Paul Krugman writes an interesting op-ed on a US study suggesting that although Americans spend 40% more on health than do the British they are sicker. The study's conclusions are worth citing:
‘The US population in late middle age is less healthy than the equivalent British population for diabetes, hypertension, heart disease, myocardial infarction, stroke, lung disease, and cancer. Within each country, there exists a pronounced negative socioeconomic status (SES) gradient with self-reported disease so that health disparities are largest at the bottom of the education or income variants of the SES hierarchy. This conclusion is generally robust to control for a standard set of behavioral risk factors, including smoking, overweight, obesity, and alcohol drinking, which explain very little of these health differences. These differences between countries or across SES groups within each country are not due to biases in self-reported disease because biological markers of disease exhibit exactly the same patterns. To illustrate, among those aged 55 to 64 years, diabetes prevalence is twice as high in the US and only one fifth of this difference can be explained by a common set of risk factors. Similarly, among middle-aged adults, mean levels of C-reactive protein are 20% higher in the US compared with England and mean high-density lipoprotein cholesterol levels are 14% lower. These differences are not solely driven by the bottom of the SES distribution. In many diseases, the top of the SES distribution is less healthy in the US as well’.
Krugman suggests that the US has achieved a sort of 'inverse miracle': Americans spend much more per person on health care than any other nation – in 2004 about 16% of GDP, it is larger than the food production sector - yet it has lower life expectancy and higher infant mortality than Canada, Japan and most of Europe.
Why? A lack of universal health insurance is a factor in the poor health of lower-income Americans but almost all upper-income Americans have insurance and their health is often worse too. Another reason seems to be that US medicine is error prone. Bad habits are part of the story as Americans are more obese. But a statistical analysis suggests that bad habits don’t explain that much. One explanation lies in the excessive workloads and stress in US society:
‘Full-time American workers work, on average, about 46 weeks per year; full-time British, French and German workers work only 41 weeks a year. ….our workaholic economy is actually more destructive of the ‘family values’ we claim to honor than the European economies in which regulations and union power have led to shorter working hours.
Maybe overwork, together with the stress of living in an economy with a minimal social safety net, damages our health as well as our families.’
These arguments are part of the reason I am not overly concerned about studies that suggest Australian labour productivity is only 80% of US levels. If productivity gains enjoyed in the US do depend on poor health outcomes, does it matter? It’s the same feeling I get when people comment on the low salaries paid to academics compared to people who work 70 hour weeks in stressful business environment. It is a matter of sorting out priorities and balancing material gains against quality of life and health outcomes.
Final comments: On the basis of the claims above the productivity of at least 16% of the US economy (their health care sector) is poor. Proposals to reform the effectiveness of the US system are capably reviewed by Paul Krugman and Robin Wells here – they support a universal health care system.