Archive for March 26th, 2010

Health and Wealth

Last night here at the university we attended part of a film festival on social justice (take that, Glenn Beck!) put together by members of our Economics and Sociology departments (Dr. John Messier and Dr. Kristina Wolff).   This is the third year of the film/lecture series, and though they choose the topic of health care awhile back, the timing of the series couldn’t have been better.   Yet the films make clear to me that passing health care reform is not in and of itself an answer to our problems.

The first film was In Sickness and Wealth, and the second a Frontline episode Sick Around the World. The Frontline show surprised students as they learned that what gets decried as “socialized medicine” here is common around the world, and works.   In most countries there are no waiting lists (or very short ones for elective surgery), private insurance companies competing for customers, and very satisfied citizens.   There are problems — in the British single payer system elective surgeries do have rather long waits (six months or so), in Germany and Japan doctors complain about being underpaid, and in Taiwan the government is scared to raise prices enough to cover costs.   In Switzerland a US like system was transformed to universal care about a decade ago, and it’s popular and working well.  Clearly the doom and gloom statements from the right are non-sensical if you actually go out and get real world examples to compare.

Yet the US is larger, more diverse, and culturally different from the rest of the world.   Health care reform will be a work in progress.   That also brings up the first film, In Sickness and in Wealth.   That film presented very compelling statistics that health in terms of life expectancy, diabetes, cancer, and heart disease gets worse as wealth declines.   The wealthiest live longer and are healthier than those who are poorer.   Moreover, this is a continuum, it’s not just a stark difference between rich and poor.   Finally, this difference exists even if you control for life style choices. Wealthy smokers live longer than smokers who are not so wealthy.   There is something about wealth that in and of itself contributes to health.

Part of it, the film argued, is the every day stress levels on people who do not feel empowered and in control of their lives.   Stress releases hormones into the blood stream, and studies show that there is a positive correlation between poverty and high stress hormone levels.  This can cause immune system weakness, early aging, weakened internal organs, and even cancer.   Moreover, this affects children.   Children whose parents were home owners have stronger immune systems than children whose parents did not, regardless of their life experiences today. The stress of a poorer childhood impacts health for all ones’ life.

To be sure, lifestyle, genetics, and other factors all play a role in an individual’s health.  But one cannot just say that poorer people are less healthy than wealthy because they made worse choices, nor can one say that giving them all health insurance and access to health care will significantly improve their health or life expectancy.   It’s class rather than access to health care that creates these problems, and the problems cost all of us in society.

They cost us first in Medicare and Medicaid, as well as in paying for those who get care but can’t pay for it.   Over 60% of bankruptcies in the US come from medical bills, in the rest of the industrialized world bankruptcy caused by medical expenses would be scandalous.  It also costs us in productivity.   Instead of being active, producing members of the economy, many of the poor battle chronic conditions due to stress and other problems.   That cost is hard to quantify, but if we had a society where class differences caused less stress and difficulty in life, the whole society would benefit.   It was interesting that in the second film a German said, “we know that unemployment increases the chances someone would get sick.  It would be irrational to take away insurance when someone gets unemployed, that’s when they need it the most.”  But in the US we do that, adding to the stress level.

No one suggests that hierarchy and class can be eliminated.   However, in Europe a mix of having health care as a right like education and police protection, along with better social programs to reduce the stress of living below the poverty line, probably explain why our health care statistics are so bad compared to the rest of the world.  We pay the most — 16% of GDP (the next highest is Switzerland with about 12%, then most others are 6-8%), but have sub optimal results.

Those results are not because of people like me.   My health care is very much like it would be if I lived in Germany, where private insurance brought through an employer covers you (and you can by supplemental insurance).   I get as good as care as I’d get anywhere.   But those who are not covered, or whose coverage gets denied, bring down the statistics.   The culture of the country also harms us.   Listen to the rhetoric by those who are angry about health care reform.   Any government effort to try to help minimize the negative effects of being poor is criticized as ‘socialism,’ as people cling to a myth that anyone can pull themselves up by their bootstraps, and it’s the poor’s fault that they are poor.

That myth is increasingly false.   Between 1900 and 1976 the gap between the rich and poorest was decreasing, and people in that era had an easier time getting the education and opportunities to control their lives.  Since the 80s there has been a tremendous shift of wealth to the elite — the upper 2% have 90% of the wealth, a statistic that has more in common with third world countries than other industrialized ones.    If this trend isn’t stopped, we may start to look more like a third world country.  It also is the underlying issue that really drives up health care costs, and which, if not addressed, will assure that health care reform can at best be a band aid, not a solution.

Somehow, Americans have to abandon the “myth of the market,” and recognize that left on its own, markets have winners, and those winners know how to subvert the game to make sure they keep winning and secure benefits for their families.  Markets are neither just nor humane, and in the realm of health care, they can be deadly.   In some areas, we need a strong government presence.  And second, we have to develop some sense of social solidarity, that we’re in this together, that it matters if many fellow citizens have severe problems.    Yes, charity is one way of showing that, but history shows that relying on charity alone just can’t work in a mass industrialized society.   We need to figure out how to use government to address these problems without giving too much authority to the bureaucrats.   There is no perfect way to do that, no pat and simple ideological solution.   But at the very least we can look to other industrialized states and learn from them a bit about what works and doesn’t work, and then adapt it to our circumstances.