Now that’s bang for the buck.
But wait, we’re different. We have certain risk factors not found in other countries, like bad health habits. Obesity, smoking, car accidents, and homicides account for this difference; not our healthcare system.
Smoking and obesity constitute the two most important behavior-related risk factors for health in the overall US population. Both are major public health problems that merit considerable attention. However, they do not appear to explain the relative performance deterioration of the US health system over time. The prevalence of obesity has grown more slowly in the United States than in other nations, while smoking prevalence has declined more rapidly in the United States than in most of the comparison countries.
Scratch the fat smoker hypothesis.
Cars and Murders?
Americans are much more likely than are residents of the twelve comparison nations to die in a homicide or traffic accident. Unfortunately, data on these causes of death are not systematically available over time in the comparison countries. Therefore, to assess the potential contribution of these causes, we examined changes in the share of US deaths attributable to homicide and traffic accidents over time. If declines in other causes of death were offset by rising numbers of deaths from homicides and traffic accidents, then homicides and accidents should account for a growing share of all mortality within the United States over time.
In fact, the share of all deaths in the age groups under study attributable to homicides and traffic accidents has been relatively low and quite stable over time. These causes of death are therefore unlikely to account for the deteriorating survival probabilities of Americans….
So, probably not these two either.
there is considerable uncertainty on this point.
Depends on what the insurance pays for. And, most Americans end up in a large single payor government run health insurance program, known as Medicare, when they reach a certain age.
The study concludes:
It is possible that rising US health spending is itself responsible for the observed relative decline in survival. There are three reasons why this might be so.
First, as health spending rises, so, too, does the number of people with inadequate health insurance. Notwithstanding the uncertainty surrounding the impact of lacking insurance on the health of the US population, higher spending could be reducing survival by decreasing the number of insured people.
Second, rising health spending may be choking off public funding on more important life-saving programs. Health spending now constitutes a sizable proportion of the federal budget. At current spending levels, investments in public health, education, public safety, safety-net, and community development programs may be more efficient at increasing survival than further investments in medical care.
Finally, unregulated fee-for-service reimbursement and an emphasis on specialty care may contribute to high US health spending, while leading to unneeded procedures and fragmentation of care. Unneeded procedures may be associated with secondary complications. Fragmentation of care leads to poor communication between providers, sometimes conflicting instructions for patients, and higher rates of medical errors. For example, two separate physicians are probably more likely than a single primary care provider to prescribe two incompatible drugs to a single patient. The extent to which these factors are determinants of population health is uncertain, though.
We found that none of the prevailing excuses for the poor performance of the US health care system are likely to be valid. On the spending side, we found that the unusually high medical spending is associated with worsening, rather than improving, fifteen-year survival in two groups for whom medical care is probably important.
We speculate that the nature of our health care system-specifically, its reliance on unregulated fee-for-service and specialty care-may explain both the increased spending and the relative deterioration in survival that we observed. If so, meaningful reform may not only save money over the long term, it may also save lives.
It isn’t so much who pays or how much that matters in healthcare, but what we spend the money on. This is why the long battle over health insurance reform was only the first step towards healthcare reform. Poverty, poor diets, older housing, and lack of primary care all affect “health” and raise the cost of health insurance for all of us.