Sunday, November 4, 2007

U.S. health care system - Beyond Those Health Care Numbers

In today’s NYT (Nov. 4), N. Gregory Mankiw, a Harvard economics professor advising the Romney campaign, puts three scare-mongering health statistics in context.

STATEMENT 1 – The U.S. has lower life expectancies and higher infant mortalities than Canada, which has national health insurance. True. Canadian men and women live 2.6 and 2.3 years more respectively. But the cause may be larger social forces beyond the control of the health system. Americans are 50% more likely to die from accidents and homicide. Americans are more obese – our men (31%) and women (33%) have a body mass index of 30 or more compared to 17% of Canadian men and 19% of Canadian women. Our high infant mortality rates are directly related to our rate of teenage motherhood out of wedlock. National health insurance is unlikely to change homicide or accident rates, obesity, or sexual mores.

STATEMENT 2 – Some 47 million Americans have no health insurance. True again. But of the 47 million 10 million aren’t American citizens. The 47 million also includes million who are eligible for Medicaid but don’t apply, and it includes 18 million who make $50,000 or more who choose to spend their money elsewhere. Comments the good professor, “We should be wary of sweeping reforms of our health system if they motivated by the fact that a small percentage of the population is uninsured.”

STATEMENT 3 – Health costs are eating up an every increasing share of Americans’ income. In 1950, the percent was 5%, in 2006, 16%. But the reasons may be symptoms of success – better medical technologies, more economic prosperity, and longer, better, more productive lives... “As we look at reform plans, concludes professor Mankiw, “we should be careful not to be fooled by statistics into thinking that the problems are worse than they really are.”


ObGynThoughts said...

I was just thinking about these issues the last two days. I am sick and tired of hearing people parroting those numbers and thinking that it says something against our healthcare system.
It just does not work to compare the US with let's say Denmark, a country of a few million with very little poverty, much less diverse and with a much longer history.
If you want to compare Denmark and the US, compare it to, let's say Vermont or Massachusetts, and you will see that the US starts looking better.
The US has a vast difference in climates, in wealth and poverty and in lifestyles. We have the most obese and most sedentary people in the world and it shows in our statistics. Adn yes, we are expensive, but we also are the best, we have the top of almost every area. Adn the top is expensive.
Plus we have an absurd legal system that the world laughs at and shakes it's head - spill coffee on your lap and become a millionaire! This system applied to medicine has disastrous consequences and leads to waste such as ordering a CT as a knee jerk reflex for too many people that come to ther ER as just one example. Defensive medicine costs many billions every year, no matter what John Edwards, who got rich with it, says.
Plaese be a little less superficial when judging the American Health Care system! (I did not mean you, Richard, but the general reader of your much appreciated blog)

Dr. Bonis said...

I agree with you, life expectancy has no so much to do with healthcare system and much more with obesity, social innequalities and so on.

But from my point of view (spaniard) you, USA people, missed the point. You are glad of having the "last" technology (CT scan highly available for example) and think this is a sign of a good health-care system.

But the objective of a healthcare system is to improve health (and this means for example longer life expectatives) and no to provide the last high-technological gadget.

The data don't lie. Canada (and Europe) have a healthier sociey. Probably because of a better health-care system. "wait a minute, this guy has said the health-care system has nothing to do with life expectancy... so his argument is no valid" you are probably thinking now...

BUT... the "health-care system" is not ONLY about hospitals, TCs, and global coverage for heart transplantation.

Health-care system is more about UNIVERSAL PRIMARY CARE COVERAGE, public health for all, vaccines available for all, nutritional advise for all, access to deportive facilities for all, no guns in the streets, no alcohol + driving, education for ALL (education level is the best predictor of socioeconomical status, and socioeconomical status is the best predictor of health... so education is the best health-care technology), ...

Maybe if you understood health-care system in a more "holistic" way you would see the links between your worse health statistics results and your "health-care system".

Better health-care system is not about CT available for every headhache but being sure that no pregnant woman (whatever she lives in Manhattan or in Bronx) has a unknown and no controlled gestational diabetes (for example). Unfortunately primary care is not technology intensive, so the market forces doe not find it interesting.