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The Doctor Is In: National Health Insurance = Longer Life?

The impact of obesity on health includes an increase in the following:

  • High blood pressure
  • Elevated cholesterol and triglycerides
  • Arthritis and back pain
  • Diabetes and insulin resistance
  • Stroke and heart disease, including heart attacks
  • Gallbladder disease
  • Breathing problems, including sleep apnea
  • Breast, Colon and Uterine cancer rates
  • Incontinence, infertility and complications of pregnancy

Obesity is the second most preventable cause of premature deaths in the United States, accounting for 300,000 lives per year.

Although access to treatment for the complications of obesity may be linked to health insurance, there is no evidence that insurance -- or even healthcare -- impacts the prevalence of obesity. Body weight is influenced far more by behavior, genetic factors, environment, cultural norms, and socioeconomic status.

Good Health -- Up in Smoke

Tobacco use is the number one cause of preventable mortality in the United States, linked to one in every five deaths. Tobacco use is associated with more deaths than AIDS, alcohol and illegal drug use, motor vehicle crashes, suicides, and homicides combined.

While a case may be made for decreasing tobacco use as a public health issue, smoking and the use of tobacco products are behaviors learned outside of the healthcare delivery system. Smoking prevention and cessation programs can be provided within communities successfully and cost-effectively, as demonstrated by the American Cancer Society and local demonstration projects across the country.

While access to treatment for tobacco-related illness is associated with health coverage, the decision to smoke or quit is related more closely to environmental and social factors than to health insurance or medical care. [Author's note: As doctors caring for patients who smoke, my colleagues and I profoundly regret this. Far more patients ignore our advice to quit than follow it, regardless of time spent counseling, warning, or cajoling. In four years of caring for women with breast cancer, I can recall only one patient who quit smoking on my recommendation. After her mastectomy, she wanted to have a complex type of breast reconstruction that was risky in smokers. She quit two days after I told her this.]

Violent crime

Among industrialized nations, the United States has the highest rates of childhood homicide. In the 1990s, among children ages 5-14, murder was the third leading cause of death. Overall, U.S. homicide victims are most likely to range in age from 18-34.

The American population most likely to be healthy is also the group most likely to die violently.

Washington, D.C. ranks highest among U.S. cities for murders per 100,000 people: 69.3 during the 1990s. New York City seems comparatively low at 16.8.

But the rate of murders per 100,000 citizens of Canada is 1.73. For Belfast, Ireland it is 4.4. In fact, figures for Sweden, Switzerland, Germany, France, and Denmark are all below 5 per 100,000.

Thirty-seven U.S. states rank higher than these North American and European countries for the number of citizens murdered each year.

The impact of violent crime on the life expectancy of U.S. citizens far outstrips that of European nations. The social and cultural implications of violent crime, important as they are, will not be addressed by health insurance. Access to healthcare is not the same as access to a safe, crime-free environment.

As you can see, comparing life expectancy in countries where government foots the insurance bill to our system here is like equating apples and oranges. Conditions relating to obesity, tobacco use, alcohol, and violencemake America unique. Adopting a national health insurance model will not necessarily lead to a longer life.