A few issues;
1. America counts infant mortality differently than some European nations. A baby which dies in the first day is stillborn in some European countries (Don't have the list on hand.) It is considered to have a lifespan of <1 day in the states. And consequently, we save more premies as well (who are generally less healthy.)
2. America has more immigrants, who have more health problems, are more likely to be poor, and who were often malnourished as children.
3. Diet and lifestyle considerations are worth considering. (What effect does US reliance on high fructose corn syrup have?) What about relative rates of drug use? Japanese Americans who keep their traditional diet have lifespans comparable to those living in Japan, suggesting that the healthcare system is not the primary operative factor in determining lifespan.
4. The effectiveness of the healthcare system should consider those exposed to it and the relative rates of effectiveness. "Lifespan" obscures the issue, for those reasons mentioned. If you're interested in how often gunshot victims are saved in the US and Europe, for instance, it would make more sense to compare those things directly.
5. America doesn't have price controls on drugs as Europe does, so we fund their drug development. (Whether we incent research in a good direction is an open question. Japanese use of proteolytic enzymes like serrapeptase for pain reduction and antibiotic augmentation seems more elegant than a lot of American solutions, which over-rely on drugs and technology.)
6. The US tends to be more litigious than Europe. This can raise costs via malpractice insurance and also via defensive medicine. (I'm not in favor of Nevada style tort reform. I'd like any tort reform tied strongly into incentives to disclose errors and compensate victims prior to a court trial.)
7. Caps on things like doctor pay can be effective in the short term, but create a doctor shortage in the long term. I'm not familiar with the statistics on this, but it seems a productive place to look.
8. I'm curious, how do you calculate spending under a government subsidized system? It's common for one government agency to offload certain portions of their paperwork to a different agency. The cost is still there, though.
theatlantic.com |
