We Americans, like so many others in the developed world, like to make resolutions at the start of the New Year. It’s a tradition. And while the psychology and behavioral science associated with this estimable tradition is questionable and what’s more interesting is what Americans are resolving to do in 2017. And according to a Marist poll, it appears that much of our focus here in the United States is upon becoming more healthy. The number three of the top five ranked resolutions this year are focused on health. These certainly are laudable goals.
However, is also clear that Americans have work to do. Not so much with regards to personal behaviors or healthy habits. These are improving.
The system is sick
The real issue seems to be with our healthcare system. A recent analysis shows that life expectancy versus expenditures have been headed in the wrong direction in the United States. The relationship in the United States is headed in the opposite direction of the other developed countries. I would encourage you to look carefully at the graph courtesy of Our World in Data, which shows that somewhere in the late 70s, the United States began to achieve significantly less health gains for money spent, than any other developed country. And the relationship isn’t casual. The rate of decline in the value derived from the money spent on healthcare in the United States is dramatic. With the CMS so focused on so-called value-based care, I would think that this type of relationship is enough to make them shake their heads. The best question is, of course, why and what we should do about.
Why is the system so “sick”
My considered opinion is that the fragmentation and complexity of the US healthcare system, and the multiple and many layered opportunities for profit are at the root of this relationship between life expectancy and expenditures. The citizens in other countries live longer than we do in the United States – Japan, for example, has an average longevity in the mid-80s, and Spain 83. The United States is about 79, and you might say, “that’s not so bad.” And some people would agree with you. The real issue is that we out-spend any of those countries by a factor of at least two. So we’re getting less, but spending a whole lot more.
Profit – Good for the economy – bad for “health”?
It is true that much of this additional expenditure gets recycled in the economy through jobs, profits and stock dividends. But this still doesn’t explain why we spend twice as much as the next most expensive country, while at the same time we rank so poorly in apples-to-apples comparisons on such things as infant mortality. So I propose a new New Year’s resolution for Americans, let’s get our healthcare system fit!