Magazine article The Christian Century

The American Health Care Paradox: Why Spending More Is Getting Us Less

Magazine article The Christian Century

The American Health Care Paradox: Why Spending More Is Getting Us Less

Article excerpt

The American Health Care Paradox: Why Spending More Is Getting Us Less

By Elizabeth H. Bradley and Lauren A. Taylor

Public Affairs, 272 pp., $26.99

This may be one of the three most important books your member of Congress will probably never read.

The first is journalist T. R. Reid's The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care (2009). A couple of hours with this book and Republican legislators might finally discover that most other economically advanced nations have systems that cost less than America's, give better results and (shocker!) aren't socialist.

The second is David Goldhill's Catastrophic Care: How American Health Care Killed My Father--and How We Can Fix It (2013). Goldhill, who is both a CEO and a Democrat, offers a health-care proposal combining free market business principles, personal responsibility and concern for the common good. A couple of hours with this book and Democratic legislators might realize that although the U.S. health-care system desperately needs fixing, Obamacare may not be the solution.

The third book is neither as entertaining as Reid's nor as concrete as Goldhill's. But if the goal is to keep Americans as healthy as possible while spending no more than necessary, it may be the most important of the three, because it completely reframes the usual (and by now tedious) discussion. The American Health Care Paradox is a paradigm shifter.

Americans spend more on health care and get poorer results, say Elizabeth H. Bradley and Lauren A. Taylor, because we are coming at health care backward. Instead of investing in social services that help people stay healthy, America spends vast amounts trying to fix people after they have fallen ill. Until the U.S. reunites social and medical services as health-care partners, all the health-care legislation in the world will accomplish little.

The authors are well credentialed: Bradley is a professor of public health at Yale, and Taylor is a presidential scholar studying public health and medical ethics at Harvard Divinity School. Two years ago they attracted national attention with a New York Times article arguing that, contrary to popular opinion, America does not spend more than any other nation on health. If health care and social service expenditures--"like rent subsidies, employment-training programs, unemployment benefits, old-age pensions, family support and other services that can extend and improve life"--are looked at together, America's total outlay is in tenth place (it has since fallen to 13th). And although most other industrialized nations spend two dollars on social services for every dollar spent on health care, America spends just 90 cents (now only 60 cents).

Sadly, the American tendency to medicalize health care seems not to be working so well. Bradley and Taylor tally the results of the U.S. approach:

   Americans have lower life expectancy
   and higher rates of infant mortality,
   low weight birth, injuries and homicides,
   adolescent pregnancy and sexually
   transmitted diseases, HIV/AIDS,
   drug-related deaths, obesity, diabetes,
   heart disease, chronic lung disease,
   and disability than people in other
   industrialized countries.

Bradley and Taylor's message, repeated in one form or another in every chapter, is that Americans need to start thinking seriously not just about how much money they are spending on health, but on how effectively they are spending it.

Readers hoping for a political way out of America's health-care impasse (or for ammunition to support their partisan preferences) will be disappointed in this book, which is much more about why than how. The authors say they grimaced when they saw the title on the New York Times article presenting their position: "To Fix Health Care, Help the Poor." They are not politically motivated, they say; nor are they advocating social justice. …

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