The Doctor Is In: National Health Insurance = Longer Life?
Q: If socialized medicine is so bad, why do people in countries with government or single-payer healthcare live longer?
A: Life expectancy in the U.S. compared with that of other countries is often cited to condemn the American healthcare system; the uninsured are dying from lack of health insurance and treatment, it is argued, while countries with universal coverage live longer as the result of their healthcare systems.
But is life expectancy primarily dependent on having health insurance? Is access to healthcare services the main determinant of longevity?
Motor vehicle fatalities are the leading cause of death for Americans aged 1-29. Driving under the influence of alcohol is the most common factor in fatal crashes. For every reported death related to a motor vehicle crash, it is estimated that thirteen individuals are injured severely enough to require hospitalization.
For trauma in the U.S. not involving motor vehicles, more than one third of all fatalities from falls, burn injuries, drownings, and homicides involved intoxicated victims, as did more than one quarter of poisonings and suicides.
Supporters of government-provided healthcare often attribute longevity to healthcare access without considering the impact of other factors. Healthcare access in the U.S. has less of an impact on mortality statistics than trauma.
Obesity: Americans Supersized
The typical American diet is high in calories and fat, and rich in processed foods, refined carbohydrates, salt and animal protein. Portion sizes have increased, and dining out -- including fast food -- is more frequent than in the past. This diet is often combined with a sedentary lifestyle focused on television, video games, and computers.
In 2006, 46 states in the U.S. had an overall obesity rate from 20-30%. For adults aged 20-74, the rate is 32.9%, and rates among children have steadily increased for the past 20 years. These figures do not include the high number of Americans who are overweight and at risk for becoming obese, which carries a higher medical risk.
Although obesity is increasingly a worldwide health problem, nearly twice as many Americans as Europeans are obese.
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.]
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.