Evan Falchuk has written a very thoughtful article about a recent graph created by National Geographic. At first glance, the implications of the graph are startlingly obvious: the US spends way too much on health care, a view that has been widely repeated throughout the health care reform debate. But Evan’s detailed analysis of the graph does make one pause to consider whether the graph might be over-simplifying things. For starters, he points out that there’s a lot of disparity between what other countries spend on health care and their life expectancies. This is true – South Korea and Luxembourg have roughly the same life expectancy, but Luxembourg spends two and a half times as much per person on health care as South Korea does. But while it’s true that the lines on the graph seem to be somewhat random, the United States is a dramatic outlier, with per person health care spending that isn’t even close to what other countries spend. No matter how we analyze this, we spend a huge amount of money on health care. Yes, it’s over-simplifying to say that we’re getting ripped off, but it’s also hard to argue that we aren’t.
One thing that stood out for me when I looked at the graph was that thicker lines (representing more frequent doctor visits) generally trended upwards. An overly simplified analysis of an upward sloping line could be interpreted as getting more “bang for the buck” with health care dollars, as all of the countries with thick graph lines had below average health care spending, but some had above average life expectancies. One of the ideas that has been floated around a lot recently is that over-utilization leads to excessive health care costs. But the graph would seem to indicate otherwise, as the countries with the most frequent doctor visits (Japan and the Czech Republic) both had lower than average per-person health care costs.
Evan’s article does a very good job of pointing out that it’s difficult to lump the entire United States into one statistical group as far as life expectancy and health care spending. It is very true that there is a huge amount of variation in both numbers from one state to another, although the average numbers for the entire country indicate that there aren’t too many states that are doing a stellar job of controlling costs and providing top-notch care. In many ways, Colorado is an anomaly with regards to health care – we have the thinnest population in the country, and one of the healthiest, and yet a relatively high percentage of our residents have no health insurance. The disparities among the states in terms of what is spent on health care, how long people live, and what percentage of the population has health insurance, makes – in my opinion – a strong case for national reform that would work to bring lagging states up to par. It doesn’t seem right that people living in a state with no high risk pool health insurance plan simply have no other options if they get declined because of a pre-existing condition. Obviously there are cultural and economic differences from one region to another that impact things like food choices and tobacco use. But we could definitely do a better job of eliminating some of the stark discrepancies in health care from one state to another.
Evan’s article was featured in Grand Rounds this week.