Spending More, Getting Less

I’ve just finished a very important book The American Healthcare Paradox: Why Spending More Is Getting Us Less. Authors Elizabeth Bradley and Lauren Taylor offer a fresh insight into the paradox that characterizes the health of the U.S. population: that we spend over 17% of our GDP – twice as much as peer nations- on medical care and yet lag behind all other industrialized countries in health outcomes.

Bradley and Taylor argue persuasively from the perspective of decades of public health research that there are important social determinants of health, that those factors affect the health of both rich and poor Americans , and that the U.S. invests far less in these areas per capita than comparable nations that have far superior outcomes.

The reasons for the current state are complex and richly entangled with the historical origins of the U.S., our complex sociology and politics. They review the parallel evolution of the healthcare and social services systems and the less-than-successful attempts to integrate them, but also notable current examples where enhanced coordination and integration result in enhanced outcomes. These range from high-end concierge wellness practices in Manhattan like La Palestra to home grown pragmatic front-line efforts born out of the inspiration and intuition of providers like Oregon Health Science’s C-Train program.

They consciously avoid simplistic and dogmatic prescriptions and provide a nuanced and sensitive analysis. As they state in the introduction:

At the same time, we have welcomed the realization that the underlying premise of the book is also deeply intuitive. As we have traveled the country (and parts of the world) explaining the implications of our research, we have been met more often by knowing nods than by puzzled looks. People of all professional and political persuasions know what we are saying to be true in their daily lives. The evidence confirms their instinct—health is built by much more than the doctors we see, the radiology scans we get, and the medications we take. We hope that readers will find our message to be as intuitive as it has been to those with whom we have preliminarily shared it.

I recommend this most important work to all.


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