I asked my cousin to pass the gravy. After I took the bowl and spread the brown goo over my turkey, my uncle went on to ask, “So Nick, what do you think of Obamacare?” Knowing he wasn’t really looking for my opinion but an argument, I poked the bear. “I think it is ridiculous a great industrialized nation like the US doesn’t offer health care for all its citizens,” I responded. Immediately, my cousin exclaimed, “BIG DEAL! You know how many people from those ‘socialized’ nations in Europe come here for their health care… It is not a problem with OUR health care system but the health of people here are poor, because we have the freedom to live the way we want…”
Before I turned this into a full on debate that would surely ruin Thanksgiving dinner, I ended the conversation with a “let’s agree to disagree.” Nevertheless, I started to think about what my uncle said. Yes, the health of the US is surely not stellar but does the health care system really not play a role in this. Maybe. One study cited that health care only has a 10% contribution to total US health, while behavioral patterns accounted for 40% (1). But does that really mean that US health care is as good or better than other countries?? Then I remembered an article and concept that I read in a previous policy class which would have surely won the argument: AMENABLE MORTALITY RATES.
Amenable mortality, or mortality that “should not occur in the presence of timely and effective health care,” (2) is a strong indicator of the US’s mediocre health care system. It is one of the methods that attempt to separate the contribution of health care to population health from other determinants of health. Dr. Nolte and Dr. McKee in a 2012 Health Affairs article showed that, between 1999 and 2007, Americans under 65 years old had a worse amenable mortality rate than some of its peers across the Atlantic, including UK, France, and Germany. In this time period amenable mortality rates dropped the least for the US, 18%, and at the end of 2007, US had the overall highest rates. However, rates were similar in the over 65 years old population. This led to the authors’ conclusion that health care in the US is effective but only to those who have access to it (over 65 -year olds have access through Medicare). Furthermore, in the discussion, the authors cited a separate study, which showed that those most likely to receive appropriate care were associated with those who used VA services and had insurance (2). Therefore, it is hard to doubt that the ACA and universal access to insurance will lead to greater access to health care and better health for America overall.
- Schroeder M.D., Steven A. “We Can Do Better – Improving the Health of the American People.” New England Journal of Medicine. no. 357 (2007): 1221-8.
- Nolte, Ellen, and C. Martin McKee. “In Amenable Mortality – Deaths Avoidable Through Health Care – Progress in the US Lags that of Three European Countries .” Health Affairs. no. 9 (Sep 2012): 2114-22.