America’s Longest War – a socio-political-military disaster – indicted by Global Commission on Drug Policy

Report of the Global Commission on Drug Policy

Last week this commission released its report,  “War on Drugs“. This once again brings into focus our longest war, Nixon’s War on Drugs. Here are the first two paragraphs from the executive summary:

The global war on drugs has failed, with devastating consequences for individuals and societies around the world. Fifty years after the initiation of the UN Single Convention on Narcotic Drugs, and 40 years after President Nixon launched the US government’s war on drugs, fundamental reforms in national and global drug control policies are urgently needed.

Vast expenditures on criminalization and repressive measures directed at producers, traffickers and consumers of illegal drugs have clearly failed to effectively curtail supply or consumption. Apparent victories in eliminating one source or trafficking organization are negated almost instantly by the emergence of other sources and traffickers. Repressive efforts directed at consumers impede public health measures to reduce HIV/AIDS, overdose fatalities and other harmful consequences of drug use. Government expenditures on futile supply reduction strategies and incarceration displace more cost-effective and evidence-based investments in demand and harm reduction.

Meanwhile the US War on Drugs grinds on and total Federal and state spending on this disaster will lurch over $35 Billion this year.

Extending Eisenhower’s Language

in his last speech as President, Eisenhower pointed to the “military-industrial complex” as a threat to the nation’s security and health. Since then, hisotry has added new layers of meaning and expanded the scope of this phrase. Today, we are in the thrall if not control of the Military-Industrial-Congressional-Executive-Spying-DrugWar-Complex. The War on Drugs has a record of failure and destructive outcomes now over 40 years old. Nevertheless, this behemoth roles along, getting bigger and more global in its reach every year. No Republicans or Democrats are willing to abandon the policies and rhetoric so cynically initiated by Nixon. Even this year of the so-called deficit debate, when Republicans and Democrats are willing to throw every bit of discretionary social or infrastructure spending under the bus, the War on Drugs (and every other element of the Military-Industrial-Congressional-Executive-Spying-DrugWar-Complex) is off limits.

Global Commission Recommendations

The executive summary continues(my highlighting):

Our principles and recommendations can be summarized as follows:

End the criminalization, marginalization and stigmatization of people who use drugs but who do no harm to others. Challenge rather than reinforce common misconceptions about drug markets, drug use and drug dependence.

Encourage experimentation by governments with models of legal regulation of drugs to undermine the power of organized crime and safeguard the health and security of their citizens. This recommendation applies especially to cannabis, but we also encourage other experiments in decriminalization and legal regulation that can accomplish these objectives and provide models for others.

Offer health and treatment services to those in need. Ensure that a variety of treatment modalities are available, including not just methadone and buprenorphine treatment but also the heroin-assisted treatment programs that have proven successful in many European countries and Canada. Implement syringe access and other harm reduction measures that have proven effective in reducing transmission of HIV and other blood-borne infections as well as fatal overdoses. Respect the human rights of people who use drugs. Abolish abusive practices carried out in the name of treatment – such as forced detention, forced labor, and physical or psychological abuse – that contravene human rights standards and norms or that remove the right to self-determination.

Apply much the same principles and policies stated above to people involved in the lower ends of illegal drug markets, such as farmers, couriers and petty sellers. Many are themselves victims of violence and intimidation or are drug dependent. Arresting and incarcerating tens of millions of these people in recent decades has filled prisons and destroyed lives and families without reducing the availability of illicit drugs or the power of criminal organizations. There appears to be almost no limit to the number of people willing to engage in such activities to better their lives, provide for their families, or otherwise escape poverty. Drug control resources are better directed elsewhere.

Invest in activities that can both prevent young people from taking drugs in the first place and also prevent those who do use drugs from developing more serious problems. Eschew simplistic ‘just say no’ messages and ‘zero tolerance’ policies in favor of educational efforts grounded in credible information and prevention programs that focus on social skills and peer influences. The most successful prevention efforts may be those targeted at specific at-risk groups.

Focus repressive actions on violent criminal organizations, but do so in ways that undermine their power and reach while prioritizing the reduction of violence and intimidation. Law enforcement efforts should focus not on reducing drug markets per se but rather on reducing their harms to individuals, communities and national security.

Begin the transformation of the global drug prohibition regime. Replace drug policies and strategies driven by ideology and political convenience with fiscally responsible policies and strategies grounded in science, health, security and human rights – and adopt appropriate criteria for their evaluation. Review the scheduling of drugs that has resulted in obvious anomalies like the flawed categorization of cannabis, coca leaf and MDMA. Ensure that the international conventions are interpreted and/or revised to accommodate robust experimentation with harm reduction, decriminalization and legal regulatory policies.

Break the taboo on debate and reform. The time for action is now.

Go to the website and read further. They provide case studies from around the world to illustrate their case for these principles and policies.

Charles M. Blow wrote an op-ed piece in the New York Times (6/11/2011) “Drug Bust“. It included the following graphics:

Einstein (Rita Mae Brown) Had Something To Say About This

Insanity: doing the same thing over and over again and expecting different results.

 

The Future of Healthcare??

I don’t generally pause long over the editorials in the NY Times. This morning’s caught my eye. As a recent state resident I watched the debate closely and supported the single payer approach. Since then the results have been interesting and as noted in the Time’s editorial generally good.

Here us the editorial:

Health Reform in Massachusetts
Last Updated: 11:18 PM EDT

Mitt Romney’s defense of the Massachusetts health care reforms was politically self-serving. It was also true.

Despite all of the bashing by conservative commentators and politicians — and the predictions of doom for national health care reform — the program he signed into law as governor has been a success. The real lesson from Massachusetts is that health care reform can work, and the national law should work as well or even better.

Like the federal reform law, Massachusetts’s plan required people to buy insurance and employers to offer it or pay a fee. It expanded Medicaid for the poor and set up insurance exchanges where people could buy individual policies, with subsidies for those with modest incomes.

Since reform was enacted, the state has achieved its goal of providing near-universal coverage: 98 percent of all residents were insured last year. That has come with minimal fiscal strain. The Massachusetts Taxpayers Foundation, a nonpartisan fiscal monitoring group, estimated that the reforms cost the state $350 million in fiscal year 2010, a little more than 1 percent of the state budget.

Other significant accomplishments:

The percentage of employers offering insurance has increased, probably because more workers are demanding coverage and businesses are required to offer it.

The state has used managed-care plans to hold down the costs of subsidies: per capita payments for low-income enrollees rose an average of 5 percent a year over the first four years, well below recent 7 percent annual increases in per capita health care spending in Massachusetts. The payments are unlikely to rise at all in the current year, in large part because of a competitive bidding process and pressure from the officials supervising it.

The average premiums paid by individuals who purchase unsubsidized insurance have dropped substantially, 20 percent to 40 percent by some estimates, mostly because reform has brought in younger and healthier people to offset the cost of covering the older and sicker.

Residents of Massachusetts have clearly chosen to tune out the national chatter and look at their own experience. Most polls show that the state reforms are strongly supported by the public, business leaders and doctors, often by 60 percent or more.

There are still real problems that need to be solved. Small businesses are complaining that their premiums are rising faster than before, although how much of that is because of the reform law is not clear.

Insuring more people was expected to reduce the use of emergency rooms for routine care but has not done so to any significant degree. There is no evidence to support critics’ claims that the addition of 400,000 people to the insurance rolls is the cause of long waits to see a doctor.

What reform has not done is slow the rise in health care costs. Massachusetts put off addressing that until it had achieved universal coverage. No one should minimize the challenge, but serious efforts are now being weighed.

Gov. Deval Patrick has submitted a bill to the Legislature that would enhance the state’s powers to reject premium increases, allow the state to limit what hospitals and other providers can be paid by insurers, and promote alternatives to costly fee-for-service medicine. The governor’s goal is to make efficient integrated care organizations the predominant health care provider by 2015.

The national reform law has provisions designed to reduce spending in Medicare and Medicaid and, through force of example, the rest of the health care system. Those efforts will barely get started by the time Massachusetts hopes to have transformed its entire system. Washington and other states will need to keep a close watch.

Just Another Cost of Doing Business? – Pfizer's $2.3 billion penalty and fine

Is $2.3 billion really a lot of money?

The Obama administration is touting the action taken this week against Pfizer for illegal promotion of several of its drugs. The $2.3 billion sounds like a lot of money to me, and I suspect most people. Is it really a lot of money or just an annoyance to a large company, just another cost of doing business?

Take a look at Pfizer’s Income and Balance Sheets (see their 2008 Financial Reports ) and a very clear picture appears. Pfizer had net incomes of $8.1 billion in 2008 and 2007 and a whopping $19.3 billion in 2006. They also have cash and short term investments (these are your well-known “quick assets” – meaning they are cash or near cash) on their balance sheets of $26 billion at the end of 2008. Now, look again at the $2.3 billion and the number looks quite different. To those who have watched the stream of pharmaceutical company ethical and legal transgressions over the years, this looks like a very manageable cost of doing business.

More Blather about Healthcare from "Experts"

Acknowledge the basic facts about how the healthcare system is working today.

Yesterday in a radio interview, “How to conquer health care challenges”, with Professor Glenn Melnick  from the Rand Corporation and USC, we were again offered up “expert” opinion that does not even acknowledge the basic facts about how the healthcare system is working today.

Here are a couple of examples from the interview lead by Kai Ryssdal:

“RYSSDAL: Well, let me make sure I understand that. If doctors and hospitals are making less money, what is that do for the quality of care? I’m just trying to think about the argument that’s going to come up on Capitol Hill on this one.

MELNICK: Quality will have to suffer in some way. Whether it’s through reduced access, whether it’s through slower development of new technology…….”

The US spends nearly 50% more on healthcare than the next closest country (Switzerland) and more than twice most developed nations. Yet our basic outcomes of infant mortality and longevity remain at near third world performance. These are the facts of our situation. Money is not the problem. It is what we spend our money on that is the problem. To say that quality will inevitably decline as a result of spending less money is just nonsense. This flies in the face of the facts of the performance of all of the developed countries in the world, except us.

Within the current US performance there are clear demonstrations of how superior performance is not driven by spending more money

Even within the current US performance there are clear demonstrations of how superior performance is not driven by spending more money. Just read “THE COST CONUNDRUM: What a Texas town can teach us about health care.” by Atul Gawande in the New Yorker. Here is part of Gwande’s discussion of this point:

Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse. For example, Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen. Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be. In fact, the four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were near the bottom of the national rankings on the quality of patient care.

Melnick is not done demonstrating his lack of awareness of further basics about how healthcare works in the US.

There are a number of economists who feel that health-care is expensive for good reason. And the reason is that it’s valuable. That new innovation and new technology, while it may add to the cost of the health-care system, also brings with it tremendous benefits. The real challenge is can we develop a system to do the research to identify those things that are going to be high value in the first place, and to screen out those things that are low value and not adopt them as quickly as we have in the past. And that will be a challenge, but I think there’s potential savings there. I don’t know any country that has done it very well so far, because new innovation is just so complex and hard to predict.

One of the well reported facts about “innovation” in American medicine is that there is no requirement for new technologies, new procedures, new medical devices, or even new drugs to prove their efficacy. This is well known and examples of the consequences are abundant. If we only knew which of all these “innovations” really provided improvements in healthcare outcomes we would all be better of and probably at a lower cost.

I am not sure who Professor Melnick is, but, based on his performance during this interview, he would appear to be another example of that alternative text for PhD.


Healthcare Crisis

Originally written in 2005

The healthcare crisis in the US is growing in severity and yet is not the subject of any real public debate. More than 44 million Americans are without health insurance and almost 65 million will experience a lack of coverage during the year. Emergency rooms are the primary care provider of necessity. All of this despite the fact that, as a nation, we spend more than any other country in the world; 11% more than the next closest country; 90% to 100% more than countries like Germany, Japan, Canada, Australia, and France. Yet the outcomes for our healthcare system are completely second tier and nearly third world.

You may be shocked to see exactly how poorly our phenomenally expensive health system is performing. Just to add some further context, note that Sweden (1st in Infant Mortality to the US 41st position) has a per capita income roughly equal to that of Mississippi (the poorest US state) and spends almost exactly half of what the US does per capita on health care. Examine the Comparative Health System Data in which I have color-coded a few countries for quick comparison.

During our quadrennial presidential personality sweepstakes, neither candidate offered real solutions, really not even a discussion of the issues. We are stuck in a political environment in which neither the Republicans nor the Democrats are offering, and I would argue, are capable of offering real solutions.

Lets make a one basic observation about the situation:

This is not a money problem. As demonstrated by the data on the Comparative Health System Data chart, we clearly are spending enough money in aggregate.

But, this crisis is about money, namely, who gets it and what do they do with it. And, starting from the last serious attempt to tackle the problem during the first year of the Clinton administration, it is very clear that the political system is completely in the pockets of the various interests who have the money now, namely insurance and drug companies, hospitals, and doctors.

It seems obvious to me that we just need to look at any of a number of the top performing countries for the solution. Then, we need to have the political forces in place to tell some of the current participants that the rules have changed.

Central to any solution will be the participation of all US residents in the system. Healthcare is a basic human right and we should not be treated as “risk” factors in insurance company profit calculations. If everyone is part of the healthcare system, then we can effectively share the individual risks and expenses of healthcare across the whole population. Healthcare should not be an actuarial game to derive profit. It should be a system that delivers a reasonable level of service to everyone in the society.

Two players clearly are at the top of the hit list. First, most assuredly the insurance industry, which adds no value to our health care, but consumes by many estimates 15% to 20% of the resources, must go. Second, the drug companies can be brought into reasonable competition for prices that will bring market forces to bear.

Ironically, given the long history of doctors opposing national or single-payer systems in the US, doctors have now been reduced to the status of wage slaves like the rest of us. Many, if not a solid majority of doctors, will support real reforms to the system.

I close here with two basic notions:

  • our healthcare problems are not about a lack of money, and
  • we need to develop political forces that can overcome the control of government (Federal and state) health policies by the current players in the healthcare system.

Given the current Bush administration, I believe the focus of reform must be at the state level. It seems feasible to envision a single-payer system that covers all residents in a state like Massachusetts. We should try it.

The Healthcare Crisis

The healthcare crisis in the US is growing in severity and yet is not the subject of any real public debate. More than 44 million Americans are without health insurance and almost 65 million will experience a lack of coverage during the year. Emergency rooms are the primary care provider of necessity. All of this despite the fact that, as a nation, we spend more than any other country in the world; 11% more than the next closest country; 90% to 100% more than countries like Germany, Japan, Canada, Australia, and France. Yet the outcomes for our healthcare system are completely second tier and nearly third world.

You may be shocked to see exactly how poorly our phenomenally expensive health system is performing. Just to add some further context, note that Sweden (1st in Infant Mortality to the US 41st position) has a per capita income roughly equal to that of Mississippi (the poorest US state) and spends almost exactly half of what the US does per capita on health care. Examine the Comparative Health System Data (below) in which I have color-coded a few countries for quick comparison.

During our quadrennial presidential personality sweepstakes, neither candidate offered real solutions, really not even a discussion of the issues. We are stuck in a political environment in which neither the Republicans nor the Democrats are offering, and I would argue, are capable of offering real solutions.

Lets make a one basic observation about the situation:

This is not a money problem. As demonstrated by the data on the Comparative Health System Data chart, we clearly are spending enough money in aggregate.

But, this crisis is about money, namely, who gets it and what do they do with it. And, starting from the last serious attempt to tackle the problem during the first year of the Clinton administration, it is very clear that the political system is completely in the pockets of the various interests who have the money now, namely insurance and drug companies, hospitals, and doctors.

It seems obvious to me that we just need to look at any of a number of the top performing countries for the solution. Then, we need to have the political forces in place to tell some of the current participants that the rules have changed.

Central to any solution will be the participation of all US residents in the system. Healthcare is a basic human right and we should not be treated as “risk” factors in insurance company profit calculations. If everyone is part of the healthcare system, then we can effectively share the individual risks and expenses of healthcare across the whole population. Healthcare should not be an actuarial game to derive profit. It should be a system that delivers a reasonable level of service to everyone in the society.

Two players clearly are at the top of the hit list. First, most assuredly the insurance industry, which adds no value to our health care, but consumes by many estimates 15% to 20% of the resources, must go. Second, the drug companies can be brought into reasonable competition for prices that will bring market forces to bear.

Ironically, given the long history of doctors opposing national or single-payer systems in the US, doctors have now been reduced to the status of wage slaves like the rest of us. Many, if not a solid majority of doctors, will support real reforms to the system.

I close here with two basic notions:

  • our healthcare problems are not about a lack of money, and
  • we need to develop political forces that can overcome the control of government (Federal and state) health policies by the current players in the healthcare system.

Given the current Bush administration, I believe the focus of reform must be at the state level. It seems feasible to envision a single-payer system that covers all residents in a state like Massachusetts. We should try it.

Solving the Health Care Crisis in the US – some data

Comparative Health System Data

Health Spending per
Capita 2002

Infant Mortality per 1000 Births 2003

Life Expectancy in Years at Birth 2003

1

United States

$4,271

1

Sweden

3.44

1

Andorra

83.49

2

Switzerland

$3,857

2

Iceland

3.53

2

Macau

81.87

3

Norway

$3,182

3

Singapore

3.6

3

San Marino

81.43

4

Denmark

$2,785

4

Finland

3.76

4

Japan

80.93

5

Luxembourg

$2,731

5

Japan

3.84

5

Singapore

80.42

6

Iceland

$2,701

6

Norway

3.9

6

Australia

80.13

7

Germany

$2,697

7

Andorra

4.07

7

Guernsey

80.04

8

France

$2,288

8

Netherlands

4.31

8

Switzerland

79.99

9

Japan

$2,243

9

Austria

4.39

9

Sweden

79.97

10

Netherlands

$2,173

10

France

4.41

10

Hong Kong

79.93

11

Sweden

$2,145

11

Switzerland

4.42

11

Canada

79.83

12

Belgium

$2,137

12

Macau

4.44

12

Iceland

79.8

13

Austria

$2,121

13

Slovenia

4.47

13

Cayman Islands

79.67

14

Canada

$1,939

14

Belgium

4.64

14

Italy

79.4

15

Australia

$1,714

15

Germany

4.65

15

Gibraltar

79.38

16

Finland

$1,704

16

Luxembourg

4.71

16

France

79.28

17

Italy

$1,676

17

Spain

4.85

17

Monaco

79.27

18

United Kingdom

$1,675

18

Australia

4.9

18

Liechtenstein

79.25

19

Israel

$1,607

19

Liechtenstein

4.92

19

Spain

79.23

20

Ireland

$1,569

20

Guernsey

4.92

20

Norway

79.09

21

United Arab Emirates

$1,428

21

Canada

4.95

21

Israel

79.02

22

New Zealand

$1,163

22

Denmark

4.97

22

Jersey

78.93

23

Spain

$1,043

23

Gibraltar

5.4

23

Faroe Islands

78.9

24

Greece

$965

24

Ireland

5.43

24

Greece

78.89

25

Portugal

$859

25

United Kingdom

5.45

25

Aruba

78.83

26

Slovenia

$746

26

Czech Republic

5.46

26

Netherlands

78.74

27

Singapore

$678

27

Jersey

5.52

27

Martinique

78.72

28

Argentina

$654

28

Northern Mariana Islands

5.61

28

Virgin Islands

78.59

29

Uruguay

$621

29

Malta

5.72

29

Malta

78.43

30

Bahamas, The

$612

30

Monaco

5.73

30

Germany

78.42

31

Barbados

$601

31

Hong Kong

5.73

31

Montserrat

78.36

32

Korea, South

$470

32

Italy

5.76

32

New Zealand

78.32

33

Lebanon

$469

33

Portugal

5.84

33

Belgium

78.29

34

Saint Kitts and Nevis

$408

34

San Marino

6.09

34

Guam

78.27

35

Czech Republic

$380

35

New Zealand

6.18

35

Austria

78.17

36

Bahrain

$358

36

Greece

6.25

36

United Kingdom

78.16

37

Hungary

$318

37

Aruba

6.26

37

Saint Pierre and Miquelon

78.11

38

Brazil

$308

38

Man, Isle of

6.3

38

Man, Isle of

77.98

39

Chile

$289

39

Guam

6.58

39

Finland

77.92

40

Slovakia

$285

40

Faroe Islands

6.66

40

Jordan

77.88

41

Costa Rica

$257

41

United States

6.69

41

Luxembourg

77.66

42

Poland

$248

42

Taiwan

6.8

42

Guadeloupe

77.53

43

Panama

$246

43

Croatia

7.06

43

Bermuda

77.41

44

Estonia

$243

44

Cuba

7.27

44

Saint Helena

77.38

45

Mexico

$236

45

Israel

7.55

45

Ireland

77.35

46

South Africa

$230

46

Korea, South

7.58

46

Cyprus

77.27

47

Colombia

$227

47

Martinique

7.62

47

Puerto Rico

77.26

48

Dominica

$208

48

Cyprus

7.71

48

United States

77.14

49

Trinidad and Tobago

$204

49

Montserrat

7.98

49

Denmark

77.1

50

Grenada

$193

50

Saint Pierre and Miquelon

8.18

50

Taiwan

76.87

51.

Lithuania

$183

51

New Caledonia

8.23

51

Cuba

76.8

52

Antigua and Barbuda

$179

52

Reunion

8.31

52

Anguilla

76.7

53

Venezuela

$171

53

Slovakia

8.76

53

French Guiana

76.69

54

Latvia

$166

54

Hungary

8.77

54

Kuwait

76.65

55

Jamaica

$157

55

French Polynesia

8.95

55

Costa Rica

76.43

56

Turkey

$153

56

Chile

9.12

56

Portugal

76.35

57

Saint Lucia

$151

57

Poland

9.17

57

Chile

76.35

58

Maldives

$150

58

Virgin Islands

9.21

58

Northern Mariana Islands

76.16

59

El Salvador

$143

59

Bermuda

9.28

59

Libya

76.07

60

Namibia

$142

60

Puerto Rico

9.3

60

British Virgin Islands

76.06

61

Peru

$141

61

Guadeloupe

9.3

61

Uruguay

75.87

62

Jordan

$139

62

Cayman Islands

9.89

62

Jamaica

75.85

63

Iran

$128

63

American Samoa

10.09

63

American Samoa

75.75

64

Botswana

$127

64

Nauru

10.52

64

Slovenia

75.51

65

Gabon

$122

65

Costa Rica

10.87

65

Argentina

75.48

66

Mauritius

$120

66

Kuwait

10.87

66

French Polynesia

75.45

67

Syria

$116

67

Netherlands Antilles

11.06

67

Netherlands Antilles

75.38

68

Thailand

$112

68

Barbados

11.71

68

Korea, South

75.36

69

Tunisia

$108

69

Estonia

12.32

69

Czech Republic

75.18

70

Burma

$97

70

Macedonia, The Former Yugoslav Republic of

12.54

70

United Arab Emirates

74.75

71

Dominican Republic

$95

71

French Guiana

13.22

71

Macedonia, The Former Yugoslav Republic of

74.49

72

Paraguay

$86

72

Jamaica

13.71

72

Slovakia

74.43

73

Fiji

$86

73

Tonga

13.72

73

Tunisia

74.4

74

Romania

$86

74

Fiji

13.72

74

Paraguay

74.4

75

Belarus

$85

75

Brunei

13.95

75

Croatia

74.37

76

Belize

$82

76

Belarus

14.12

76

Brunei

74.3

77

Malaysia

$81

77

Bulgaria

14.18

77

Dominica

74.12

78

Guatemala

$78

78

Uruguay

14.25

78

Turks and Caicos Islands

74

79

Honduras

$74

79

Lithuania

14.34

79

Serbia and Montenegro

73.97

80

Bolivia

$69

80

Grenada

14.63

80

Poland

73.91

81

Kazakhstan

$62

81

Saint Lucia

14.8

81

Venezuela

73.81

82

Bulgaria

$62

82

Latvia

14.96

82

Bahrain

73.72

83

Ecuador

$59

83

Sri Lanka

15.65

83

New Caledonia

73.52

84

Nicaragua

$54

84

Saint Kitts and Nevis

15.83

84

Reunion

73.43

85

Guyana

$51

85

Dominica

15.94

85

Qatar

73.14

86

Swaziland

$46

86

United Arab Emirates

16.12

86

Saint Vincent and the Grenadines

73.08

87

China

$40

87

Saint Vincent and the Grenadines

16.15

87

Saint Lucia

73.08

88

Congo, Democratic Republic of the

$40

88

Palau

16.21

88

West Bank

72.68

89

Cape Verde

$37

89

Mauritius

16.65

89

Sri Lanka

72.62

90

Philippines

$37

90

Seychelles

16.86

90

Oman

72.58

91

Zimbabwe

$36

91

Bahamas, The

17.08

91

Albania

72.37

92

Albania

$36

92

Argentina

17.2

92

Panama

72.32

93

Bhutan

$36

93

Greenland

17.28

93

Mexico

72.3

94

Kenya

$31

94

Serbia and Montenegro

17.36

94

Bosnia and Herzegovina

72.29

95

Nigeria

$30

95

Turks and Caicos Islands

17.46

95

China

72.22

96

Turkmenistan

$30

96

Romania

18.88

96

Hungary

72.17

97

Sri Lanka

$29

97

Bahrain

19.18

97

Solomon Islands

72.1

98

Ukraine

$28

98

British Virgin Islands

19.55

98

Lebanon

72.07

99

Cote d’Ivoire

$28

99

Panama

19.57

99

Ecuador

71.89

100

Papua New Guinea

$25

100

Jordan

19.61

100

Barbados

71.84

Data for Spending: World Bank. 2002. World Development Indicators 2002. CD-ROM. Washington, DC

Data for Infant Mortality: CIA World Factbook, December 2003

Data for Life Expectancy: CIA World Factbook, December 2003

All data courtesy of http://www.nationmaster.com/index.php (09/29/04)