Friday, July 29, 2011

Health Expenditures and Longevity

Steve Wenner sent me a graph he had come across showing for a number of Western countries and Japan life expectancy on one axis and per capita health expenditures on the other. The results for each year from 1970 to 2008 were plotted on a line along the graph.

The US line was well below that of all the other countries. Wenner’s conclusion was that “we are paying and arm and a leg and not getting much for it.”

I don’t agree fully with that, but before commenting I will say that we pay too much – more than we need to – and that it is past time that we should do something about it.

Having said that, my first comment on Wenner’s remark is that in comparison with the other countries shown, I believe the US population has by some considerable proportion more poor and culturally challenged people concentrated in places like Appalachia, certain parts of the south, and large cities. Violence, teen-age pregnancies, drug abuse, obesity and other destructive life-style behaviors among these groups skew the longevity numbers unfavorably.

My second comment is that it is easy to exaggerate the relationship between health care and longevity. The main determinants of longevity are things like clean water, sanitation, immunizations, nutrition, and living practices. Health care has an effect on longevity, but much less than is commonly assumed.

Finally, I would point out that our spending for health care buys more than longevity. Here are a few of them:

- Care available when and where we want it.
- As much care as we want.
- Free choice of providers.
- Care provided in modern, comfortable, well equipped facilities.
- Care provided by competent, courteous, highly trained and well-paid staff.
- Easy access to specialists, diagnostic tests, and treatments.

The changes needed to get cost down and quality up will pinch on these things somewhat but not, to my mind, in any serious way. But so far we have not been willing to consider even that.

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