A January Institute of Medicine report reinforces a series of studies finding the United States spending much more on health care than any other nation but getting much worse results. IoM's summary identifies four major explanations for our shorter lives and poorer health:

  • Health systems. Unlike its peer countries, the United States has a relatively large uninsured population and more limited access to primary care. Americans are more likely to find their health care inaccessible or unaffordable and to report lapses in the quality and safety of care outside of hospitals.
  • Health behaviors. Although Americans are currently less likely to smoke and may drink alcohol less heavily than people in peer countries, they consume the most calories per person, have higher rates of drug abuse, are less likely to use seat belts, are involved in more traffic accidents that involve alcohol, and are more likely to use firearms in acts of violence.
  • Social and economic conditions. Although the income of Americans is higher on average than in other countries, the United States also has higher levels of poverty (especially child poverty) and income inequality and lower rates of social mobility. Other countries are outpacing the United States in the education of young people, which also affects health. And Americans benefit less from safety net programs that can buffer the negative health effects of poverty and other social disadvantages.
  • Physical environments. U.S. communities and the built environment are more likely than those in peer countries to be designed around automobiles, and this may discourage physical activity and contribute to obesity [Institute of Medicine, "Report Brief: U.S. Health in International Perspective: Shorter Lives, Poorer Health," 2013.01.09]

In other words, if Americans followed practices and policies that the Madville Times regularly suggests—cover the uninsured, put down your booze and guns, fix poverty and income inequality, invest more in education, and build communities to favor walking and biking—Americans would live better and longer. Alternatively, living along the lines of Dakota War College or The Right Side will make you sicker and deader.

Another reader of the IoM report suggests we might want to act less like John Wayne and John Galt and more like Jean Chrétien:

One major impediment is that the US, which emphasises self-reliance, individualism and free markets, is resistant to anything that even appears to hint at socialism. Interestingly, as a group, classically liberal nations like the US and the UK – free market-oriented with less regulation, tax and government services – are the least healthy among wealthy democracies.

By contrast, social democratic countries such as Sweden – in which the state emphasises full employment, income protection, housing, education, health and social insurance – enjoy better overall health, although health inequalities within these nations are not always the smallest.

Debates about the relative merits of "cut-throat" US versus "cuddly" Swedish capitalism contend that there are important trade-offs between economic growth and innovation on the one hand, and growing inequality, high poverty and a weak social safety net on the other. Unfortunately, these debates often fail to factor in our health. That needs to change [Laudon Aron, "Why Is the Rich US in Such Poor Health?" New Scientist, 2013.07.15].

It's tough to innovate and generate wealth when you're sick or dead. If you want America to be economically competitive, you've got to pursue not just health care reform but a change in the American mindset that would allow a panoply of changes in public policy and private behavior.

Related [08:20 CDT]: If you're going to the Brookings Summer Arts Festival this weekend, remember that 6th Street from Main Street west to festival site Pioneer Park is all torn to heck. But festival vendor Connie Balcom says you'll be fine if you just park your car elsewhere and walk:

"I don't think that road is going to be a big fat pain," Balcom said. "For the person driving their car down that road, yes. But not after they once get here."

For those who don't want to mess with construction on 6th Street, festival organizers have set up a series of shuttles around the city where you can park and be taken to Pioneer Park for free [Hailey Higgins, "Brookings Art Festival," KELOLand.com, 2013.07.12].

And remember: walking will help you burn off that deep-fried alligator and funnel cakes!