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Jun 21 / Jonathan

Krugman: Live long and prosper

Paul Krugman, with a concise response to the idea that we shouldn’t be comparing health outcomes in other countries with our own.

Live long and prosper

Via Andrew Gelman, Greg Mankiw describes the use of international comparisons of life expectancy as part of the argument for reform as “schlocky.”

Grrr. Not many serious advocates of reform use the life expectancy differences to argue that health care is clearly better in other advanced countries than it is in the United States; when it comes to care, the general assessment seems to be that it’s comparable, with no advanced country having a clear advantage. The reform argument actually goes like this:

1. Every other advanced country has universal coverage, protecting its citizens from the financial risks of uninsurance as well as ensuring that everyone gets basic care.

2. They do this while spending far less on health care than we do.

3. Yet they don’t seem to do worse in overall health results.

So Greg suggests that maybe it’s all because we have an unhealthier lifestyle — what Ezra Klein calls the well-we-eat-more-cheeseburgers argument.

Three things. First, surely the burden of proof here is on Greg. I mean, we’re spending 6 or 7 percent of GDP more on health care than other countries — call it a trillion dollars a year — without any clear advantage. That’s not the sort of thing you wave away with a casual suggestion that maybe we have bad habits.

Second: you know, people have thought about this — and tried hard to measure it. For example, the huge McKinsey Research Institute study on the cost of US healthcare tried to quantify the costs of lifestyle-related issues — and found that it didn’t explain much.

Third, read Atul Gawande!

Bottom line: this is the most important domestic policy issue we face. It deserves more than casual just-so stories about how the kids American health care might, despite all appearances, be alright.

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