Spending Twice As Much On Healthcare

An oft-repeated refrain goes like this, "We Americans spend twice as much on healthcare as the Europeans, but we don't live any longer." Attending a lecture by Dr. Mehmet Oz, Professor of Cardiac Surgery at Columbia College of Physicians and Surgeons, gave me an "Aha!" moment on this issue. He opened up his lecture with the statement, "We spend twice as much on healthcare as the Europeans because we're twice as sick!"

Dr. Oz gets involved when cardiovascular disease has progressed to a critical stage. Starting at the beginning, Dr. David Kessler has documented the effects of the three demons--sugar, fat and salt--on our diets. Our kids are overweight and sedentary. Moving into adulthood, they may become obese. With obesity comes the beginning of cardiovascular disease, hypertension, high cholesterol and inflammation, diabetes, peripheral vascular disease, and stroke. Certain population groups have very high incidence of end stage renal disease which is expensive to treat, and difficult for the patient's quality of life.

Cultural norms and the significantly lower degree of commoditization of food in Europe helps them avoid some of this progression, at least to our degree. Remember the wisdom of "The Mediterranean Diet?" We also tend to spend a lot of lifetime healthcare dollars at the end stages, and Europeans are more sanguine about end of life issues than we are. A distinguished German cardiologist said to me once, "Over here, it's okay for people to die. We don't pull out every high tech intervention for every patient." Cold, but a good point.

We have wonderful research, medical diagnostic and treatment tools, and the best doctors and institutions. We overuse many of these tools, and sometimes use them beyond their clinically indicated uses to little incremental patient value. We haven't asked some of the hard questions implicit in the German cardiolgists remarks; at least we haven't done it in public debate.

The transaltion of the spending comment to the increased lifespan comment is ripe for some quantitative treatment, and you can find a lucid treatment on the Becker-Posner blog.