The paradox of wealth and disease.

Many of our friends on the Left have repeatedly told us that health care in England is better than health care in the United States BECAUSE England has state provided care. I have repudiated that claim fairly regularly on this blog, especially during the debate when Obama was pushing his “reforms” onto the country though some rather unenviable methods.

The RAND Corporation compared the two systems in a rather interesting way. The first thing they did was study disease rates between the two countries. The U.S. did not do as well when it came to illness rates. But this doesn’t necessarily say anything about the medical systems. You have to examine which diseases they used to determine that. For instance, if Americans were dying from the flu there might be a problem with the health system. But if they are dying from lung cancer it might be because of different lifestyle choices.

And the illnesses that RAND studied did tend to be closely linked to lifestyle: diabetes, high-blood pressure, heart disease, heart attack, stroke, chronic lung diseases and cancer. Some simple changes in personal preferences could change disease rates in these areas rather significantly. What measures the quality of health care here is not the disease rate, but the survivability rate. This study particularly looked at two age groups: those from 55 to 64, and those over the age of 65.

What they found was that Americans in both age groups had higher rates of these illnesses, which is to be expected based on lifestyle differences. But the death rate for the younger Americans was no different than for the similar group in England. But older Americans, while still getting ill at a higher rate, “had a lower death rate than similar people in England.”
James Smith, on of the co-authors of the study said: “If you get sick at older ages, you will die sooner in England than in the United States. It appears that at least in terms of survival at older ages with chronic disease, the medical system in the United States may be better than the system in England.”

RAND says there are two possible reasons for this. “One is that the illnesses studied result in higher mortality in England than in the United States. The second is that the English are diagnosed at a later stage in the disease process than Americans.”

Smith, however, says both explanations “imply that there is higher-quality care in the United States than in England, at least in the sense that these chronic illnesses are less likely to cause death among people living in the United States.”

Co-author James Banks points out the obvious, though it useful to point it out since so many people continually miss it. He says that the “health problem” in the United States “is not fundamentally a health care or insurance problem, at least at older ages. It is a problem of excess illness and the solution to that problem may lie outside the health care delivery system. The solution may be to alter lifestyles or other behaviors.” Bingo!

The London Telegraph’s Richard Alleyne, put it this way: “[W]hile English people have healthier lifestyles than Americans, the latter’s health care system is better able to patch them up.”

Co-author Smith told Alleyne: “We are spending twice as much as England on health and we are getting the benefit of the extra years of life. If English people spent the same amount I have no doubt people would live a lot longer. That is a choice they will have to make.”

So, if the healthier English spent as much as Americans spend they would live longer as well. But, if Americans adopted, voluntarily of course, healthier lifestyles the survivability gap between the Brits and us would grow even larger. And, I should point out, would reduce the cost of health care substantially.

I also contend that the cause of America’s health “crisis” is largely a problem of prosperity. I lived in Europe for extended periods of time and can compare life in the US to Europe. And while I love the culture of Europe more than I do that in the US, I know that Americans tend to be much more prosperous.

Here are some basic facts.

First, Americans tend to have higher incomes than Europeans do.

Second, they are taxed less and thus keep more of the higher income as well.

Third, the cost of living for many things is much cheaper in the US than in Europe. Housing is much cheaper, petrol is much cheaper, food is much cheaper, and energy is much cheaper.
This means that Americans earn more, keep more of what they earn, and can buy a lot more with their money. The average American home is about three times the size of the average British home, for instance, and almost double what the French or Danes enjoy.

And that means Americans can indulge more.

Americans are more likely to drive everywhere, even short trips while Europeans are more likely to walk or cycle. The significantly higher costs of owning a car in Europe forces Europeans to drive less. That means they get more exercise, which is healthier for them.

Americans can also indulge in greater quantities of food. For instance, I like roast beef sandwiches for lunch. In England I was paying $1per slice of roast beef that I purchased. I get much roast beef for the same $1 in the US. Americans simply can afford to eat more and that impacts health. The greater ability to consume sweets and snacks will mean Americans will be more obese and more likely to suffer from diabetes, high blood pressure and the like.

On the other hand, that higher standard of living also means Americans can purchase a lot more health care so that they are living longer than their British counterparts.

There’s the paradox. Our greater wealth means our lifestyle choices are less healthy but means we can afford the care the British can’t, so we live longer anyway. And, for those who say they can’t afford the health care in the US, I might point out that simple lifestyle choices, that are entirely within your power to make, can dramatically improve your health and lower your health care costs. The problem is when people want the unhealthy lifestyles and then bitch about the costs of the choices they make.