American Health: Higher Cost But Less Health

The US rates 23rd out of 30 developed countries on most measures of health status. More money spent on healthcare does not equal better health. Americans could become the longest lived population if they ate better and exercised more.
Americans spend far more per capita on healthcare than people in any other nation. In the last 40 years the percentage of the US GNP going to healthcare has increased from 5% to 16%. Now if all this money resulted in Americans being the healthiest and longest-lived people on the planet one might argue that all this money is worth it. However, as Dr. Schroeder pointed out in a special article published in the New England Journal of Medicine, our healthcare dollars are producing relatively little bang for the buck. Dr. Schroeder noted that “Among the 30 developed nations that make up the Organization for Economic Cooperation and Development (OECD), the United States ranks near the bottom on most measures of health status.”1

Dr. Schroeder noted that life expectancy at birth for US women ranked 23rd out of 30 countries with a life expectancy 5.2 years shorter than that of Japanese women.
American men fared little better trailing American women and Icelandic men by about 5 years with a life expectancy at birth of 74.8 years ranking them 22nd among the 30 OECD countries. How does Dr. Schroeder explain our poor ranking compared to countries that spend far less on healthcare? He notes that “…first, the pathways to better health do not depend on better healthcare, and second, even in those instances in which healthcare is important, too many Americans do not receive it, receive it too late, or receive poor-quality care.”
The truth is the vast majority of medical care dollars are spent on diagnostic tests and treatments that make little or no difference in terms of how long someone will live. For example, in 2004 Americans with stable coronary artery disease underwent about 1 million angioplasty operations mostly paid for by health insurance companies, Medicare and Medicaid. However, research has shown these expensive procedures do little to reduce angina and absolutely nothing to reduce the risk of having or dying from a heart attack or other cardiovascular disease. Angioplasty cost a lot but does nothing to increase the patient’s life expectancy.
Since 1970 the number of Americans with type 2 diabetes has gone from about 5 million to over 20 million largely because the American diet is calorie dense, nutrient poor and low in fiber and because most Americans are couch potatoes. This has resulted in 2/3 of Americans becoming overweight or obese. This leads to insulin resistance, the metabolic syndrome, and eventually type 2 diabetes. A healthier diet and a more active lifestyle would keep us thinner and reverse insulin resistance and the metabolic syndrome. If you’re overweight and heave the metabolic syndrome you’ll find your health insurance, Medicare, and Medicaid pay little or nothing to see a RD or exercise physiologist even though diet and exercise have been proven to dramatically cut the risk of developing type 2 diabetes. Once you’ve got diabetes they’ll spend thousands of dollars each year for drugs, surgery, and other medical treatments. Even so, type 2 diabetes will shave at least 5-10 years off one’s life expectancy.
Over 90% of Americans develop hypertension largely because they consume too much salt. People with hypertension lose at least 5-10 years off their life expectancy and yet drug treatment of hypertension at best gives back about a year. The US Food and Drug Administration classifies salt as “generally recognized as safe” and puts no limits on how much can be added to foods even though the US Institute of Medicine’s experts concluded even young healthy Americans should cut their salt intake by at least 50%. As a result 80% of the salt the typical American consumes comes from processed food.
Bottom Line:
If the US government limited the amount of salt that could be added to processed foods and restaurant meals to about half what is currently used, life expectancy in the US would increase by several years. If Americans ate half as much bad fats, cholesterol, and refined sugars and grains and exercised more, Americans could become the longest-lived population on the planet. At the same time money now being spent and largely wasted on ineffective and marginally effective medical treatments could be cut by 50% or more with no reduction in average life expectancy.
By James J. Kenney, PhD, RD, FACN
References:
1.  N Engl J Med 2007;357:1221-8

Diabetes costs
The national cost of diabetes in the U.S. in 2007 exceeds $174 billion. This estimate includes $116 billion in excess medical expenditures attributed to diabetes, as well as $58 billion in reduced national productivity. People with diagnosed diabetes, on average, have medical expenditures that are approximately 2.3 times higher than the expenditures would be in the absence of diabetes. Approximately $1 in $10 health care dollars is attributed to diabetes. Indirect costs include increased factors such as absenteeism, reduced productivity, and lost productive capacity due to early mortality. For comparison sake, the cost of the war in Iraq is about $200 billion per year (Source: NY Times) and the cost of Hurricane Katrina clean up was about $150 billion (en.wikipedia.org, marshall.edu).
Source: Diabetes Care 31:1–20, 2008 diabetes.org

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