The Cheeseburger Problem

Paul Krugman writes about excuses people make for the poor performance of the American health care system. One excuse -- too many cheeseburgers:

Americans don’t have a bad health system, say the apologists, they just have bad habits. Overeating and teenage sex, not the huge overhead of America’s private health insurance companies — the United States spends almost six times as much on health care administration as other advanced countries — are the source of our problems.

There’s a grain of truth to this claim: Bad habits may partially explain America’s low life expectancy. But the big question isn’t why we have lower life expectancy than Britain, Canada or France, it’s why we spend far more on health care without getting better results. And lifestyle isn’t the explanation: the most definitive estimates, such as those of the McKinsey Global Institute, say that diseases that are associated with obesity and other lifestyle-related problems play, at most, a minor role in high U.S. health care costs.

One might also note that insofar as Americans have less healthy lifestyles than we should -- which we certainly seem to -- that this, too, is a policy problem worth addressing, not just a factoid to wave around. One wouldn't want to go too far in terms of restricting liberty in the name of public healthy, but we certainly ought to take a closer look at the public health implications of our farm subsidies and land use policies (here both in terms of car accidents and the lost moderate exercise that comes from walking).

On top of all of that, however, is the point that giving people sound lifestyle advice and getting them to follow it is part of a good medical professional's job and part of the job of a good health care system would be to create a situation where people are getting their health status checked up and getting good advice about what they should be doing.

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