There are a few simple truths that every American should understand before they even begin to talk about (in a positive or negative light) the effectiveness of the US healthcare system.
1) The vast majority of one’s health outcome is determined by the interaction between day to day choices of how to treat your body and personal genetics. We’re talking foods you eat, exercise, the substances you use (alcohol, drugs, tobacco), how much you sleep, etc. These have more predictive power in health outcomes than outright access to medical care. So the assumption that “access” means a tectonic shift in the health of the populace doesn’t hold much water.
2) Part of what is concerning about this fact is the realization that obesity due to day to day choices of food is becoming a national concern. In fact, at least these authors warn that obesity can undo the changes that reductions in smoking rate and high blood pressure have brought over the past few decades.
When talking about food choices, most people focus on that of those in low-income areas. The concern is over “food deserts” and access to higher quality food.
However, food choices are dependent on a several factors–not the least of which is price. A McDouble costs $1 and five minutes. A salad costs $4 and twenty minutes if you make it (or $6-$10 and ten minutes). These types of tradeoffs may be driving part of the health disparity between rich and poor.
But a working paper at NBER (National Bureau of Economic Research) suggests that even if people have access to more nutritional foods, they often won’t take the opportunity.
From the abstract:
“Spatial differences in access are small and explain only a fraction of the variation that we observe in the nutritional content of household purchases. Systematic socioeconomic disparities in household purchases persist after controlling for access: even in the same store, more educated households purchase more healthful foods. Consistent with this result, we further find that the nutritional quality of purchases made by households with low levels of income and education respond very little when new stores enter or when existing stores change their product offerings. Together, our results indicate that policies aimed at improving access to healthy foods in underserved areas will leave most of the socioeconomic disparities in nutritional consumption intact.”
In other words, a massive policy response on the supply side is not likely to change minds. Food stamps are unlikely to get the poor to shift their food choices heavily.
But does any government, be it federal or local, have the maturity to reformulate its approach?
Every government employee wants to be a part of a change that will shift the social landscape and lead to a better life for everyone. Each wants to make their mark in an historic way.
But honestly, very few will. In fact, the aspiration of being the governmental hero by creating a grandiose policy response to a problem that needs small policy solutions has harmed a lot of people over the years.
It is by small means, incremental changes, that lasting shifts toward the better come. Behavioral “nudging” and better education of how to think about nutrition rather than just what to think needs to be a stronger priority.
It doesn’t help that we forcibly cross-subsidize poor health behaviors in the healthcare marketplace. Doing so is effectively a tax on health, and is the opposite of where we need to be. Addressing the payment mechanism for medical care (insurance) is the grandiose response to a problem that, by and large, begins with the individual’s choice of what to eat for lunch.