, more homemade healthier food, cheaper fresh food..aka farmer markets...and a slower passe of life) until that happens what ever reform we do will crush under the weight of a population that's 65% obese and all the problems (more advanced) that will come with it.

most people dont realize that doctors move with a population. If, lets say, there are too many heart surgeons in the usa then medical schools will stop doctors on that path (i know they did it with one feild a while ago.. but cant remember it). but if there not then they keep that path open. consequently because people are unhealthy and dont change their life styles they come to hospital when its too late and only expensive procedures will be needed. thus, more doctors enter into the more expensive fields then preventive medicine because thats where most of the patients are.

then if most people are sick, then a larger population needs more expensive pharmaceutical drugs. thus giving pharmaceuticals power.

consequently, the fault for why PREVENTIVE health care (the best) is horrible is because of the people of the usa and how they treat themselves.

as to how to change it..

universal: prevents people with serious problems from getting the care they need, dirty hospitals (this is a big big problem, not because of the dirt but because of the possible creation of mutated virus and bacteria), over worked doctors and nurses (which the world is short on) and long waiting times.

usa health care: better times, in some cases under worked doctors, pricey, and not everyone can afford it, but the fastest, high in technological advances and cures, and lines arn't long.

to me these seem like the extremes.. hopefully one day someone will come up with a way thats in between.



been in hospital in the states and the service is way worse than the health service in turkmenistan or the countries in cental asia.


When the US government decided to allow insurance companies to cover health care costs during the Nixon administration, it opened a whole new can of worms.

With little oversight, except to generally praise the health care industry for being profitable, federal and state governments since then have allowed one over-riding emotion to run health care; greed.

Profits have trumped human needs, yet the opponents of reform vigorously defend this deplorable situation at every step.

HMOs, insurance firms and drug companies have had things go their way for too long, and they are pulling out all the stops to prevent reform. They think it is going to kill their profits.

I would ask them to tell it to the millions whose lives have literally or physically been destroyed by their actions. What does profit mean then?


Having had years of concurrent and continuing experience in both the US and three of the continental european systems, there is no comparison. The european systems are so far superior it really doesn't merit discussion.