Jonathan Portes and Others on the Mystery of Why Americans are So Unhealthy

In my post “The OECD Compares Health Care Systems” earlier today, I posed this question:

To what extent is the bad performance of the U.S. in life expectancy really a failure of Medicaid—the government medical program for the poor? If we did Medicaid right, while keeping the rest of the system the same as it was before the Affordable Care Act (Obamacare), could we dramatically reduce mortality while at most modestly increasing Medicaid expenditures?

Jonathan Portes answered “probably no” by email, saying “this paper and predecessors is the best comparison of health outcomes (not just mortality, but quite a few more which may be more directly related to health system quality) between US and UK”:

James Banks, Alastair Muriel and Jim Smith: “Disease Prevalence, Disease Incidence and Mortality in the United States and in England." 

I know Jim Smith from a joint University of Michigan-RAND project on "Internet Interviewing” that we are both involved in (the origin of Arie Kapteyn’s amazing American Life Panel), and have the highest respect for him. Jonathan zeroes in on this description that James Banks, Alastair Muriel and Jim Smith give of their previous work:

In a recent widely cited paper, we compared disease prevalence among middle age adults 55-64 years old in England and in the United States (Banks et al. 2006). Based on self-reported prevalence of seven important illnesses (diabetes, heart attack, hypertension, heart disease, cancer, diseases of the lung, and stroke), Americans were much less healthy than their English counterparts, differences that were large along all points of the socioeconomic status distribution. Moreover, using biological markers of disease, we found similar health disparities between Americans and the English, suggesting that these large health differences are not simply a result of differential reporting of illness in the two countries. They also exist with equal force among both men and women (Banks et al.2009). Since we purposely excluded minorities (African-Americans and Latinos in American and immigrants in England), these differences were not solely due to American health issues in the African-American or Latino populations or the growing immigrant population in England. Finally, these disparities in prevalence of chronic illness were not the consequence of differences between the two countries in conventional risk factors such as smoking, obesity, and drinking. Health disparities were essentially unchanged when we controlled for different levels of these risk factors in America and in England.

Jonathan summarizes this by saying

The key point here is “Americans were much less healthy than their English counterparts, differences that were large along all points of the socioeconomic status distribution.” I.e., it’s not just about the poor. Equally, it’s certainly not just about the health system either–public health more generally, income distribution, the rest of the welfare state, etc, all probably play a role.

James Banks, Alastair Muriel and Jim Smith emphasize that the lower health in America applies across the board, for both the high and low of society. But the differences between different socieconomic groups in America are remarkable too. Jim House, my colleague in the Survey Research Center at the University of Michigan told me this fact: in the United States, the gap between the health of those who have college degrees and those who don’t has been growing dramatically. In particular, in recent years it has become apparent that those with college degrees tend to live a long time and then have only a short period of bad health in the period right before death–a pattern significantly less common for those without college degrees. Here is one of his academic papers backing up that claim.