Amid all the debate concerning the morality, legality, and feasibility of health-care reform, the United States faces a central paradox in its health-care system: we spend more than any other industrialized country on health, yet we rank among the lowest in many dimensions of health. Our health-care spending is more than 17 percent of our gross domestic product, nearly double the spending in many other industrialized countries. But we rank far below most of these same nations in measures of life expectancy, infant mortality, and maternal mortality, among other key statistics. The huge costs and poor outcomes are difficult for Americans to fathom, and we have been eager for decades to reform our extraordinarily expensive system. Like previous reform efforts, President Obama’s recently passed health-care law pertained to financing, provider payment, and quality measurement. The goal was to provide access to high-quality medical care for most of the 51 million previously uninsured Americans, while keeping a lid on overall health-care spending. Meanwhile both the president and the Republican leadership in Congress are slashing funding for social-service programs as they seek to reduce the federal deficit.
But the question is: is the country targeting the right policy area with these reforms? What really underlies the “spend more, get less” paradox?
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An important pattern emerged: the United States spends, as a percentage of GDP, about half of what some of the other industrialized counties spend on social services (such as housing, employment training, unemployment benefits, old-age assistance, and family support services). The ratio of social-service spending to health-care spending in the United States is less than 1:1, while the average among other OECD countries is 2:1. Across the board, OECD countries, including the United States, spend about a third of their GDP on combined health and social services. But the United States has inverted the standard allocation pattern.
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...a population’s health is largely a result of social and behavioral factors and much less related to medical care or health services. For instance, safe housing, reasonable employment, and proper food supports may be more important for the population’s overall health than specific medical care.
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