U.S. Healthcare System Failing to Improve Life Expectancy

A new analysis published this week in the American Journal of Public Health, and reported in The Atlanticfound that the U.S. ranks among the worst in extending life expectancy through healthcare spending.

Every additional $100 spent on healthcare per person translated into a gain of less than half a month of life; in Germany, the best-performing nation, every additional $100 spent resulted in an additional four months of life. Note that the American healthcare system is the most expensive in the developed world by a large margin.

According to the study, the main reason the U.S. lags in longevity is that we spend far less on preventive measures than other countries do. Three-quarters of our healthcare spending goes toward treating chronic problems like diabetes and hypertension, and 45 percent of Americans have a chronic health condition. The researchers made sure to note that prevention includes developing a healthy infrastructure, such as easier access to healthier food, or creating more sidewalks, parks, and bike lanes.

Furthermore, the better-performing nations in the study had worked to reduce poverty, since being poor can worsen health outcomes. They also promote physical activity more aggressively, and they weave more prevention counseling, such as nutritionist appointments, into their medical systems.

Needless to say, it’s time for a change, if not an outright overhaul of the system and the culture of profit and short-termism that has poisoned it.



Stitches For Over $2,000?

There can be little doubt that the U.S. healthcare system is not only woefully inefficient, but often capricious and predatory. The New York Times has a sobering piece that reveals the extent of this insanity: basic and routine treatment is often charged in the hundreds, if not thousands, of dollars:

At Lenox Hill Hospital in New York City, Daniel Diaz, 29, a public relations executive, was billed $3,355.96 for five stitches on his finger after cutting himself while peeling an avocado. At a hospital in Jacksonville, Fla., Arch Roberts Jr., 56, a former government employee, was charged more than $2,000 for three stitches after being bitten by a dog. At Mercy Hospital in Port Huron, Mich., Chelsea Manning, 22, a student, received bills for close to $3,000 for six stitches after she tripped running up a path. Insurers and patients negotiated lower prices, but those charges were a starting point.

These depressing anecdotes aside, there’s plenty of metadata showing this to be indicative of a systemic problem:

Hospital charges represent about a third of the $2.7 trillion annual United States health care bill, the biggest single segment, according to government statistics, and are the largest driver of medical inflation, a new study in The Journal of the American Medical Association found.

A day spent as an inpatient at an American hospital costs on average more than $4,000, five times the charge in many other developed countries, according to the International Federation of Health Plans, a global network of health insurance industries. The most expensive hospitals charge more than $12,500 a day. And at many of them, including California Pacific Medical Center, emergency rooms are profit centers. That is why one of the simplest and oldest medical procedures — closing a wound with a needle and thread — typically leads to bills of at least $1,500 and often much more.

Indeed, the process is every bit as arbitrary as it sounds — there is no legitimate basis for these prices, nor even a consistent rule or policy. It varies from hospital to hospital, with not even the pretext of an explanation.

There is little science to how hospitals determine the prices they print on hospital bills.

Orla Roche with her mother, Emer Duffy. Orla, 2, fell and cut her forehead during a family vacation. The visit to the emergency room, where her cut was treated with skin glue, cost $1,696.Fred R. Conrad for The New York Times

“Chargemaster prices are basically arbitrary, not connected to underlying costs or market prices,” said Professor Melnick, the economist. Hospitals “can set them at any level they want. There are no market constraints.”

Prices for any item or service are set by each hospital and move up and down yearly, and show extraordinary variability, health economists say. The codeine that costs $20 and the bag of IV fluid that costs $137 at California Pacific are charged at $1 and $16 at the University of California San Francisco Medical Center, across town. But U.C.S.F. Medical Center charges $1,600 for an amniocentesis, which costs $687 at California Pacific.

In fact, another recent report from the Times found that even ambulances, once free, are contributing to the skyrocketing costs. There seems to be no aspect of this health care system that isn’t exploited to serve some for-profit motive.

To add more insult to injury, all of this expense doesn’t amount to better health outcomes for patients — everything from average life expectancy to infant mortality is at best mediocre compared to the developed world average. It should be fairly obvious how broken the system is, even for those with insurance.

The Affordable Care Act vs. Obamacare

According to a recent CNBC poll, 30 percent of the American public don’t know what the Affordable Care Act is, compared to only 12 percent who don’t know what Obamacare is (they’re the same thing, by the way).

This has amusingly (and concerningly) led to statistically significant differences of opinion: 29 percent of the public supports Obamacare compared with 22 percent who support ACA; 46 percent oppose Obamacare and 37 percent oppose ACA. So putting Obama in the name raises the positives and the negatives depending on who you are — men, independents, and Republicans are more negative on Obamacare than ACA, while young people, Democrats, nonwhites, and women are more positive on Obamacare.

It goes to show you how important language and framing are in influencing people.


A Concise Video on Why American Health Care is so Expensive and Inefficient

From the ever-reliable John Green of Mental Floss comes an 8-minute video that explains the many reasons why US health care is in such abysmal shape. Needless to say, it’s complicated, and leaves little question that our system is by far one of the most dysfunctional and unsustainable in the developed world.

It’s apparently the first part in what will be a periodic series on health care costs and reforms, leading up to the introduction of the Affordable Care Act (aka Obamacare). You can find the sources on the original YouTube page.

I highly recommend that everyone read this TIME report on the US healthcare system. It’s by far one of the most in-depth and impartial articles on the subject I’ve ever read.

Among many other topics, it discusses the little-known “chargemaster” system that exists in most hospitals, which arbitrarily marks up prices by as much 150%; it reveals that the healthcare industry is altogether the single biggest lobbyist in Washington; and that our public discourse is wrongfully focusing more who should pay rather than why healthcare is so expensive (and ultimately inefficient) in the first place.

This should be required reading for everyone, namely the folks in Congress — assuming they even care.


Young Americans Fare Poorly in Study on Health

Panelists were surprised at just how consistently Americans ended up at the bottom of the rankings. The United States had the second-highest death rate from the most common form of heart disease, the kind that causes heart attacks, and the second-highest death rate from lung disease, a legacy of high smoking rates in past decades. American adults also have the highest diabetes rates.

Youths fared no better. The United States has the highest infant mortality rate among these countries, and its young people have the highest rates of sexually transmitted diseasesteen pregnancy and deaths from car crashes. Americans lose more years of life before age 50 to alcohol and drug abuse than people in any of the other countries.

Americans also had the lowest probability over all of surviving to the age of 50. The report’s second chapter details health indicators for youths where the United States ranks near or at the bottom. There are so many that the list takes up four pages. Chronic diseases, including heart disease, also played a role for people under 50.

And the culprit? Well, as to be expected, it’s complicated:

The panel sought to explain the poor performance. It noted the United States has a highly fragmented health care system, with limited primary care resources and a large uninsured population. It has the highest rates of poverty among the countries studied.

Education also played a role. Americans who have not graduated from high school die from diabetes at three times the rate of those with some college, Dr. Woolf said. In the other countries, more generous social safety nets buffer families from the health consequences of poverty, the report said.

Still, even the people most likely to be healthy, like college-educated Americans and those with high incomes, fare worse on many health indicators.

The report also explored less conventional explanations. Could cultural factors like individualism and dislike of government interference play a role? Americans are less likely to wear seat belts and more likely to ride motorcycles without helmets.    

The United States is a bigger, more heterogeneous society with greater levels of economic inequality, and comparing its health outcomes to those in countries like Sweden or France may seem lopsided. But the panelists point out that this country spends more on health care than any other in the survey. And as recently as the 1950s, Americans scored better in life expectancy and disease than many of the other countries in the current study.

Universal Healthcare vs. Freedom?

There is a widespread notion that providing universal healthcare, or something closer to it, comes at great cost to economic and political freedom. However, empirical evidence suggests otherwise: most of the countries that are ranked high in both economic and political freedom – many of them above even the US – offer universal healthcare systems, among other “big government” policies.

The conservative think tank, the Heritage Foundation, bear this out in its Index of Economic Freedom, as does the libertarian Fraser Institute. And Freedom House consistently ranks “socialistic” countries at the top of political and press freedom in its reports.

There are certainly problems with this healthcare act, but state-sanctioned oppression is not one of them. Expanding healthcare, in and of itself, is not mutually exclusively with overall liberty and well-being. One could argue whether what works for other societies works for America, but that’s a different discussion compared to the idea that healthcare is, in principle, a detriment to liberty and well-being.

The U.S. Health Report Card

The following is a list of some basic facts about the state of U.S. healthcare system and the subsequent health of Americans, courtesy of sources such as TIME and The Economist.

  • The U.S. spends more on healthcare than any other country, equaling 16% of our GDP. That’s several trillion dollars, considering that our total GDP is around 11 or 12 trillion. Healthcare is thus already big business, though it’s soon to get bigger: in 9 years, 20% of our economy will revolve around healthcare.
  • Most of that spending—about 30% or so—revolves around hospitals, followed by 21% for doctor and clinical services and 10% for prescription drugs (the remainder is split between nursing homes, administrative costs, etc). Like most rich countries, our population is aging, which will likely cause a rise in hospital and healthcare costs (especially as we’ll soon have slightly more old people than young; thankfully we’re not as bad as Western Europe or Japan, which will have close to 30% of their populations over 65)
  • Only about 10 or so states spend more than $6,000 per person to fund healthcare, leaving most states (including big ones like California, Texas, and Florida) spending comparatively little. Texas sees about 25% of its population without insurance. In fact, 32% of the 46.6 million uninsured, 32% are Hispanics and 8.1 million are children. That’s not including the under-insured…
  • Despite all that spending, we’re nowhere near the top 20 countries in terms of some health measurements. We rank 34th in terms of life expectancy (Japan, Switzerland, Australia, and Canada being the highest in that order) and 29th in infant mortality (deaths), on par with Poland and Slovakia (and not that far off from Cuba, which is far poorer and less well funded, despite popular belief). Demographically, Asian American women (88.8 years on average) are the longest lived while African-American men are shortest lived (69.4 years); in terms of infant mortality, African Americans, followed by Native and Puerto Rican Americans, grimly lead while Cuban Americans and Asians have the lowest rates. Also, Virginia has the highest life expectancy, while Kentucky has the lowest.
  • Close to 443,000 Americans still die every year thanks to tobacco-related illness. However, in terms of smoking we luckily don’t come anywhere near the top, our smoking rate having more than halved to just 19.8% (in the 60s more than half of men smoked and 40% of women). Greece, by comparison, has 51.8% of its population smoking, followed by Russia at 48%. In fact, most of Western Europe and Japan maintain higher rates of smoking, even though they all still have longer life expectancies and are generally healthier. How’s that so…?
  • Obesity. Studies in Sweden have confirmed that being overweight—particularly obese (being 30lbs or higher)—is more deadly than smoking. At least 67% of Americans are overweight; within this figure, 35% of American adults are obese as are 20% of 6 to 19 year-olds, and—sadly—15% of children 2 to 5). Black women lead the rates, with 52% of them being overweight, followed by 31% of black men and whites of both sexes. There’s a lot compounding this: about 40% of adults get no exercise and a huge 96% of us don’t eat enough fruits and veggies. In fact most of those that are overweight are actually malnourished; the food we’re eating gets us fat but provides little to no nutrition. Imagine and overweight American having the same nutritional health as a starving child in a third world country. This combination of no exercise, poor diet, and poor lifestyle in general is the biggest contributor to our death rate.
  • We’re making huge progress in terms of disease and tackling our Big Three: heart disease, cancer, and stroke. At least 29 years ago, 70% of all deaths were caused by either one of these: as of four years ago, only 50% of deaths were related to them. In 1980, 28% of Americans had high cholesterol: now only 17% do. Hypertension remains an issue though, with 27% of the population suffering from high blood pressure. Prostate cancer in men and breast in women are the most prevalent types to occur; luckily, 99% of men survive their cancer as do 91% of women. Lung, Pancreas, Ovarian, and Esophagus cancer are among the deadliest. As a whole though, 67% of cancer patients survive at least give years or more, up from 51% back in the 70s. As usual, Asian women (followed by Hispanic women close behind) are the least at risk of all of these, while black men are most susceptible. The reasons for this include culture (blacks generally have a poor diet), genetics (some ethnic groups are more susceptible to certain illnesses than other) and economics (many blacks are still poor, diluting their access to healthcare and drugs).
  • Annual preventable deaths per 100,000 thousand people: 110 in the U.S., compared to 65 in France, 71 in Japan and Australia, and 77 in Canada, with its much touted free healthcare system. France has been rated as having the best healthcare system in the world, followed by the usual suspects of Norway, Canada, Denmark, and Switzerland. The US ranks at around 39th, according to the WHO.

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