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Credit Diet not Doctors for Longer Life

September 09, 2009

By David Gratzer

“Half a world away from the U.S. healthcare debate, Japan has a system that costs half as much and often achieves better medical outcomes than its American counterpart.” So begins a lengthy article by the Washington Post’s Blaine Harden on Japanese health care.

Harden’s argument comes down to this: People live longer in Japan, therefore the healthcare system is better.

But, as I’ve argued here before, life expectancy doesn’t simply reflect healthcare. It is influenced by genetics, diet, exercise, smoking, and a host of other factors. Indeed, healthcare may not be the most important of these factors (and, as a doctor, it pains me to write that). Consider that in Japan, people have fewer heart attacks than in the United States – but, when they do, they are twice as likely to die. That’s not quite a ringing endorsement of Japanese healthcare.

In concise prose, the Hudson Institute’s Marie-Josee Kravis considers life expectancy here and across the Western world in a Forbes column. (It can be found in the 21 September issue, but also online here.)

She begins:

The U.S. spends much more on health care services as a percentage of GDP than other developed countries, and yet in life expectancy it lags most of these others. A specious connection built around these two facts has become a staple of discussions about health care, even though health care is only one of many determinants of life expectancy.

She notes that the United States has higher car accidents and homicide rates.

Take road fatalities: The U.S. holds the unenviable record of one of the highest rates in the developed world. Its road mortality rate is 15 per 100,000 people compared with 6.6 in Japan, partly because we drive more. Would universal health care shorten commutes or stop speeding? Would driver-distracting cell phones be shelved and more seat belts worn if there were universal health insurance? Now to the homicide rate, ten times as high in the U.S. as in the U.K. Will insurance cards replace guns? Can anyone credibly argue that health care reform will lower the homicide rate?

Most interestingly, she also notes the importance of obesity of American higher health costs and lower life expectancies.

The Organisation for Economic Co-operation & Development reports that 32.2% of Americans are obese. The OECD average is 14.6%, with Japan at 3%, France 9.5%, Germany 13.6%, Canada 18% and Australia 21.7%. Obesity isn’t caused by the health care system, but it does reduce life expectancy. It’s a lifestyle choice whose expenses are borne by everyone. Costs attributable to obesity account for almost 10% of health care spending in the U.S. In Canada the corresponding figure is from 2% to 3.5%.

Obese Americans spend an average of 36% more for health services and 77% more for medications than people of normal weight. They are 20 times as likely to develop diabetes, 2.5 times as prone to heart disease and twice as vulnerable to cancer, hypertension and asthma. Will health care reform cut portion sizes?

Harden — like so many — wants to connect life expectancy with health care. That is glib and misleading. Kravis raises a good question that leads to a larger one: what are we going to do about obesity? For all the talk of the White House about “bending the curve,” the path to lower health costs is unlikely to be found in some Washington created bureaucracy like IMAC, but rather in finding a way for Americans to take more ownership of their own health.

Original Source:



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