The Health Indicator shows that the United States provides more health care services at higher costs per capita than any other country in the world – but with no better outcomes than countries spending much less. After the anthrax attacks of 2001, the US public health services were revealed as woefully under-funded and wholly inadequate to their new tasks in an age of bioterrorism. Some funding increases have passed the Congress, but are still viewed by health professionals as a fraction of what is required. The enormous health sector of our economy is also becoming a top focus of national concern since it delivers only modest improvements in health status in some areas and none in others. Of deep concern are the over 40 million Americans who have no health insurance, and are expected to be covered under “Obamacare” which also has boosted health care coverage for 19 to 25 year olds. However, even though upheld by the US Supreme Court, “Obamacare”, officially the Affordable Care Act, is still highly contested in many states.
The National Bureau of Economic Research (NBER) released a working paper, which finds that better health boosts a country’s GNP. Authors David Bloom and JP Sevilla analyzed data from 104 countries and found that a one-year improvement in a country’s life expectancy contributes a 4% increase in its economic output (December 3, 2001). In a later study, they found that good health has a positive, sizable and statistically significant effect on aggregate output (2004). British researchers Kate Pickett and Richard Wilkinson in The Spirit Level (2009, 2010) and others at The Human Givens Institute show that investments in human health and wellbeing are basic to a nation’s overall progress and performance.
This points to the need to re-categorize health budgets in GNP/GDP national accounts from “expense” items to investments in human capital. In spite of many economists’ recommendations, GDP still has no asset account to record investments in human capital: health and education. Some public investments in infrastructure began being recognized in the USA and Canada in the late 1990s and reduced their so-called “deficits” accordingly (see also Infrastructure Indicator). Thus, nations still appear to be much more indebt than if the assets these debts create were recorded to balance them (e. g., “Education As Investment” and “Statisticians of the World Unite,” Hazel Henderson).
The debate over a “Patient’s Bill of Rights” to hold health maintenance organizations and insurance companies more accountable for decisions over patient treatment is becoming urgent. Pharmaceutical companies’ drug prices soar at three times the rate of inflation and the Medicare-related law passed in 2003, providing drug coverage for seniors, and the drug benefit portions of “Obamacare” are widely-criticized for the “holes” in benefits and rewards to pharmaceutical companies. Concerns grow regarding the privacy of medical records, and drug reactions and medical mistakes proliferate (see “Health and Wellness” at ethicalmarkets.tv). Newer worries concern terrorism and the need for public health clinics nationwide, where uninsured people who may have been exposed to pathogens can be quickly tested and evaluated so as to limit epidemics. As efficient as the response was to the Boston bombings, many hospitals would be greatly challenged by a like incident.
Obesity and related illnesses, including type-2 diabetes, now affect 70 million people in the US. Many criticize the industrialized food sector – and agricultural subsidies for the plethora of junk food, laced with sugar, fat and salt, all highly advertised and available in schools – for this increase in obesity. If fresh fruits and vegetable were subsidized as much as corn, wheat and other agribusiness crops, this would radically reform our food supply and lead to lower health costs.
The Health Indicator offers a model of our current system that helps to clarify the situation as a systemic set of issues. Health is being redefined beyond the medical intervention model (see “Health and Wellness” on ethicalmarkets.tv). Today, Americans are focusing on prevention, public health, stress-reduction, and life-style choices. Beyond terrorism, tobacco, alcohol use and other drugs, including misuse of prescription pain-killers, even the availability of guns are issues entering the public health debate. More Americans now consult “complementary” and “alternative” health providers than visit conventional medical doctors and facilities. This is a paradigm shift that is restructuring the entire medical-industrial complex and its technocratic, bureaucratic approach, which represents over 17 percent of our GDP. The lobbying by the insurance, pharmaceutical, hospital interests as well as by doctors and high-tech providers, prevented the debate over “Medicare for All!” favored by many groups of doctors, nurses and alternative health care providers, as well as many legislators. Private insurance overheads average 14% (for compensating shareholders, executives, advertising, claims, adjusters, etc.), compared with less than 4% for Medicare, even though its accounting misses some $60 billion of fraud annually. No other country in the world permits advertising of prescription drugs such as those flooding US airwaves and print media.
How will we integrate all these very different approaches to health? How will we provide for those left out of the current system, especially children? An October 1999 study in the Federal Reserve Bank of New York’s Economic Policy Review cites the effects of urban poverty. Fifteen-year-old black and white male’s life expectancy rates were compared in several cities. In areas of New York City that were predominantly low-income and African American, only 37% of the population was expected to live to age 65. In Detroit, the figure was 50%. White fifteen-year-olds in poverty areas of Detroit and Cleveland did a little better. In Detroit, 60% were found likely to live to age 65 with 64% likely in Cleveland. Average life expectancy for all US whites is 78.3 years compared to 73.8 years for blacks. Our indicator allows us to see such gaps, which of course relate to similar data in our Income, Shelter, Public Safety, Education, and Human Rights Indicators.
One of our key expert advisors for the Health Indicator is Dr. Trevor Hancock, prominent internationally for his work on health indicators focusing on prevention and broad public health factors. Dr. Hancock, who serves on our Advisory Board, is a full time advisor to the Ministry of Health Planning of British Columbia, Canada. Dr. Hancock, among his many important posts has advised the World Health Organization, many European governments, and was Regents Lecturer at the University of California, Berkeley in the School of Public Health. With Dr. Hancock’s help, our Health Indicator includes Healthy Life Expectancy and factoring in disability and quality of life as people age with the WHO’s Disability-Adjusted Life Year (DALY).