Krugman: Our sick society

[Guest guest]

Paul Krugman: Our Sick Society

 

Paul Krugman, The New York Times, May 5, 2006

 

http://rozius.blogspot.com/2006/05/paul-krugman-our-sick-society.html

 

Is being an American bad for your health? That's the apparent

implication of a study just published in The Journal of the American

Medical Association.

 

It's not news that something is very wrong with the state of America's

health. International comparisons show that the United States has

achieved a sort of inverse miracle: we spend much more per person on

health care than any other nation, yet we have lower life expectancy and

higher infant mortality than Canada, Japan and most of Europe.

 

But it isn't clear exactly what causes this stunningly poor performance.

How much of America's poor health is the result of our failure, unique

among wealthy nations, to guarantee health insurance to all? How much is

the result of racial and class divisions? How much is the result of

other aspects of the American way of life?

 

The new study, " Disease and Disadvantage in the United States and in

England, " doesn't resolve all of these questions. Yet it offers strong

evidence that there's something about American society that makes us

sicker than we should be.

 

The authors of the study compared the prevalence of such diseases as

diabetes and hypertension in Americans 55 to 64 years old with the

prevalence of the same diseases in a comparable group in England.

Comparing us with the English isn't a choice designed to highlight

American problems: Britain spends only about 40 percent as much per

person on health care as the United States, and its health care system

is generally considered inferior to those of neighboring countries,

especially France. Moreover, England isn't noted either for healthy

eating or for a healthy lifestyle.

 

Nonetheless, the study concludes that " Americans are much sicker than

the English. " For example, middle-age Americans are twice as likely to

suffer from diabetes as their English counterparts. That's a striking

finding in itself.

 

What's even more striking is that being American seems to damage your

health regardless of your race and social class.

 

That's not to say that class is irrelevant. (The researchers excluded

racial effects by restricting the study to non-Hispanic whites.) In

fact, there's a strong correlation within each country between wealth

and health. But Americans are so much sicker that the richest third of

Americans is in worse health than the poorest third of the English.

 

So what's going on? Lack of health insurance is surely a factor in the

poor health of lower-income Americans, who are often uninsured, while

everyone in England receives health care from the government. But almost

all upper-income Americans have insurance.

 

What about bad habits, which the study calls " behavioral risk factors " ?

The stereotypes are true: the English are much more likely to be heavy

drinkers, and Americans much more likely to be obese. But a statistical

analysis suggests that bad habits are only a fraction of the story.

 

In the end, the study's authors seem baffled by the poor health of even

relatively well-off Americans. But let me suggest a couple of possible

explanations.

 

One is that having health insurance doesn't ensure good health care. For

example, a New York Times report on diabetes pointed out that insurance

companies are generally unwilling to pay for care that might head off

the disease, even though they are willing to pay for the extreme

measures, like amputations, that become necessary when prevention fails.

It's possible that Britain's National Health Service, in spite of its

limited budget, actually provides better all-around medical care than

our system because it takes a broader, longer-term view than private

insurance companies.

 

The other possibility is that Americans work too hard and experience too

much stress. Full-time American workers work, on average, about 46 weeks

per year; full-time British, French and German workers work only 41

weeks a year. I've pointed out in the past that our workaholic economy

is actually more destructive of the " family values " we claim to honor

than the European economies in which regulations and union power have

led to shorter working hours.

 

Maybe overwork, together with the stress of living in an economy with a

minimal social safety net, damages our health as well as our families.

These are just suggestions. What we know for sure is that although the

American way of life may be, as Ari Fleischer famously proclaimed back

in 2001, " a blessed one, " there's something about that way of life that

is seriously bad for our health.

 

 

" To be nobody-but-myself in a world which is doing its best, night and day, to

make me everybody else - means to fight the hardest battle which any human being

can fight, and never stop fighting. " -e.e. cummings-