The Health Care Crisis: We Have Met the Enemy, and It is Us

Image source: The Atlantic

Thought experiment: What if you had the same health care system as Sweden…. but populated it with Americans? Would you have the same health outcomes as Sweden? Would health care as a percentage of the economy cost the same?

Writing in The Atlantic, David H. Freedman argues that high costs and poor medical outcomes are driven not only by the structure of the health care system but the expectations and behaviors of Americans.

We ought to consider the possibility that if we exported Americans to … other countries, their systems might end up with our costs and outcomes. That although Americans (rightly, in my opinion) love the idea of Medicare for All, they would rebel at its reality. In other words, we need to ask: Could the problem with the American health-care system lie not only with the American system but with American patients?

Freedman points to a 2017 study that finds that 74% of the variation in life expectancy across U.S. counties is explained by health-related lifestyle factors such as inactivity and smoking, and the conditions associated with them such as obesity and diabetes — “which is to say, by patients themselves.” Unhealthy behaviors such as sedentary lifestyles are rooted in cultural norms.

Americans, he suggests, also have a unique attitude toward health care that money is no object — especially when someone else is paying. “Attempts to cut back on expensive treatments are met with patient indignation.” When insurance companies try to limit expensive or unproven procedures, “they invariably run into a buzz saw of public outrage.”

Further, American patients are frequently over-treated, especially with regard to expensive tests that aren’t strictly needed. It is commonly held that doctors and hospitals promote tests to keep their incomes high. But surveys show that doctors prescribe tests to cater to the wishes of their patients or out of fear of malpractice lawsuits. In other countries, doctors are deified — they give orders and patients follow. But in America, patients are far more likely (for better or worse) to question their doctors’ judgments.

Other factors: American’s lead the world in drug noncompliance. The per-capita cost of noncompliance is up to three times as high in the U.S. as in the European Union. In the U.S., patients are less resigned to the inevitability of death. “Death, even for the very aged, tends to be fought tooth and nail, and not cheaply,” writes Freedman.

Asks Freedman: “Medicare for All could … [refuse] to pay for unnecessarily expensive care, as Medicare does now—but can it prepare patients to start hearing ‘no’ from their physicians?”

Bacon’s bottom line: America’s health-care cost crisis, and Virginia’s, too, is largely largely self-inflicted. Broadly speaking, public policy at the federal and state level can either (a) subsidize Americans’ counter-productive cultural proclivities or (b) demand that Americans take greater responsibility for their own personal welfare. Which shall it be?

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8 responses to “The Health Care Crisis: We Have Met the Enemy, and It is Us”

  1. Steve Haner Avatar
    Steve Haner

    No No No – it must be somebody else’s fault! I’m entitled to good health and free care! I can drink all the sugar sodas, smoke coffin nails, guzzle beer by the pint and vegetate on the couch all day and night, and my neighbor can pay for it all! Entitlement USA…..There certainly are fat Europeans, but the fattest people I’ve seen in my recent trips have been my fellow travelers….Great article by the guy. He’s also dead on, pardon the pun, about high cost and pointless end of life care.

    1. LarrytheG Avatar

      People in northern Virginia have life expectancies the same as Japan in other countries like Sweden because they get good healthcare that helps them to stop smoking and keep their weight down and manage places where there is not good medical Care and/or they cannot afford it then people who get diabetes or people who want to stop smoking don’t get the medical care to help them do that.
      Folks who do not have access to regular medical Care they don’t even know they have diabetes much less get treated for it

      1. TooManyTaxes Avatar

        Larry – what else should we do? We’ve expanded Medicaid. We’ve covered all the people who you argued should be covered. They have the coverage that can give them the medical help needed.

        But there reaches a point where individuals need to take responsibility for their own lives. Now and then my wife watches My 600 lb Life. Dr. Younan Nowzaradan tells the patients that they need to diet and if they follow his instructions, they will lose weight. He tells the patients that they have no excuses.

        If we provide expanded Medicaid and those people can get access to the care and instructions that they need, when do they become responsible for their own lives?

        At some point, there’s nothing to be done.

        1. LarrytheG Avatar

          re: what else

          1. – it will take a while for the expansion to have an effect but the key thing is that people who get REGULAR medical care WILL be helped on their poor lifestyle choices – rich and poor – rural and urban – the key is regular visits to the doctor.

          2. – In rural areas with poor access to doctors – being insured won’t necessarily get you regular visits if there is no one near you.

          It’s NOT that Americans have “worse” lifestyles – perhaps compared to the Swedes but compared to the 30 other countries with univeral care – the real difference is that in those 30 other countries – everyone has regular access to a doctor – who, just like the folks in NoVa – will see their doctors and receive help in dealing with weight, smoking, diabetes, etc.

          Our apologists keep looking for excuses as to why we have such worse outcomes and it’s partially lifestyle – but a good doctor will set a lot of these folks straight – just like they do in NoVa and the 30 other countries.

          We keep making excuses as to why our health care system is so bad compared to those other 30 countries – so we try to blame people instead.

  2. “We keep making excuses as to why our health care system is so bad compared to those other 30 countries – so we try to blame people instead.”

    I’d turn your proposition on its head. We keep making excuses why people are so unhealthy compared to 30 other countries — so we blame the system instead.

    1. LarrytheG Avatar

      We blame OUR system BECAUSE it’s the one that is grossly different and clearly less effective than the 30 other countries – many of which ALSO have people with “unhealthy” lifestyles.

      It’s like American are unique in the world for being dumbasses about their own health – and of course it’s the “deplorables” and such who are typically low income and live in rural areas and/or don’t see doctors.

      It’s like Italy and France and Germany don’t have obese people or people who smoke or have diabetes – only us Americans!

      It’s a dumb narrative but it continues to be promoted and accepted by those who DEFEND the US system which is just a mess that is claimed to be “not socialist” and instead free-market-based.

      70% of Americans have employer-provided healthcare which is heavily subsidized for the lucky ones who do have it while those who work in lower-income jobs do not get it and Conservatives and Libertarians have consistently “blamed” them for not having it and having bad lifestyles.

      It’s totally bogus. People who don’t have access to Doctors do NOT have their diseases and health conditions treated whereas those who do have health insurance DO get treated.

      People who are obese, smoke, have diabetes NEED ACCESS TO HEALTHCARE so their conditions will be treated – just like those conditions ARE treated for people who DO have access!

      The “anti” types go around their elbows to blame people and defend a bad system and claim that a market-based approach would “provide” healthcare – when no such system exists on the planet.

      It’s like they do not understand economics where insurance companies – will get rid of anyone who costs them more than premiums if they can.

      If the “blamers” world – everyone not as healthy as a Swede would be kicked off Medicare because they are old, obese and have other health conditions due to a lifetime of poor lifestyle choices!

      Conservatives/Libertarian have no viable solutions to health care other than blame and the mythical “market”.

  3. Reed Fawell 3rd Avatar
    Reed Fawell 3rd


    The US Census reports some connection has been found between men and fatherhood in America. The Daily Progress today struggles unsuccessfully to figure that out and report it to us on Father’s Day.

    Meanwhile –

    UVA, promising to be not only great as it obviously is to UVA, UVA also now promises to be GOOD – as it is struggling mightily to find a way to produce competent teachers of K through the 8th grade in America in only four years of great study at UVA!

    That’s the News Today on Father’s Day from Charlottesville Virginia!

  4. Reed Fawell 3rd Avatar
    Reed Fawell 3rd

    Another newsflash from Charlottesville Virginia via the Daily Progress-

    “The developer behind the Dewberry Hotel appears to be instead planning a luxury apartment building for the unfinished structure on Charlottesville’s Downtown Mall.

    The Dewberry Group has moved the property from its “hospitality” section of its website, which features a hotel, to the “living” section, which features luxury apartment complexes.

    Multiple attempts to reach the developer were unsuccessful in the past two weeks. Developer John Dewberry is also elusive to city staff and officials, and some haven’t heard from company representatives in well over a year.

    “The problem with Dewberry is nobody really knows what he’s doing,” said former Councilor Bob Fenwick. “He’ll tell people he’ll do one thing and then he’ll never come through.”

    However, city staff may have little interaction with the company because the apartments would be allowed by-right, though only about 12 are legal under the current Downtown Corridor zoning. The building has eight floors above street level.

    Any additional apartments would require a special-use permit, but city staff members haven’t received any correspondence in more than a year …”

    I wonder if this is a planned luxury high rent apartment project for the rich?

    And, if so, whether if it might have any connection with, indeed if it might serve, hedge fund managers in jodhpurs and others of similar ilk visiting the new high rent Innovation Center popped down alongside Charlottesville’s historic Mall characterized by The Peoples’ Republic of Charlottesville as:

    “Charlottesville’s Dining, Entertainment & Shopping District!

    A visit to Charlottesville isn’t complete without a stop at the Downtown Mall. It is one of the most beautiful and successful pedestrian malls in the nation, and it’s located in historic downtown Charlottesville. A wonderful mix of restored and renovated buildings that typified small “downtowns” throughout the country can now be seen by visitors as they enjoy shopping, dining and visiting along the brick-paved pedestrian area.

    The Downtown Mall is a vibrant collection of more than 120 shops and 30 restaurants (many with outdoor cafes) housed in the historic buildings on and around old Main Street. Enjoy dining al fresco (in season) at a number of fine restaurants, shop at any of the unique boutiques or meander by flowing fountains. For family fun, it’s easy to cool off in our ice park or take your children to the hands-on Virginia Discovery Museum. Enjoy attending a movie or play in one of the many fine theaters, or simply relax under magnificent oak trees along the red bricked mall. Convenient parking in nearby garages and parking lots, as well as free trolley service connecting the Downtown Mall to the University of Virginia along West Main Street make a visit to the downtown easy for visitors of all ages.”

    Does this development, if truly planned, raise a host of questions for The People’s Republic? Like, for example, is all of this in lieu of the long established car garage that served the mall and skating for kids. Who needs cars when you can fly or take thoroughbred horses into town while other less advantaged people take the bus? And who needs their poor kids in a skating rink anyway, either?

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