What the US excels at in health care – and why it fails at health

In Seattle yesterday I was listening to a keynote by Dr. Jack Shonkoff who is a breain researcher at Harvard with an interest in early childhood development.  He said an interesting thing about American health care which kind of answers the question for me about what the US is good at.

Many Americans who are opposed to public health care use the argument that people from other countries come to the United States for the world’s best treatment, surgery and acute care.  No question that if you can afford it, the USA has the best.  BUT – and this was a revelation to me, to hear from a leading doctor – no one moves to the USA permanently for their health.  In the case of almost every industrialized country, and several developing countries as well , the USA trails in health promotion.  So while people do come for treatment, they go back home to countries that support better overall health.

And insurance based system  is to blame for this.  Pouring money into insurance means that treaments, including surgery and drugs are developed and widely available because there is an incentive for private companies and public institutions to develop excellent treatment, activities and products that you can charge for.  Health promotion is not a profit making venture, so if you choose to put public resources in private insurance, you get private, price based solutions.  Building a system that prioritizes prevention, healthy communities, health promotion and safety is the way to reduce the need for acute treatments later in life, but no one can make a profit at it, so it requires a public, social response to build that infrastructure.

So that’s kind of interesting, especially as we hear the debate in Canada clamouring for more private involvement at the treatment end of things.