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If US health Care's So Good, Why Do Other People Live Longer?
Ask around for the healthiest country in the world, and the United States won't come close to topping the list.
People live longer in just about every industrialized nation, from Canada to our north, throughout much of Europe, and around the Pacific in Japan, Australia and New Zealand.
New mothers and their babies also face a rockier start here, with U.S. infant and maternal death rates double some of our industrialized peers.
As debate swirls in Washington and at town halls nationwide over health care reform, there is also a more fundamental question — what about health?
Could policymakers change our medical system in ways that would make America a healthier country?
Insuring everyone should help — but less than people might think, according to doctors and public health experts who've studied the issue. Putting more resources into primary care should also make a dent, they say.
Neither one, though, is likely to send America to the top ranks of its global peers.
"If you want to see dramatic changes in health, you're not going to get there even by doubling the efficiency and effectiveness of the health care system," said Dr. Richard Kravitz, a University of California, Davis, professor of medicine whose research interests include quality of care.
"When you need it, you really need it … but in general, the benefits of medical care to populations are a little bit overrated," he said.
When taken all together, the other factors that play a bigger role include education, income, toxins in the environment, crime, violence, family structure, stress, obesity, nutritious food and exercise.
Across large populations, he said, numerous studies suggest that medical care contributes only modestly to overall health, perhaps somewhere between 10 percent and 25 percent.
Health care for all would provide a "very large" improvement for some deprived populations, Kravitz said, but "a surtax on high fructose corn syrup would probably be more effective … than anything we could do for the health care system, just because of obesity."
Researchers who have delved into the effects of medical care on the health of large groups overall have made some surprising and sometimes conflicting discoveries.
An experiment in the 1980s that extended different levels of insurance to otherwise uninsured people found that more coverage fostered more use of the medical system but not necessarily healthier people, said Dr. Peter Muennig, a professor of health policy and management at Columbia University's Mailman School of Public Health.
A 2006 study that compared white people in England with whites in the United States, in an effort to keep different ethnicities from complicating the findings, reached conclusions Muennig found startling. Even the richest white Americans, who are pretty much universally insured, had more diabetes, more high blood pressure, more heart disease and more cancer than the richest white Britons. On most measures they were a little less healthy than middle income Britons.
This points to a vast range of things health care cannot do, from providing mass transit that makes it likelier people will walk more, to providing the kind of education that correlates strongly with better health.
"Education is the fundamental ingredient for what you need to survive in any ecological niche," Muennig said. People with less education are likely to have jobs that are lower paying, higher stress and possibly more dangerous. They're likelier to live in unsafe housing and eat cheap, calorie-dense food. They're less likely to be offered job-related health insurance. Except for the insurance, he said, health care reforms cannot fix that.
Those who examine health across many nations puzzle over other oddities.
In international health care measures, America's ranking improves when life expectancy is measured for people age 65 and older. While still not at the top of the health heap, Americans who make it to age 65 have remaining life expectancies closer to 65-year-olds in other developed countries, and men stack up a little better than women against their peers worldwide.
That might mean that American medicine treats older people more effectively. Or it could mean that Medicare, universal coverage available at age 65, may be keeping older people healthier. Or it could be something called the "survivor effect," suggesting those who have lived past earlier perils are more robust.
While the factors that optimize health are complex, doctors say there are things federal policymakers could do to make America a little healthier.
Among them are strengthening primary care, finding ways to encourage better diet and exercise, and effectively reforming how health care is financed, said Dr. James G. Kahn, a professor of health policy and epidemiology at the University of California, San Francisco.
People do better in nations that encourage them to have a regular primary care provider, Kahn said, perhaps partly because regular, front-line care helps bolster healthy habits.
"Even in the United States, in locations with a higher concentration of primary care providers, people have somewhat better outcomes and also lower costs," he said.
Rewarding and encouraging primary care might also offset an American tendency to do too much, driven by a system that pays for each procedure performed by a doctor, hospital or testing lab, Kahn added.
"We do too many surgeries," he said. "Rates of cardiac surgery are lower in Canada, yet they have better outcomes."
There is hope, too, for "accountable care" groups that would move away from fee for service payments but be held accountable for keeping all their patients as healthy as possible, said Stephen Shortell, dean of the school of public health at UC Berkeley.
Shortell is also pleased that the health legislation being discussed in Washington includes billions for disease prevention and health promotion.
"You can't ignore the health care system, but the big payoff is in lifestyle factors and disease prevention," he said. "A dollar spent on those activities saves $5 in health care costs."
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35 Comments so far
Show AllI think the life expectancy rankings are mostly a joke. Sure Europe's are way ahead of ours...by a virtue of living a year or two longer, big deal. What I think the measure of an effective healthcare system is if the population is guaranteed access to it and it makes the population healthier. Is that so hard?
The biggest problems with US health care are the rapidly escalating cost and quality of insurance and the rapidly escalating cost of treatment, not the quality of the care (when it is obtainable).
Compared to Europe, Japan, Canada, Australia and New Zealand, the US is the only nation where a significant % of the population is one big medical bill away from bankruptcy.
"The biggest problems with US health care are the rapidly escalating cost ... "
Yeah. Like $324 to have one damn tooth pulled. Next time I'll buy some oxycontin from a street dealer, crush it up, snort it, and pull my own damn tooth with a pair of vise grips.
That's it. Don't mention single payer.
AD
This makes Single Payer even more important. It puts a real push on congress to clean up our environment. No more corporate pimping to poison our food, water and air.
How has a nation with so many dumb people become the World powerhouse it has.
Hmmm, That ranks up there with "If God is all powerful, can he create a rock so heavy that he can't lift it".
The world powerhouse thing is a myth. The greatest, most powerful military the world has ever seen has so far been unable to "pacify" Baghdad at a cost so far of around a trillion dollars. Not much "bang for the buck" there, I'd say.
ALL military spending is a waste. You could send a kid to college for one year for the cost of one 2000 pound "smart" bomb, and you wouldn't create another dozen collaterally damaged "terrorists" by not having that bomb to drop.
Sure, we can't make the people there stop hating us and wanting to attack us. But we sure as hell can destroy the infrastructure of any country on the planet and inflict unbelievable amounts of misery.
The major determinant of health and well being for wealthy countries is how equally the aggregate income is shared. This is also true for states within the US. The fairer and more equal the income distribution, the longer the life span. Fairer and more equal societies also have more trust, fewer homicides, fewer teen pregnancies, less obesity, fewer high school drop outs, fewer prisoners, lower infant mortality...You name it. See www.equalitytrust.org.uk for more and see my article at http://www.alternet.org/workplace/141645
Thank you Jeff, you are completely right. Inequality is the source of our biological and social sickness.
But "corporate responsibility" is a mirage, as long as corporations are run by private wealth. When they have been taken over by workers and communities, THEN we will have more equality.
Economic inequality cannot be solved on a political level alone. The New Deal is proof of that. The Wagner Act of 1935 gave more power to workers and unions, but then in 1947, only 12 years later, Taft Hartley took it back; and the unraveling of all the other New Deal reforms began, as the unions weakened.
Why? Because ECONOMIC power was still in the hands of private corporations, and they used that power to win back all the political concessions which were wrung out of them by the outrage of the depression. Social democracy, which is the political limitation of naked capitalism, is always unstable and temporary.
Only when workers and neighbors have relearned the arts of co-operation and solidarity will any real progress towards equality be possible.
Simple answer. The U.S. doesn't actually have a health care system as such. It has a Darwinian system of life support that is rationed by the insurance industry based on the ability to pay. If you die poor, it's because you weren't fit to live a long life in the first place.
The motto is taken from the Dickensian observation made by Ebenezer Scrooge: "And if they would rather die, they had better do it, and decrease the surplus population."
matthew loughran
i agree rv. that describes the US non health non system to a T.
That is one of my favorite quotes RV: "And if they would rather die, they had better do it, and decrease the surplus population."
For the rest of us who are still in decent health:
"Are there no prisons? Are there no work-houses?
I would like to take this opportunity to again thank a certain man.
A few years ago I went to Disneyland, here in southern California. I was finishing the Matterhorn ride, and my rail car was moving slowly toward the disembarking point.
However, there was a problem in a car ahead of me. There was a man, a large man, obese in fact, who could not exit his car.
There was such a back-up that the ride attendant brought my car around past the exit and I got to ride the mountain again (without having to wait another hour in line).
Thank you, obese American man. While you inconvenienced everybody else around you (and there were a lot around you, because you had such a large 'around'), I benefited from your unhealth and your rotundness.
What was the topic, again?
I believe it was found out in California that Doctors were performing open heart surgery, NOT because it was medicaly necessary but because it increased profits .
The costs to perform transplants and other major surgeries in the US are 2 to 3 times higher then comparable surgeries in Canada. This excluding single payer.
Canada advertises itself as a medical Tourism destination to US citizens because the costs are so much lower.
This is bought and paid for stuff.
One would think that with the larger market in the US and all that competition costs would be lower thus the same procedures could be offered at a lower cost.
http://www.findprivateclinics.ca/resources/general/medical-tourism.php
Health-care quality, health-care affordability and the overall level of health in a given population are certainly separate measurements, but they are very interrelated. For example, I recently heard about a research study finding that, while healthy habits lead to better quality of life and longevity for individuals, the assumption that this will significantly reduce a population's overall health-care costs is way overstated.
According to this study, healthy lifestyles allow more people to survive to old age, which is when the majority of health-care expenses are incurred.
I would also add that a healthy lifestyle is more than just eating nutritious foods grown in your neighborhood victory garden and gathering outside with your neighbors every morning to do Tai Chi exercises. It also means regular check-ups, dental exams, eye exams, etc. As a displaced manufacturing worker who has had to deal with declining wages, I've been putting off many of these things while I wait for the nation's economy to suddenly improve (or my own personal economy somehow improves).
In the meantime, I continue to fight the good fight for Single-Payer. Let's win that battle first--and then we'll see if we need a couch-potato tax.
One reason our life expectancy is shorter in the US - the NRA-supported high levels of lead poisoning, to the tune of ten 9/11s every year.
Clean water is what counts most in enhancing national health/life expectancy. 80% of out increased life-expectancy is attributed to public (i.e.government) health measures.
Keeping the shit out of the drinking water is a big, complex job, which can only be done by government. Happily, our fed/state/local governments get it done. Federal standards and incentives are needed because a lot of local governments are corrupt and or/lazy and/or stupid.
Most of the "bad" behaviors favored by Americans - smoking, drinking, over eating foods high in fat & sugars, watching TV rather than exercising, etc., all have one thing in common: they provide immediate comfort and distraction.
Why do we seek that kind and amount of comfort/escape more than other societies? Are we looking for relief? From what?
Anxiety? Uncertainty? Anger? Resentments?
Any connection between the number of mood altering drug ads and the news programs they sponsor?
Anxiety? Uncertainty? Anger? Resentments?
Yes, all of the above; and all exacerbated by inequality. People who are despised and discounted are anxious and insecure, which floods the body with deadly stress hormones.
Yes. You bring up a very good point. Why worry about your health if not caring about your health means you escape to a death from a culture/society at odds with you a little bit sooner?
Do USans have some things to learn from their brothers and sisters outside the fortress walls? This article refutes the liberal spirit as much as it refutes the conservative spirit. The liberal spirit designates the dysfunction inside the fortress walls as legitimate as everything else, which is baloney.
Outside the red white and blue segre-Gated "community" USA, there is awareness of nature, the beautiful biosphere and all side of human nature, and appreciation and attachment to the good side of human nature, and little tolerance for the organization of the dark side.
Human nature is the same inside and outside the USA but inside the fortress the continuity of tribes and traditions has been intentionally destroyed for the great majority, and in search of an identity this majority lurches at nationalism and feverishly defends its relatively brief and plunderous legacy. Since the plunder has to be defended, the healthcare has to be the best. Everything has to be the best in the US, the best in the west, the westest of the west, more western than you, more bester than you. Who else can occupy the western edge of the universe better than the US?
Meanwhile the beautiful biosphere proceeds to produce its bounty of magic herbs that aid in ridding the people of predators, parasites and pathogens. The wild food and the semi-wild permaculture outside the US sphere of influence is keeping all the people alive and well according to nature's plan. Where the empire heat inflames cannibalistic predation, enslavement and oppression, people fare not so well.
Bad work kills.
I have always been fascinated by the bare bones health statistics comparing the U.S. to other industrialised nations, especially Canada. The U.S. numbers are invariably bad. Are Canadians and Americans so different? Are their environments so different (other than winter :)) - I don't know.
One thing I do know is Americans work harder with longer hours than most do in other western industrialised nations. Americans also get much less vacation time as well. Maybe Americans are just plain wearing themselves out before people in other nations do. Then there is the fear of getting sick or injured, not for health's sake but for fear money will become a big problem - it is an every day threat.
No matter what, the current system must be changed. It is unsustainable and morally wrong - oops, I said it - but there it is....
The FEAR of not having health care, and the inferiority it implies, are just as deadly as the direct medical consequences.
Therefore the provision of single payer will have a much more beneficial effect than the statistics indicate.
Across large populations, studies suggest medical care "contributes only modestly to overall health, perhaps somewhere between 10 percent and 25 percent," says Dr. Richard Kravitz.
Perhaps overall health isn't the most important target of health reform. Perhaps the goal should be helping the relatively small number of men, women, and children whose lives are in shambles, or who die, because they can't afford health care. I think government, and by implication all citizens, have a moral responsibility to provide help to such people, partly because we could easily do so.
Americans have problems other than our health system, such as infatuation with violence and the Second Amendment, and our mania for unhealthy food, that set us apart from more civilized nations. The article suggests that different approaches may be in order for those problems.
There's a moral imperative for government to assist people who unnecessarily suffer and die because they can't get medical care. I don't think true health insurance or health system reform will occur until more people recognize that.
The people in this country will never be healthy if they continue to eat corporate food, GMO food, fast food, and consume the world's highest amounts of sugar, especially corn syrup.
All the medical research and science will never make up for the assembly line, manufactured, cardboard crap most Americans put into their bodies on a regular basis. While their immune systems become compromised by this non-nutrition, making them available hosts to every bacteria and virus, they are treated with the latest and strongest antibiotics, sulphers, bromides and chemicals - not to mention anti-depressants because who can feel good in their bodies or minds ingesting such things?
The REAL culprit in this debate about National Healthcare has yet to be revealed. It is called: DISEASE FOR PROFIT
If the best health care was available for FREE to every American it wouldn't make a damn bit of difference. As 'claughery' said, Americans cannot begin to live healthy lives if they continue to eat crap while lying on the TV couch.
A right to health care for all Americans would change one big dynamic. Right now allowing crappy food, water, environment and dangerous industrial practices is cost shifted onto the poor, people without health care, and illegal aliens. The right to care would dump these costs on the tax bill aligning costs closer to the government decision makers who allow people to be damaged by food, water, environment etc.
I actually contribute most of the single payer better results to the above. European countries got rid of transfat sooner and regulate many more chemical exposures at lower levels and quicker than the U.S. The governments just don't feel as financially driven to run up health care costs out of purely selfish reasons.
I believe that IF you watch the deaths of most people, you will find they are almost always in the mid to late 70's or some are even OLDER than 100. Why don't you check the obits in your area and check the ages. Of course we do not count suicides and murders.
"A 2006 study that compared white people in England with whites in the United States, in an effort to keep different ethnicities from complicating the findings, reached conclusions Muennig found startling. Even the richest white Americans, who are pretty much universally insured, had more diabetes, more high blood pressure, more heart disease and more cancer than the richest white Britons. On most measures they were a little less healthy than middle income Britons.
This points to a vast range of things health care cannot do, from providing mass transit that makes it likelier people will walk more, to providing the kind of education that correlates strongly with better health."
Oh? And what about England's NHS? England's universal health care? Perhaps that is the difference?
A piss poor article.
I think it's caused by the obesity epidemic in the US. I eat a fairly tasty diet, but don't eat processed foods or anything packaged in boxes, bottles, etc. It keeps me healthy and I don't gain weight.
United Health Care took the state of Georgia employees' contract away from BC/BS last year, and it is increasingly restricting payment for precription medicine. Even my long-term blood pressure medicine shows "No Refills" and requires a mthly dr. contact. I used to receive a 30-day supply of other meds w/co-pay. Now I am blessed with 20.
Recently afflicted w/skin mites, from local animal clinic, I was allotted one tube of cream to treat all family members! Refill order from doctor was denied ins. coverage. Itch medicine?? Take 2 or 3 daily- until your 20 runs out. No refills. OMG!
THIS IS A HELLISH SCOURGE I'D LIKE TO SHARE WITH CERTAIN KNOWN SUSPECTS: Pharm and Insurance CEOs; Corporate lobbyists; Wall-Street banksters; sold-out politicians; govt. "Czars".
Now that would effectuate a cozy ambience in the boardrooms and private jets. And a single tube for all, would most certainly increase THEIR "quality of life"!!
Is this some kind of joke?
"Enhance nutrition and primary care to get people healthy"??? What?
This will not happen when you have the cheapest foods in the stores as the most unhealthy, full of sugar and trans fats. Organic veggies are too expensive. Real health is too expensive. All meats are industrial and all dairy is full of rBGH and is not grassfed. Health FOOD in the USA (and not just food products made from food) is impossible to find.
You're not going to see better nutrition until BigAg is gone and the profit making motive from food is gone too. Unless people have money to buy food, they're going to go with noodles, ramen, and whatever is cheapest and filling. That's a money problem and a poverty problem, not a "lack of education" problem. I have years of education, both informal and formal under my belt of how to eat healthy, proper nutrition and exercise.
Guess what? That doesn't mean squat if I can't pay for a $8/bunch of asparagus or a $4 piece of grapefruit. Or it doesn't mean much when food stamps won't pay for the only raw, organic whole milk in the store. But will pay for the lowfat non-organic version.
This is a poverty problem. Nothing else.