Now, here’s an interesting idea. We’re spending so much on health care because we’re under-spending on programs and services that make for a healthy population.
This is the thesis of a new book entitled The American Health Care Paradox. It’s not for the casual reader, and I confess I haven’t read it.
But public health professor and Health Stew blogger John McDonough provides a summary of the main argument, with eye-popping graphs. And we get another, broader overview of the research in slides the coauthors prepared for a conference last September.
The paradox the title refers to has been often discussed. The U.S. spends much more per capita on health care than any other highly-developed country — 50% more than the next two biggest spenders, according to recent figures from the OECD (Organisation for Economic Co-operation and Development).
But the outcomes don’t show it. Life expectancy is below the average for the OECD countries — lower, in fact, than all but eight of them, none nearly so wealthy as the U.S.
The U.S. also ranks very low on some other common health indicators — both maternal and infant mortality rates, for example, and the rate of infants born weighing dangerously little.
It’s common to attribute these, as the OECD does, to the fact that the U.S. is one of the very few developed countries without a universal healthcare system and to our extraordinarily high obesity rate — a function, the OECD suggests, of the many “disadvantaged” among us.
The American Health Care Paradox coauthors don’t dismiss these factors. But they’ve got a different explanation. Basically, we spend a lot on curing illnesses — or keeping people alive when we can’t, even when they’re almost sure to die very soon.
But we scrimp on what they call social services, e.g., education and job training, housing assistance, cash benefits for jobless workers and people with disabilities, support services for seniors and “family supports,” by which I suppose they mean things like high-quality affordable child care.
We spend less on these than any other OECD country. And our ratio of social services to healthcare spending is the lowest too. This, said ex-Wonkblogger Ezra Klein, helps explain why 5% of the population accounted for about half our healthcare spending in 2008.
Well, we’re moving bumpily (and imperfectly) toward an expanded, publicly-subsidized healthcare system. And we already have some evidence that the Affordable Care Act is slowing the growth of healthcare spending.
But at the same time, we’re in a cost-cutting mode on social services. The recent budget deal doesn’t alter this, since real-dollar spending for non-defense programs that depend on annual appropriations will be 15% lower this year — and 17% lower next year — than in 2010.
Spending isn’t the only issue. Our healthcare services move on one track and our social services on another — actually, on many tracks.
A child may show up in an emergency room on a regular basis, gasping for breath, despite the medications for her asthma. The treating physicians may suspect that mold in the home and/or fumes from the highway outside are triggers.
They’ll tell the parents, one supposes, if they’ve taken the time to talk about the home environment — and know how to listen. But linking them to a nonprofit legal service that will go after the landlord or to a public agency that could provide the assistance they’d need to move is generally not how a hospital operates.
There are some exceptions. As I’ve written before, a nonprofit called Health Leads fills “prescriptions” for food, heating and other assistance as a partner with physicians in the clinics where it’s located.
It aims, its website says, to “align the forces necessary” to change our healthcare system to one that “addresses all patients’ basic resource needs.” Forces do seem to be aligning in various ways.
Hospitals, for example, have begun tackling hunger as a health issue, as U.S. News reports.
A dozen in an Ohio-based system have been feeding local residents. The system itself has opened a grocery store with fresh produce, whole grains and the like in a food desert where one of its hospitals is located.
And some of its hospitals now screen patients for food insecurity and sign those at risk up for SNAP (the food stamp program) or give them a supply of groceries when they’re discharged.
Massachusetts General Hospital also screens for food insecurity and helps with SNAP applications, as do two of its primary care clinics. The clinics also enroll pregnant women and mothers of young children in WIC, operate food pantries and offer healthy meals cooking classes.
The Affordable Care Act provides incentives for hospitals to address public health issues like food insecurity, says the former executive director of one in Connecticut that serves low-cost meals to seniors.
Links to unaffiliated social services still seem limited, however, even though the American Health Care Paradox coauthors found that both healthcare and social service providers want the more holistic approach that linkages could provide.
They’ve got barriers to overcome, including insufficient resources. But investing in systems that would support collaboration — and in the social services themselves — would pay off in lower healthcare costs.
More genuine well-being for low-income patients too.