Producing a Healthy, Long-Lived Populace on a Budget – Who in the World is Getting the Job Done? Part 3

In Part 1 of this article, I expressed the desire to take an objective view at the health care systems of different nations to see if I could find a good example of a country who was pulling off a healthy population, a high life expectancy, and a quality health care system without breaking the bank.

In Part 2, I discussed the shining example of Singapore in doing just that – Singapore has the 4^th highest life expectancy in the world (people live to age 82 on average), has the 6^th best health care system, and the government of Singapore spends only 3.7% of its GDP on health care! For the details on how they accomplish this, read here.

In this final section I wished to contrast Singapore, who literally is getting the job done, to that of another part of the world. In this part of the world, government leaders decided that instead of finding a way to focus on having healthy citizens while cutting unnecessary costs, they would instead focus on making sure the entire population had health insurance. Health insurance, they surmised, was the key to the population’s health, as well as the key to keeping down the health care costs for both the government and the citizenry.

What have been the results? Did this government achieve its objective of insuring the masses? And if so, has this brought the desired curb in health care costs? Are the previously uninsured better off now that they have this insurance? Is everyone enjoying the fruits of this initiative?

I am sad to say that this experiment took place in our very own state of Massachusetts, and so far, it doesn’t look good.

According to a March 2, 2009 article in the Boston Globe, healthcare reform in Massachusetts

has:

1. Failed to achieve universal coverage (200,000 are still without health insurance),
2. Failed to address the problem of health insurance being tied to ones’ employment,
3. Failed to make health insurance affordable for many citizens (including middle and low-income individuals and families),
4. Failed to shore in costs for the state (healthcare costs for the state of Massachusetts have doubled from $630 million in 2007 to an estimated $1.3 billion for 2009),
5. Failed to assure citizens’ access to healthcare.

http://www.boston.com/bostonglobe/editorial_opinion/oped/articles/2009/03/02/mass_healthcare_reform_is_failing_us/
A more recent Christian Science article from October 21, 2009 concludes that “a mandate on individuals to buy health insurance can work – just don’t expect it to reduce the cost of care.” http://features.csmonitor.com/politics/2009/10/21/what-lessons-massachusetts-holds-for-us-healthcare-reform/

There may be some residents of Massachusetts who are happy with the results of the healthcare reform that have been enacted there, but the problems remain paramount.

If Massachusetts is, at best, no better off for its healthcare reform that has doubled healthcare expenses for the state, then should we not take some heed as our entire nation appears ready to plunge onto a similar course?

Should our main focus as a nation be universal health insurance? Shouldn’t we find a way follow the example of Singapore and focus on:

1. Population wellness through disease prevention,
2. Enacting policies that put more healthcare decisions into the hands of individuals, and fewer into the hands of the government?

For a brilliant essay on healthcare reform by a Democrat who has come to some of the same conclusions that I have in my cursory research, check out -- http://www.theatlantic.com/doc/200909/health-care .

In the meantime, I suggest each of us take actions to give us the best chances of having good health -- eating a balanced diet low in processed foods and high in minimally-processed plant-based foods, drinking plenty of clean water, getting adequate exercise and sleep, and using low-cost and oftentimes effective holistic means for taking care of problems when they first arise (such as herbs, essential oils, massage, acupuncture, reflexology, etc...), thus potentially using more expensive Western modalities more sparingly as a result.

To your health!

Producing a Healthy, Long-Lived Populace on a Budget– Who in the World is Getting the Job Done? Part 1

Are you familiar with the saying that if you want to become successful at something, find someone who has what you want and do what they do?

Applying this simple wisdom to the healthcare debate, I decided to see what I could turn up. Out of all the countries in the world, which nations have the populations with the best health measured by the highest life expectancy, and how is this accomplished?

I was hoping to come across a comprehensive study by some think-tank or prominent university giving detailed statistical analyses of factors affecting life expectancy and health, showing which nations around the world have the healthiest populations, and how they accomplish this, but I couldn’t find anything substantial.

I will attempt to provide some rudimentary findings in this article.

I started with searching for life expectancy rates in the different nations. I figured that life expectancy was the simplest measurement of the health of a populace. Here is the Top 10 List:

Countries with Highest Life Expectancy

1. Macau (part of China) -- 84.36
2. Andorra -- 82.51
3. Japan -- 82.12
4. Singapore -- 81.98
5. San Marino -- 81.97
6. Hong Kong -- 81.86
7. Australia -- 81.63
8. Canada -- 81.23
9. France (metropolitan) -- 80.98
10. Sweden 80.86
    

-- -- --

50. United States 78.11

Why do people living in these countries on average outlive the rest of the world? Does universal health care coverage play a key role? What about the lifestyle of these groups? What about factors that can’t be changed, but still play a role such as wealth and demographics of the populations?

Wouldn’t it be important to have an in-depth understanding of why these populations are so long-lived before undertaking any expensive, extensive, and potentially revolutionary changes to our own health care system?

As it turns out, each of the nations that made the top ten are relatively wealthy when compared with many other parts of the world, but those with the highest life expectancy are certainly not the wealthiest. From this, I must conclude that wealth may play a role in life expectancy, but there are clearly other factors involved.

Japan is noted for its extraordinarily low obesity rate – only 3% of Japanese citizens are obese (while in the United States, a full 32% of the populace is obese)! Since several of the top killers of Americans are chronic illnesses that occur with a significantly greater prevalence in the obese (heart disease, cancer, stroke, diabetes), it would make sense that America’s portly and out-of-shape populace is a literal drag on the nations’s life expectancy. Japan’s relatively lower rates of these chronic diseases gives further credence the significant role of obesity in life expectancy.

An interesting side note about Japan’s low obesity rate is how they avoid this modern plague – Japanese children are taught to eat only until 80% full, fresh vegetables and fish are eaten in abundance, sweets are eaten occasionally, and more people in Japan get exercise in their daily lives than in America. I think we can learn a lot about a healthy lifestyle from the Japanese!

In terms of demographics, some of the countries in this top-ten list have a tiny population size with a racially homogenous populace (such as San Marino, Andorra, Macau, and even Sweden). Others have larger populations, but still a very homogenous population such as Japan and Australia (92% of the Australian population is of European descent). But Canada, France, and Singapore all have a good degree of racial diversity.

A quick look at demographics reveals that having a small, homogenous populations may be positively associated with higher life expectancy, but it is clearly not the main player in the life expectancy game.

Next I wanted to look at the health care systems of each of the countries on this top-ten list.

Unfortunately, a complete statistical analysis of the health care systems of nations with high life expectancies is beyond the ability of my poor little brain, and beyond the scope of a blog entry. But here's what I can say so far:

Each of the nations and nation-states with the highest life expectancies appear to give access of at least basic health care to even the poorest of their citizens. If someone is having a heart attack, they won’t be turned away. If someone is mauled in an accident of some type, they will receive care. Any person with a chronic illness will receive at least basic care in a public clinic of some kind.

I have much more research to do to compare how this differs from what is currently offered to the poor in the United States under the Medicaid and Medicare program. I’m sure there are may be some significant differences, and I would like to know what they are.

In my research on health care systems, I made a very surprising find that I want to share. Did you know that in the list of countries with highest life expectancies that there is a country that is less affluent than the U.S. that has an infant mortality rate one-third less than that of the U.S., that spends one-seventh of what the U.S. government spends on health care for its populace, and its population lives an average of almost four years longer?

What country is this, and what are they doing right?

And did you know that there is a part of the world where a push to give each and every citizen health insurance has succeeded at insuring almost everyone, but has increased the cost of health care for many of its citizens while showing little or negligible increases in their actual health, while practically bankrupting its government in the process?

Stay tuned for the scoop.