We Spend So Much on Medical Services Because We Spend So Little on Social Services

Fascinating article at Boston.com by John McDonough. He comments on a book entitled “The American Healthcare Paradox“. In particular, these sources elaborate on a frequent hobby horse of mine (and many, many others who are far more knowledgeable) – that the U.S. spends way more on healthcare and gets similar or worse results:

The U.S. pays so much more for medical care than does any other advanced nation, and from that societal investment, we get mediocre to poor results on life expectancy (26th place), infant mortality (31st), low birth weight (28th), maternal mortality (25th), you name it. It’s been true since the early 1980s, and we keep looking for solutions from within the health care sector itself.

We might not be looking at all of the relevant information. Apparently there is a connection between the money we do spend on healthcare and the money we don’t spend on social services. Of the advanced (OECD) nations, we spend the absolute least on non-health social services. If you combine the two, we come in 10th place in terms of combined spending.

“Social services expenditures included public and private spending on old-age pensions and support services for older adults, survivor benefits, disability and sickness cash benefits, family support, employment programmes (eg, public employment services and employment training), unemployment benefits, housing support (eg, rent subsidies) and other social policy areas excluding health expenditures.”
. . .
“Inadequate attention to and investment in services that address the broader determinants of health is the unnamed culprit behind why the United States spends so much on health care but continues to lag behind in health outcomes.”

Some great charts in there too. Professor McDonough goes on to suggest that this means that the solution to our healthcare problems can’t be fixed from within, at least not solely within, the healthcare industry.


  1. Stuart says

    And I’ll bet that, in every one of those areas, Indiana scores in the bottom half, too. I suspect that our legislators think that, because those are high numbers (e.g., 36/50), that’s a good thing, sort of like achievement scores. Or maybe a lot of them had bad experiences when the social workers were called to visit their homes when they were kids.

    • says

      The money is also going to flow differently and yield different outcomes depending on where and how it’s allocated. The people who are profiting off of the current situation are obviously going to resist a re-allocation, even if the re-allocation would yield better outcomes.

    • jharp says

      Indiana ranks 47th in infant mortality.

      Shameful. And Mike Pence chooses not to expand Medicaid that clearly would get tens of thousands of pregnant Hoosiers the pre natal care that saves babies lives.

      A fucking disgrace that really angers me.

  2. says

    pasted from Indy Students blog: yes I wrote it!

    I see the panhandlers down at the Hardee’s (they all know each other) off of 10th street downtown. One of my buddy’s at work states his brother is a panhandler and the reason he is homeless is that he just can’t function in society. Vince has tried along with his whole family to try to help his brother and it just doesn’t work. A lot of these people just have mental illnesses (hey they used to be in the mental hospitals that are all closed) and can’t hold jobs and function in a normal environment. The money for the mental ill has been diverted to silly stuff like building stadiums on the taxpayers dime.

        • says

          Actually I am not old! I am 56 with 3 boys! Started late in life so my oldest is a Junior at U Indy, number 2 is a Junior in H.S. at the Indiana Academy of Science, Math and the Humanities Academy at Ball State and my youngest is a 7th grader in public (we have great schools and teachers down here in Franklin Twsp) school. Have a full time job and wonderful wife who works part time as a paralegal for a Carmel law firm. I run a blog at http://guy77money7.wordpress.com/

          the name is Investing – Science – Sports and whatever strikes my fancy…

          Heck Doug and your fellow readers 50 is the new 40! So if you want to read a new blog I am out there. Started it Thanksgiving weekend. after that post about taking over your blog. Hey you can make time for anything you want to do in life! Right!

  3. Stuart says

    I hope you are right, but that will mean that we will know a whole lot about how to treat serious mental illness than we do now. It’s still pretty primitive. Meds effectiveness has been oversold for years, and these folks are often very fragile and unable to function in a real sense of the term. It’s another one of those situations where the politicians saw the opportunity to save money, closed the institutions and told everyone to check in with your local comprehensive mental health center. Then they strangled those. Return to the original story. That leaves them with nursing homes or jails, which is another huge story. Mental health services are positive and helpful, but they are far from being able to “fix” people, either with therapy or meds, and one or two hours a week doesn’t hook people up people with therapists who have walked on water recently.

    • says

      Ever watch undercover boss where the boss can’t do simple tasks like run a cash register. Well cash registers aren’t simple anymore. Technology can make the easiest job tough to do. Maybe these people don ‘t have the skills to do a cash register job. So what else do they do? Not many manufacturing jobs left that require limited skills. You have to almost have computer skills to do any job. I saw where a union worker was out the street because he lacked the ability to change his job skills.

      • Stuart says

        I heard a stunning NPR story recently. Many many folks in the south are unemployable because the companies where they had the skills no longer need them. Drs. write evaluations saying that they are unemployable, recommending them for disability. There is no such thing as “welfare” anymore, so disability is the only way, and the Fed pays, which is a sneaky way to get “welfare” for people in a southern state which takes no responsibility for helping these people. This is not going to turn out well.

  4. Stuart says

    For the NRA which recommends more mental health involvement to prevent gun violence, the American Psychological Assn. just released a paper outlining their recommendations. Guess what? Prevention is the first thing, and that, and every thing else, requires lots of the kinds of services mentioned. So we need lots of social services, but nobody wants them while nobody wants gun violence. That will be interesting. (http://www.apa.org/pubs/info/reports/gun-violence-prevention.aspx)

  5. says

    You are right Stuart – I have a friend who works in Anderson as a social worker and the kids she deals with want to be on disability just like mom and dad. Free money and in the small towns you don’t really need an automobile making life a fairly cheap and boring existence. At least if would be for me but these people don’t know any better. It’s happening in all the small towns across Indiana.

  6. Stuart says

    It’s especially significant to see the most conservative states enabling that sort of behavior, failing to take responsibility for it, and passing on the heavy lifting–funding–to the evil Federal government so their hypocritical redneck reps (as in Indiana) can complain about Federal expenditures.

  7. says

    Hey Stuart I know your not making it up! The Federal government will be supporting a whole bunch of people in the future. Did you see Big Blue destroy the Jeopardy champions. Won’t be long before phone jobs are a thing of the past. 60 minutes did a show on automated warehouses, you better be a programmer or a robot operator or repair man. Throw in the drones for package delivery and jobs that take very little skills will be gone. The Federal government may have to make up jobs like they did during the depression.

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