Whence the ACA

Compared to Europeans, Americans are more likely to die at any age, from birth till about age 75. For their trouble, Americans get to pay double the OECD average for healthcare, spending more than $8000 per person, per year. Switzerland and Norway rank 2 and 3 – and the US outspends them both by about 50%.

America’s poor performance on infant mortality means 7,000 American babies die before age 1 simply because they werent born in France – and France doesnt even crack the top 10 for infant mortality.10,000 American babies die because they werent born in Japan. And France and Japan spend less than half what Americans spend on healthcare.

American kids who live to celebrate their 1st birthday still arent out of the woods. They’re over 50% more likely to die before age 5 than children in Estonia, Slovenia, Korea, The Czech Rep. and Cyprus – not to mention nearly every country in western Europe. American pre-schoolers have about the same odds of seeing their 5th birthday as kids in Bosnia and Uruguay.

Greater risk of death follows Americans though their adult lives, with American life expectancy lagging well behind almost every country in the developed world. Considering that life expectancy within a country is roughly predicted by per capita income – and given that American per capita income is among the highest in the world – Americans are dying about 5 years younger than they should be.

Few people on the right understand the size of gap between health in America and elsewhere – and the few who do like to write off poor American health outcomes to lifestyle: that 3 month olds eat too much TV and watch too many fried foods, that it’s those durn immigrants to blame, that Americans are rich, lazy and fat. There is scant evidence behind any of these beliefs.

Americans indeed are more likely to be overweight – however, the latest and best scholarship suggests that people who are slightly overweight (BMI 25-30) are LEAST likely to die. And while Americans are number 1 in caloric consumption, countries right behind on the list (Italy, Austria, Greece, Belgium) all enjoy relatively long lives.

The most comprehensive study of sedentism, published recently in Lancet, show Americans to be fairly active compared to the residents of many other developed countries. Italy and Japan are among the most couch-potatoey nations In the developed world – and among the longest-lived.

Of course, the notion that high US mortality rates are driven by lifestyle is dogged by the fact that American babies have particularly high mortality rates compared to their counterparts elsewhere in the developed-world – before lifestyle has had an effect.

Contrary to popular myth, the US does NOT have an exceptionally large foreign-born population. The other immigrant nations – Australia, Canada, NZ – all have proportionately much larger foreign-born populations; Sweden’s is similar in size – and all four of these countries rank very high in life expectancy. Even within the US, states with the shortest lives and highest infant mortality rates tend to have the fewest immigrants.

Conservatives, as we’ve learned, know the answer to questions before they do any research. Poor American health, they will tell you, is attributable to anything and everything EXCEPT American healthcare, which is simply awesome, no matter the cost or body count. That America has the MOST privately-financed healthcare in the world, and that America has the MOST expensive healthcare in the world, and that America was the WORST health outcomes in the developed world – well that’s just a coincidence, y’all. Move along now.

At long last there’s a comprehensive review addressing the abysmal state of American health, poetically titled “Shorter Lives, Poorer Health: Panel on Understanding Cross-National Health Differences Among High-Income Countries.” The investigators cast a broad net to find out why, among 16 nations, Americans came in 1st in spending, and last in living to tell about it. The healthcare system itself takes a large share of the blame. In America, primary care physicians are scarce. As people change insurers, they’re forced to changed doctors frequently, losing continuity of care. And Americans are more likely to say that they failed to seek follow-up care or fill a prescription because of financial burdens. It all points to the obvious: that poor American health is significantly attributable to poor American health care.

This is the backdrop to the ongoing national struggle of conscience that gave rise to the ACA. The status quo was untenable. Only conservatives could proffer pathetic excuses for dead children, shortened lives and financial ruin, in the name of free enterprise, or some other hazily-defined concept they dont half understand.

And in the 3 years since the ACA was passed, something bizarre happened: per-insured healthcare costs in the US grew at the slowest rate since records started being kept in the 1960s. It’s true that cost-growth had been slowing down for several years, but healthcare costs usually jump after a recession, as pent-up demand surges to be met – but under the ACA, following the Great Recession, it did not happen.

Only time will tell if the ACA delivers on its promise of insurance for (almost) all, and control over costs that have surpassed 17% of US GDP. (In no other developed country are they higher than 12%.) But – even as Congressional Republicans vote to repeal the ACA for the 50th time – there can be no return to the way things were before. Life is too short.


why is america so unhealthy – study summary:

Click to access USHealth_Intl_PerspectiveRB.pdf

the full report:

Click to access IOM%20Report.pdf

costs since the ACA:

Click to access healthcostreport_final_noembargo_v2.pdf












  1. Mr. Bill

    How much did a dismal WEB site cost and it still is not complete, think maybe the 1.6 billion could have helped the poor ?

    Now how about our elected Leaders who enacted the ACA then gave themselves a pass themselves.

    Medicaid was always there for the needy the ACA claiming victory is bogus.

    Wait until the sucker states have to pay for Meicaid.

    The countries quoted are for the most part are of one peoples, not a melting pot like the USA.

    I think the author may wish to revisit the stats provided by our President last night during his interview.

    How many people are now uninsured because of the ACA ?

    How much money has the ACA diverted from Medicare to prop up the ACA ?

    Now how many babies die because of abortion each year in the USA ? And they call abortion “health care”, need to revisit definitions.

    Did the author happen to see Mrs. Pelosi on the Jon Stewart show the other evening, worth a view.

    She embodies the best in ignorance, remember she made the ACA happen with only Democrats voting for it, what a charmer.

    • Mr. Bill

      So now we have a CBO report too —

      February 4, 2014
      CBO: Obamacare Driving Millions Out of Work Force, Price Tag Tops $2 Trillion
      Guy Benson
      2/4/2014 1:20:00 PM – Guy Benson

      The nonpartisan Congressional Budget Office (CBO) determined in early 2011 that the president’s healthcare overhaul would cost the US economy 800,000 jobs. Democrats balked at the figure, insisting that the new law would be a job creation boon. Nancy Pelosi said a fully-implemented Obamacare program would create four million American jobs — and 400,000 “almost immediately:”

      Implementation is upon us, and the CBO has revised its numbers:

      The Affordable Care Act will also reduce the number of fulltime workers by more than 2 million in coming years, congressional budget analysts said in the most detailed analysis of the law’s impact on jobs. The CBO said the law’s impact on jobs would be mostly felt starting after 2016. The agency previously estimated that the economy would have 800,000 fewer jobs as a result of the law. The impact is likely to be most felt, the CBO said, among low-wage workers. The agency said that most of the effect would come from Americans deciding not to seek work as a result of the ACA’s impact on the economy. Some workers may forgo employment, while others may reduce hours, for a equivalent of at least 2 million fulltime workers dropping out of the labor force.

      The official numbers indicate that more than two million Americans will simply leave the work force (the workforce participation rate is already at a 36-year low) over the next four years as a result of the “Affordable” Care Act. Jake Tapper on the analysis’ raw estimates:

      Democrats’ sunny expectations were only off by about six million jobs — in the wrong direction. NBC’s Chuck Todd notices that the nonpartisan data reinforces Republicans’ warnings about the law from day one. Vindication:

      The GOP campaign ads practically write themselves. This law is increasing national healthcare spending, raising premiums and out-of-pocket costs for millions, kicking people off of their preferred plans, limiting patients’ access to care, contributing to deficits, and drastically reducing employment. Panicked lefties online are squealing that the report merely states that people will choose to leave the workforce, not that Obamacare will directly kill jobs, per se. Good luck with that argument. Over the next few years, millions fewer Americans will get up in the morning and go to work because of Obamacare’s impact on the economy. The report’s authors have concluded that the healthcare reform discourages work. That’s horrible, unspinnable news. Attempts to spin it will sound desperate and tone deaf. The public will not buy “less people working” as anything other than bad news. Ross Douthat elaborates on Todd’s point about the law “feeling” as if it’s raising taxes (beyond, you know, the taxes — including the Mother Tax):

      Another note from the CBO document: Democrats touted a $900 billion price tag for the law in 2010, citing a cynically-manufactured CBO score. What will the first ten years of Obamacare cost now that it’s in full swing? More than $2 trillion. Beyond that, the government’s projected Obamacare enrollment total for 2014 has dropped by one million people. Paul Ryan’s office also notes that on our current path, the annual deficit is expect to shrink to “only” $514 billion next year (Bush’s average deficit was in the neighborhood of $250 billion, even with two active wars), but it will begin a steady climb after 2015, hitting $1 trillion within eight years:

      Our short-term deficits problem isn’t good. Our long-term obligations crisis is a disaster, and Democrats have no solutions to fix it — aside from raising taxes on “the rich,” which they’ve already done, and won’t work. Kevin has more on the overall report here. I’ll leave you with a reminder that we call this. All of it.

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