/

Spending More on Healthcare Does Not Improve Health Outcomes

In 2008 the state of Oregon inadvertently ran a randomized health insurance experiment regarding Medicaid. They decided they had just enough money in their annual budget to give Medicaid health insurance coverage to an additional 10,000 citizens, randomly assigned via a lottery. There was no improvement in their health outcomes, but they did increase hospital admissions by 30%, outpatient ones by 35%, and ER visits by 40%. It cost a lot of money – 36% more – for no tangible benefit.[1] Unnecessary treatments cause stress, injury and sometimes death.

Amazingly, there is not a strong relationship between healthcare spending and health outcomes – America spends around twice per head as most other developed nations, and approximately half of it is taxpayer-funded. Healthcare outgoings in America approach $4 trillion a year and with only 4% of the world’s population the USA consumes half of the pharmaceuticals consumed worldwide. If this approach was working, The USA would be the healthiest country on the planet. Japan and Singapore spend only a fraction of what the USA spends per head on healthcare and the people there live healthier and for over five years longer, and healthier lives too.

This might be because extra spending on healthcare mostly goes on overpriced, ineffective, and unnecessary treatments. It is generally assumed that more care is caring more, but the reality echoes the eerily astute insight of Ivan Illich, put forth in the initial pages of his (1970) book Deschooling Society, in which he deconstructs the bureaucratic ethos, stating that they, Confuse process and substance. Once these become blurred, a new logic is assumed: the more treatment there is, the better are the results; or, escalation leads to success. The pupil is thereby “schooled” to confuse teaching with learning, grade advancement with education, a diploma with competence, and fluency with the ability to say something new… Medical treatment is mistaken for health care, social work for the improvement of community life, police protection for safety, military poise for national security, the rat race for productive work.”[2] (my emphasis added)

Actually, clean drinking water, access to nutritious food, workplace safety, sanitary living conditions, being able to get a job, having a supportive social network have a bigger effect on health outcomes than access to healthcare. The Centers for Disease Control and Prevention told us in 1999 that, while “the average lifespan of persons in the United States have lengthened by greater than 30 years [since 1900]; 25 years of this gain are attributable to advances in public health,”[3] rather than medicine. In 2000, the prestigious journal Pediatrics released a very comprehensive study in which they explained that the 90% decline in all infectious disease mortality were down to improvements in sanitary conditions and nutrition rather than medical treatments.[4] Cleaner drinking water was responsible for nearly half of the total mortality reduction in the 20th century, and nearly two-thirds of the child mortality reduction.[5]

Longer lifespans and better health, where it is still enjoyed (as life expectancy has been falling since 2014 and chronic disease is more prevalent than ever) is largely due to the availability of better nutrition and hygiene, housing with ventilation, indoor heating, garbage collection, cleaner water and food, and sanitary sewage systems. In the 19th century, people’s housing – as well as the conditions they worked in improved dramatically. Most of the basic conveniences we take for granted today, like an indoor toilet that flushes and clean running water through the faucet, were not widely available in the first half of the 20th century. Before the internal combustion engine, city streets were lined with horse dung. People lived several to a room, sharing disease. The average living space per person in America doubled as recently as between 1973 and 2014.

Poor people typically have worse health outcomes than affluent people do, and the healthcare they do consume is largely comes at the taxpayer’s expense.  So, if someone, getting into government, really wanted to do something to improve the health and longevity, they could go to the areas of the country where living conditions are worst health outcomes poorest and redirect a percentage of the huge sums of money squandered on Medicaid to improve the quality of the worst housing. Low hanging fruit, like eliminating mould in apartments where big families are breathing it in. The program would more than pay for itself due to the drop-off in health visits. Go to the places with the worst water supplies and improve them. Go where the air is dirty and clean it up or litigate against the polluters. Publicise information on the effect of poison herbicides like round-up (glyphosate) on the microbiome. Improve the quality of the soil so people get access to more nutritious produce. Every dollar spent would likely result in several dollars saved on treating preventable illnesses.

The fact that this is never proposed indicates that our so-called “public servants” are less interested in improving people’s health than they are in shovelling public money into the hands of their cronies in the medical industry.

 

I will be explaining how we get out of this mess in my forthcoming book Big Pharma – None Dare Call it Quackery! – you can download an excerpt from it and make a voluntary contribution towards its completion at: https://7pharmamyths.com/


[1] Flynn, S. M. (2019) “The Cure That Works: How to Have the World’s Best Healthcare – At a Quarter of the Price”  Regnery Publishing, p179-181

[2] Illich, I. (1970 “Deschooling Society”,  p3

[3] “Ten great public health achievements-United States, 1900-1999” CDC MMWR Weekly 48:241-243, 1999

[4] “Annual Summary of Vital Statistics: Trends in the Health of Americans During the 20th Century”

[5] Cutler, D. and Miller, G. (2005) “The role of public health improvements in health advances: the twentieth-century United States” Demography 42, 1(February 2005): 1-22.