From the September 21, 2009 Forbes Magazine
September 21, 2009
by Marie-Josée Kravis
The U.S. spends much more on health care services as a percentage of GDP than other developed countries, and yet in life expectancy it lags most of these others. A specious connection built around these two facts has become a staple of discussions about health care, even though health care is only one of many determinants of life expectancy.
Life expectancy measures the average number of years remaining at a given age. It changes over time. The sum of your age and your expected remaining years tends to rise after the first year of life and after puberty, and if you get to 65 the prospects of a longer life are higher still. U.S. life expectancy at 65 (17.1 more years for males and 20 for females) is higher than in the U.K. and Germany. The more important point, however, is that life expectancy reflects not only health care but also diet and lifestyle. A raw match of life expectancy against health care spending is naive.
Take road fatalities: The U.S. holds the unenviable record of one of the highest rates in the developed world. Its road mortality rate is 15 per 100,000 people compared with 6.6 in Japan, partly because we drive more. Would universal health care shorten commutes or stop speeding? Would driver-distracting cell phones be shelved and more seat belts worn if there were universal health insurance? Now to the homicide rate, ten times as high in the U.S. as in the U.K. Will insurance cards replace guns? Can anyone credibly argue that health care reform will lower the homicide rate?
The Organisation for Economic Co-operation & Development reports that 32.2% of Americans are obese. The OECD average is 14.6%, with Japan at 3%, France 9.5%, Germany 13.6%, Canada 18% and Australia 21.7%. Obesity isn't caused by the health care system, but it does reduce life expectancy. It's a lifestyle choice whose expenses are borne by everyone. Costs attributable to obesity account for almost 10% of health care spending in the U.S. In Canada the corresponding figure is from 2% to 3.5%.
Obese Americans spend an average of 36% more for health services and 77% more for medications than people of normal weight. They are 20 times as likely to develop diabetes, 2.5 times as prone to heart disease and twice as vulnerable to cancer, hypertension and asthma. Will health care reform cut portion sizes? A more pertinent question: Will obesity be classified as a preexisting condition preventing insurance companies from providing incentives for healthier life choices?
Smoking, drugs and alcohol are other lifestyle choices that can lower life expectancy irrespective of the health care regime. They bloat the cost of health services but aren't a function of whether we rely on private plans or government-backed insurers. Why, then, is the sophism relating U.S. spending on health care and life expectancy so persistent?
A less spurious comparison of the impact of different health care services among countries would require comparisons of survival rates for illnesses rather than life expectancy figures. Survival rates imply some interaction with the health care system or a condition that can be addressed by health care. The OECD recently began a review of health care indicators among its members. Preliminary findings show U.S. mortality rates for all cancers to be 166.3 per 100,000, compared with an average of 171 in OECD countries and a rate of 173.2 in Canada, 170.2 in France and 175.6 in the U.K. Last year the journal Lancet Oncology found that Americans have a higher survival rate for 13 of the 16 most common forms of cancer. Are these results worth the relatively higher cost of U.S. health care? Not for me to put a price tag on life.
This leaves the argument that infant mortality rates in the U.S. are higher than in most other developed countries. Proponents of health care reform will flag this as proof of our defective health care system. But the U.S. has a much more diverse population than other developed countries, and infant mortality rate is decidedly a function of the mother's choices (notably, age, marital status and drug use). Teen pregnancy rates are higher, and pregnant women in the U.S. are more likely to be living alone than in other countries. These facts provide a partial explanation--not an excuse--for the comparatively higher rate of U.S. infant mortality. They point to the need for substantial changes in public health, education and medical practices but also remind us that complex socioeconomic problems will not be resolved solely by changes in the health care system.
Marie-Josée Kravis is is Vice Chair of the Board of Trustees and Senior Fellow at Hudson Institute.
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