March 22, 2017

MEGAN MCARDLE: Better Health Care for Less Money? It’s Not Easy.

“America spends more on health care than other rich nations, but has lower life expectancy.” If I had a nickel for every time I have been informed this by an email, seen it in a headline, heard it in conversation, or watched it scroll across my social media feed, I would be able to personally fund a single-payer health-care system.

As with many political memes, its usefulness to policy wonks is inversely proportional to the weight that its casual proponents place on it. As stated, this meme is true enough: America does have higher health-care costs than anywhere else, and we do indeed have shorter life expectancies than some nations. But of course people are not introducing these facts as a fun bit of trivia, like “Babe Ruth used to wear a cabbage leaf under his baseball cap to keep cool.” What they are actually interested in communicating is the implication that America could switch to a single-payer health-care system and thereby enjoy longer life expectancies at lower cost. And that implication is considerably more dubious.

Some of the disparity may indeed be attributable to the fragmented nature of our health-care system. But most of it probably isn’t — which means it can’t be fixed by changing the form of our health care system, either.

Start with mortality. A recent survey concluded that “regardless of cross-national differences in access to quality medical care, the fact remains that the overwhelming contributors to the incidence of disease (e.g. poor health behaviors) operate largely outside the influence of medical care.” Americans seem to be sicker than people in other countries, and while people often attribute this to lack of preventive care, on some metrics that ought to improve our life-expectancy — such as screening tests — America actually does more than other places. Other contributing conditions, such as obesity, have shown little response to the things that primary care physicians can do, such as tell you that you should lose weight.

We’re also at greater risk for fatal injuries than people in other countries. We have a higher homicide rate, in part because Americans seem to be more violent and in part because we have greater access to guns. And we drive more, so more of us die in auto accidents. No matter what you think of America’s car-driven development policy, or its gun-control regime, you can’t think that altering our health-care system is going to keep Americans from driving to their suburban homes, or shooting each other.

Skeptical? Let’s look at what happened when the U.S. greatly expanded the government’s funding of health care: Between 2014 and 2015, age-adjusted mortality rose for the first time in decades.

Making it better and cheaper is hard. Making it worse and more expensive is as close as your nearest politician.

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