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April 12, 2005

Health Care Quibble

Actually, I think this is more than just a quibble.  In an otherwise on-target edtiorial, New York Times columnist Paul Krugman triggered one of my pet peeves.  Here's the passage:

[T]he U.S. health care system is wildly inefficient. Americans tend to believe that we have the best health care system in the world... But it isn't true. We spend far more per person on health care than any other country - 75 percent more than Canada or France - yet rank near the bottom among industrial countries in indicators from life expectancy to infant mortality.

My peeve is this:  Krugman, like many other commenters, seems to equate health care with health.  That is, he suggests that the fact that the US fares so poorly on standard measures of health (life expectancy, infant mortality, etc.) is prima facie evidence our health care system is broken.  I've seen this kind of reasoning in other venues as well.

But the health care system is just one of many, many factors that influence our health. What are the others?  Well, for starters, car accidents. And obesity. And lack of exercise. And violence. And social isolation. And income disparities. And social attitudes. And public health programs. And on, and on, and on. 

On lots of these factors, America fares really poorly compared with most of the developed world: for starters, we're more violent, we get in more car accidents, we exercise less, and we're more obese.  A better system of medical care wouldn't change those facts.

In other words, it's not just the health care system that's broken in the US.  If anything, the health maintenance system--the policies, attitudes, social relationships, and physical environments that help keep us from getting sick in the first place--is in worse shape.

Mind you, I'm not arguing that the US health care system isn't inefficient.  It is, and badly so.  But fixing it is only the first of many, many steps that will be needed if we want to pull our health statistics in line with other developed nations.

Update:  See this Washington Monthly article for a similar take, via Matthew Yglesias.

Posted by ClarkWD | Permalink


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What gets measured gets managed.

Using indicators provides policy-makers information with which to make a decision. I agree with your assessment above, Clark, but we don't have good indicators to measure the laundry list of things that prevent health and wellness in our society. Hence, folks pound on the things that we have in hand, now, to make their point.

I'm all for giving a wide, loud voice to the excellent list above. But I need some numbers to paint a picture beyond the conceptual, so folks can visualize it in their minds.



Posted by: Dano | Apr 12, 2005 5:24:08 PM

What is broken is the care and feeding of publc health. The AMA and the big drug companies have played a major part in breaking it.

The AMA has successfully made the med schools more important than the public health schools in the funding of education. The bitter opposition of the AMA to "socialized medicine" has made it impossible to implement a system that would look at total costs and benefits and make rational recommendations. The big drug companies make money when people get sick- don't expect their Representatives in Congress to work real hard to keep people from getting sick.

The healthcare industry basically has no incentive to actually say or do things that would improve their client's health. In the absence of such motivation, they deserve all the criticism they get for PRETENDING to be the solution.

Posted by: serial catowner | Apr 12, 2005 5:42:59 PM

We spend less on health care than comparable countries.

Posted by: Andrew Spark | Feb 11, 2006 2:19:34 AM