Of a Healthcare System on the Moon

A nation might build the universe’s greatest hospital on the moon – but in the absence of a lunar lander, the claim that that nation has the “best medical care” cannot be made without irony. But this is what conservatives who defend America’s national healthcare apparatus must do every day. The US healthcare system, by design, keeps needed care out of reach for a large fraction of the US population. And so millions of Americans get told every day that America has “the best healthcare in the world” – though they themselves are unable to access it. For them, it might as well be on the moon – which only a lunatic could envy.

In theory, any country could improve healthcare for a fraction of its population by excluding another fraction from care. Putting aside the morality of such a system, you dont come out ahead in the bargain anyway, because you tend to lose more at the bottom than you gain at the top. The metrics, which count everyone, betray the true cost of such policies, as seen in higher American mortality, from birth through till age 75.

American babies are more likely to die before their 1st birthday than babies in other rich countries. American children are more likely to die before age 5 than children in other rich countries. American adults at all ages are more likely to die than adults in other rich countries. It’s only Americans surviving till age 75 who compare favorably with 75 year-olds elsewhere – and we’re left to wonder whether it’s their single-payer government-provided universal health insurance (aka Medicare) that’s responsible – or if it’s merely selection bias: that it’s so much harder for Americans to make it to 75 without dying, that those who succeed are hardier.

We might parse out health outcomes by income, and find the same result. Wealthy Americans live shorter lives than their wealthy counterparts in other rich countries. Poor Americans live MUCH shorter lives than their poor counterparts in other rich countries. White babies born in America are more likely to die before their 1st birthday than white babies born in other rich countries.

To put it differently, it is NOT the case that the US has a bimodal distribution of life expectancy, with rich Americans doing better and poor Americans doing worse. ALL Americans do worse – it’s just a matter of degree. Hey, if living long is important to you, it definitely helps to be born rich, white and female – but it’s also beneficial to be born elsewhere.

To give it a Rawlsian twist: imagine yourself as an Unincorporated Spirit, hovering in the ether, about to be inserted into some body to live out a life. You are given a choice of populations to be cast into randomly. If life expectancy is your sole criterion – the US would be about 30th on your list of preferred destinations. As Regina sings it: it’s all about the moon.




Click to access USHealth_Intl_PerspectiveRB.pdf


One comment

  1. Junkphilosopher

    Nice analogy. Far better than my attempts trying to explain to people how “the best healthcare in the world” amounts to a few exclusive hospitals and research centers scattered across the country, inaccessible to almost everyone.

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