The United States spends about twice as much per capita on health care as other high-income countries. Yet our health outcomes are not as good, on average. It’s not that all Americans are in poor health, it’s that some Americans are in poor health and pulling down the average. As I’ve said before, health is correlated with wealth and education. Wealthier is healthier. The following is from Amy Finkelstein and Liran Einav, both professors of economics at MIT and Stanford, respectively:
A 40-year-old American male can expect to live 15 years less if he’s one of the poorest 1% of Americans rather than one of the richest 1%. Black children who live in the richest parts of the United States have higher mortality rates than White children in the poorest parts of the country.
The U.S. is unique among high-income countries in that health coverage is not universal. Rather, it’s a patchwork of public and private, public subsidies for private insurance and the uninsured. There are those on the Left who blame health inequity on the lack of universal coverage. The following is Finkelstein and Einav’s response:
They’re wrong. While these two facts are correct, they have very little to do with each other. There are good reasons to support universal health coverage, but noticeably improving population health is not one of them.
Indeed, the evidence suggests that the health disparities among Americans are not driven by differences in access to health insurance or to medical care. Rather, the key to improving health is far more complex: It lies in changing health behaviors and reducing exposure to external sources of poor health.
As evidence the authors point to Sweden and Norway. The differences in life expectancy between the top 10% and the bottom 10% of the income distribution are similar to the U.S. Then the authors point to Oregon where Medicaid enrollment was expanded by a lottery system. There were some noticeable differences between those who were able to enroll in Medicaid and those who were not but the uninsured received about 80% of the care those who won Medicaid coverage received.
And once we realize that everyone in America can access medical care, it becomes much clearer why formalizing this access – while important for other reasons – is unlikely to make an important difference for people’s health, or substantially reduce the large disparities in population health.
So, what is the source of early mortality among America’s poorest? It mostly involves behaviors: drinking, smoking, drug use, overeating and maintaining a poor diet. The anecdote provided was originally from Victor Fuchs. Health comparisons of Utah and Nevada illustrate how two populations right next to each other can have very different health outcomes. Utah has a large Mormon population that abstains from drinking and smoking, while Nevada includes Las Vegas where vices are more common. Yet, it has nothing to do with health insurance.
This was adapted from the book, We’ve Got You Covered: Rebooting American Health Care by Liran Einav and Amy Finkelstein.