More Health Care, Less Health

The number of Americans with health insurance has greatly increased. And health care spending grew by 5.8% in 2015. Yet this growth in health care coverage and spending did not make Americans healthier on average. On the contrary, Americans died at a quicker rate.

President Barack Obama’s Affordable Care Act is largely responsible for the increase in health insurance access. During 2014 and 2015, “the insured share of the population increased 4.9 percentage points and reached 90.9 percent.” This increased access to insurance was accompanied by a concomitant increase in health care utilization. And the federal government picked much up much of the tab. For the first time ever, the federal government became the single largest health care payer in the country, accounting for 29% of total health care spending.

The increase in health care coverage and utilization coincided with a massive increase in spending. In 2015 alone, US health care spending increased 5.8%. It reached $3.2 trillion, up from $3 trillion in 2014. If the 2015 growth rate continues, nominal US health care spending will double over the next 12 years, and quadruple by 2040.

The jump in health care expenditure did not improve America’s health, however. The death rate “increased from 724.6 per 100,000 people to 733.1 per 100,000.” As a result, the life expectancy for an American born in 2015 was lower than the year prior. It dropped from 78.9 to 78.8 years.

America’s chronic disease epidemic drove the increase in deaths. As NPR reports, “mortality from heart disease and stroke increased after declining for years.” Apparently there’s a limit to cardiovascular health improvement through pharmaceutical interventions, absent serious lifestyle changes. Here’s CDC’s table of the top 10 causes of death in the US:
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8 of the 10 fall into the chronic disease category, meaning they are highly correlated with malnutrition and sedentary lifestyles. As CDC reports,

“The rate increased 0.9% for heart disease, 2.7% for chronic lower respiratory diseases, 6.7% for unintentional injuries, 3.0% for stroke, 15.7% for Alzheimer’s disease, 1.9% for diabetes, 1.5% for kidney disease, and 2.3% for suicide.”

So Americans used more health care and became even less healthy.  Should this result surprise you?

Not if you have been paying attention. Previous research has shed doubt on the idea that health insurance and increased health care utilization improve health. The Oregon Medicaid Experiment looked at thousands of new Medicaid participants and contrasted them with those who remained without insurance. It found that Medicaid “increased health care utilization” yet “produced no statistically significant effects on physical health or labor market outcomes.” Other research arrived at similar conclusions.

But in 2015 America’s health didn’t stay the same – it got worse. Might the death rate increase have something to do with expanded health care access?

Consider iatrogenic harm, the damage caused by medical treatment itself. It is estimated to be the third leading cause of death in the United States. A Johns Hopkins study assessed that medical accidents cause 250,000 U.S. deaths per year. And more health care utilization almost certainly means more deaths due to medical accidents. (It is interesting to note that the CDC report does not mention this cause of death).

2015 was a highly disappointing year for America’s health. We began dying at a faster rate, despite spending more money than ever on health care. Yet Tashina Cromes bucked the trend. The Practice CrossFit client reports she decreased her health care utilization and increased her health:

“Two solid years of losing weight, figuring out what works, running, CrossFit, doctor appointments, weaning off of diabetic insulin and medication and hitting that final goal. New PRs, new challenges and new things to learn. There’s days you move forward and days you feel stuck. Days to take a rest and days to push through. There are no short cuts. No secrets. No magic pill that will make it happen faster. Just time and work.”

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CrossFit affiliates like Practice CrossFit provide non-medical health care.

2 comments

  1. None of this surprises me after four decades of practicing medicine. One issue that you didn’t discuss in this post is how health insurance actually works in the real world. Guess how much they pay me to prevent or reverse diabetes, obesity, metabolic syndrome, hypertension or heart disease? The answer is zippo! Insurance companies will pay me to “manage” these diseases. Per this scheme physicians should have donuts in their waiting rooms! Unless this issue is addressed we will not see any improvement in our national health. Healthy eating and exercise are the main drivers of improved health, not medications.

  2. Your post made me surprised! Can’t believe that medical accidents cause 250,000 U.S. deaths per year! Is it number reliable?
    Anyway, we should not rely on any organization or any policy but help ourselves by exercising and eating healthy.

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