Why Does Exorbitant Healthcare Spending Not Equal Good Health In the U.S.?

The International Herald Tribune reported last summer that "Combined public and private spending on health care in the U.S. came to $8,233 per person in 2010, more than twice as much as relatively rich European countries such as France, Sweden and Britain that provide universal health care." Yet a study, commissioned by the National Institutes of Health carried out by experts appointed by the National Research Council and the Institute of Medicine -- released last week according to the New York Times -- found "on average, Americans experience higher rates of disease and injury and die sooner than people in other high-income countries."

Conundra such as these make great headlines, but the causal factors are far more complex than many of our politicians care to acknowledge. This is the first NIH analysis "to compare the burden of multiple diseases and injuries in the United States and 16 other affluent democracies, including Western European countries, Australia, Canada and Japan [in which] American men ranked last in life expectancy among the 17 countries and American women ranked next to last. The United States also ranked at or near the bottom in nine areas, including heart disease, chronic lung disease, obesity and diabetes, injuries and homicides, and sexually transmitted diseases."

Another analysis of the NIH Study, For Americans Under 50, Stark Findings on Health by Sabrina Tavernise reports the following sober findings:
-- "Deaths before age 50 accounted for about two-thirds of the difference in life expectancy between males in the United States and their counterparts in 16 other developed countries, and about one-third of the difference for females."
-- "Car accidents, gun violence and drug overdoses were major contributors to years of life lost by Americans before age 50."
-- "The rate of firearm homicides was 20 times higher in the United States than in the other countries, according to the report, which cited a 2011 study of 23 countries.
-- "Sixty-nine percent of all American homicide deaths in 2007 involved firearms, compared with an average of 26 percent in other countries..."
-- "The United States has the highest infant mortality rate among these [17] countries, and its young people have the highest rates of sexually transmitted diseases, teen pregnancy and deaths from car crashes."
-- " Americans lose more years of life before age 50 to alcohol and drug abuse than people in any of the other countries."
-- "... the United States has the highest rates of poverty among the countries studied."
-- "Americans who have not graduated from high school die from diabetes at three times the rate of those with some college."

So why does the U.S. pay the most for healthcare -- at over 15% of GNP according to the World Health Organization -- and reap third world results? We fail to keep our eye on the ball. Heck, we're hardly ever willing to look at the whole playing field. The NYT coverage of the NIH study cites that "Likely explanations include a large uninsured population and more limited access to primary care, two problems that should be mitigated by the health care reforms that will kick in next year; higher levels of poverty and income inequality in this country; weaker safety net programs; sedentary lifestyles and obesity; higher rates of drug abuse and traffic accidents that involve alcohol; and greater use of firearms in acts of violence." All of the latter are also political anvils in the U.S. Other possible contributors include myriad -- and costly -- diagnostic testing that is often times unnecessary (and potentially harmful), ubiquitous consumption of excessively advertised over-the-counter and prescription medicines (many with horrific disclosed potential contraindications) and last but not least, our overly litigious culture that incentivizes physicians to pull out all the stops for fear of financial retribution if they don't.

One of the biggest obstacles to solving this conundrum could be our culture of rugged individualism -- a hallmark of U.S. greatness in many respects. But I suspect that upon reading these statistics, many people say to themselves "this doesn't apply to me; I eat well, exercise, seek preventative medical care, get treatment as needed and I'll beat those odds." Potentially so, though we're all at risk of suffering the potential consequences of our societal failure to systematically address and treat mental illness, drug addiction, extreme poverty and the dysfunction and violence that they perpetuate.

To wit, todays NYT reported separately that spending cuts to programs "including food stamps, children's health insurance, Medicaid, ... grants for initiatives like Meals on Wheels" will all need to be on the table in order to gain a [legislative] consensus on raising the debt ceiling before March 27th. Which Christine LaGarde, Managing Director of the I.M.F., warned yesterday "could be catastrophic for the global economy if it is not raised in time."

A recent U.S. poll "rates the U.S. Congress below cockroaches and colonoscopies." Could it be that they don't actually represent their districts? Maybe outlawing PACs and corporate financing of political campaigns would incent our "elected representatives" to focus on that which matters most to their citizen constituency, impartially analyze other systems that work, and improve our collective health and safety.

Other solutions from the Spend Matters community? We're all paying for this complex comparative failure both monetarily and with the reduced quality of our lives. "And as recently as the 1950s [as Ms. Tavernise concludes], Americans scored better in life expectancy and disease than many of the other countries in the current study." But let's resist waxing nostalgic. As my favorite ex-brother-in-law is fond of stating, "Isn't that when Johnny died of polio."

- William Busch

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