Poor Health Care History

Nick Kristof argues that once we pass health care, we're going to see a big spike in life expectancy.  Why?  Because, well, it worked in the 1940s!

Was it the late 1800s, when anesthesia made surgery easier and far more common? Was it the 1930s, when antibacterial medicines became available? Or recent decades, when CAT scans and heart bypasses proliferated?

The correct answer is: none of the above. While data differ and the statistics aren't fully reliable, a good bet is that the best answer is the 1940s. In that period, life expectancy increased about seven years.

Indeed, American life expectancy appears to have been longer in 1942, 1943, 1944 and 1945 -- even as hundreds of thousands of young Americans were being killed in World War II -- than it had been when America was at peace in 1940.

A prime reason is that with the war mobilization, Americans got much better access to medical care. Farmers and workers who had rarely seen doctors now found themselves with medical coverage through the military, jobs in industry or New Deal programs.

This is just not right.  While it's true that the first antibiotics, the sulfa drugs, were discovered in the 1930s, they didn't come into widespread use until the late thirties--the paper announcing Prontosil's miraculous effects wasn't even published until 1935.  Penicillin, the forerunner of the new class of miracle antibiotics, was first produced in 1942.

There is no medical improvement in modern history that can compare with the improvements in water supplies and other public sanitation measures of the 19th and 20th centuries, the synthesis of insulin for Type I diabetes, or the invention of antibiotics.  But we're not talking about expanding access to antibiotics, which are among the most widely available medicines in the country--some supermarkets in the south literally give them away as loss leaders.  We're talking about expanding access to more expensive treatments with less dramatic results, and more side effects.

On a side note, there weren't a lot of people suddenly taking New Deal jobs in 1940.

But it's a nice testable prediction.  I assume health care reform will pass.  And if Kristof is right, and I am wrong about the limited mortality benefits of expanded health insurance access, then we should see a dramatic increase in life expectancy.  Maybe seven years is too much, so let's make it easy--say three or four years by 2020.  That would make American among the the longest-lived people in the world.  And if this happens, then absent some miracle invention like a broad-spectrum cure for cancer, I will happily admit that I was wrong.

Of course, if this doesn't happen--if American life expectancy improvements continue to grind along at roughly the same slow pace--then it seems to me that Nick Kristof et. al. should unhappily admit that they were wrong, and that they seem to have convinced us to spend a whole bunch of money without saving many lives.  Will this happen?  Or will we be told that the problem is that we just didn't spend quite enough money, and must spend even more to actually realize the full glory of reform?