Monday, August 13, 2007

A few comments on healthcare and cross-country comparisons

American lifespans aren't keeping up with much of the rest of the developed world. What to do about it? Universal healthcare, perhaps:
Researchers said several factors have contributed to the United States falling behind other industrialized nations. A major one is that 45 million Americans lack health insurance, while Canada and many European countries have universal health care, they say.
But does that provide the simple solution? An argument easily used against government-provided healthcare as a panacea is that of the 44 countries that provide free healthcare, 25 have an average life expectancy lower than that of the US. Americans live longer than residents of most of the countries that provide universal healthcare do.

Compared to northwestern Europe, however, the US is near the back of the pack (at 78.0 years), according to the CIA factbook.

There is a problem in comparing the US with the rest of the Euro-descended world. It crops up in other places as well (although in this case it's effects are relatively mild): Almost one-third of the US population isn't white. Black Americans die nearly six years before whites do. Accurate data on Hispanics are harder to come by (the CDC reports I found historically tracked only whites and blacks), but just removing the black handicap puts the US at about 78.7 years, the same as the European Union on the whole. This adjustment leaves the US behind most of affluent Europe, but by a small amount. It is even with the UK, and ahead of Finland, Ireland, Poland, Denmark, and Portugal (all of which have universal health systems in place). Attributable to the remaining variance in part is that we eat more, work longer, and sleep less than our European counterparts.

A similar phenomenon is seen in infant mortality, where the death rate is twice as high among black Americans as it is among whites.

Of course, US drug companies subsidize much of what is produced in the rest of the world as legal generics or outright duplication. Spending on pharmaceutical research and development in the US far outstrips that of any other country (see page 11). The US healthcare industry, of which pharmaceutical companies are a part, is rarely acknowledged in this regard when such criticisms of the US' lack of universal coverage are made. That the blockbuster drugs may be prohibitively expensive for many, the part of the US market that will buy them is the a driving force behind them being made in the first place. Government-funded healthcare will disrupt this.

With universal coverage more costly in the US than the rest of Europe due to demograhics, I'd like to see the insurance providers and private industry tackle the problem in a few other ways:

- Disqualify smokers, drinkers, recreational drug users, and people who are overweight or obese from company-sponsored healthcare plans, or charge them less favorable rates. Many companies do this to some extent using vice questionnaires, but more should go the way of Weyco and cut people who voluntarily put themselves at high-risk (and by extension, high-cost).

- Host group exercise sessions on-campus. This is not unusual in East Asia, where life expectancies are longer than non-genetic estimation methods predict. Build some camaraderie in the process. Also, create 'healthy lifestyle' awards--recognition and prizes like extra vacation for the employee in the department who loses the most weight or lowers his LDL the furthest.

- Insurance companies should be able to provide unfettered catastrophic insurance coverage. Throughout the US, there are around 5,000 mandaates across various types of coverage plans relating to what must, by law, be covered and to what degree. I haven't been to a physician in years. I'm young, workout regularly, eat well, and do the necessary hygienic stuff. Why should I have to pay $50 a month for my employer-sponsored healthcare coverage? That's as cheap as I can go without being uninsured. I should pay one-fifth of that, cover my own doctor and dentist visits, and kick the remaining $40 into investments or spending.

Imagine how expensive car coverage would be if the automobile insurance market worked in the same way as healthcare coverage does. People would take vehicles in for minor things, like small hood tents, that might cost $500 in body work--things they would not have otherwise had done. If I wanted liability on an old clunker, I'd have to pay much more in getting coverage for things I wouldn't want covered and would be better off paying out-of-pocket for, if at all. The success of companies like Progressive, and the benefit they provide to consumers, is sorely needed in the healthcare arena. In addition to cost reduction, market forces would also incentivize healthier behavior. Progressive doesn't put up with bad drivers. I'd like a healthcare insurer that doesn't deal with the overweight or smokers.

Advocates of quasi-socialist systems frequently point to the successes of European nations by comparison to the US. In so many instances, like when comparing income inequality or social pathologies, racial demographics are crucial to garnering an understanding of differences. But the omerta on discussions about different behavioral patterns by different racial/ethnic groups obfuscates this. The trend means the whitest European nations have the most expansive entitlement structures in the West, the Scandanavian countries being the kings of the hill.

Unfortunately, the most 'progressive' social structures are only viable in the whitest places. As the proportion of the population that is comprised of the unskilled underclass rises, so does the difficulty in sustaining these generous systems. With Islamic immigration into Europe, the Old Continent is being forced to empathize with the difficulties--chronic underachievement, criminality, heavy welfare use, etc--the US faces in dealing with its struggling minorities.

The importance to leftists: Importing lots of unskilled, uneducated third-worlders works against what you support. They strain the welfare system and fail to contribute as much as they consume, rendering it untenable in the long run. They increase criminality so markedly that liberal policies on crime also become untenable.


John said...

Except that maybe leftists were hoping to kickstart the class war with insupportable programs and mandates. 2/3 should be 1/3. That's a good point on how drug R&D takes up a large part of our medical costs. Europe and several Asian countries seem altogether too pleased to allow us to do almost all the drug research, since the results can be had cheaply later or even stolen.
mainly, though, this kind of research as it crowds out other kinds in one country, leads on to greater medical expenditures; a supply which creates its own effective demand and in a political way.

Audacious Epigone said...


Thanks, I fixed it.

Right. Promise a lot, without the money to deliver, and watch the populous squabble along class/racial lines. The researchers excerpted from the MSNBC article lamented how much the US spends on healthcare without having the longest life excpectancy in the world.