By Ali Mehdi
In less than two weeks, Americans will elect their next President. Affordability of health care is a “very big problem” for 65% of Democrats and 48% of Republicans — or those who lean towards the respective parties (bit.ly/3XldBot). Both leading candidates agree that this is a challenge.
What exactly is the problem?
Household health expenditure (out-of-pocket) per capita (PPP, current international $) in the United States increased by $582 between 2001 and 2021, compared to $495 in high-income countries and $268 in China (World Development Indicators, The World Bank).
However, much more worrisome is the return on investments (ROI) in health. Healthy life expectancy at birth in the US went up by 1.4 years in 29 years (1990-2019), only to decline by 1.8 years in a short span of two years (2019-21), thanks to Covid-19. And in five years from now, in 2029, it will be at 66.5 years — a level the country had reached way back in 2009.
China, on the other hand, surpassed the US on healthy life expectancy at birth in 2011 (chart 1) — and six years later, on gross domestic product (GDP) in purchasing power parity (PPP) terms (chart 2). And the gap between the two on both indicators is projected to grow further.
Robert Fogel, the 1993 Nobel laureate in economics, argued that improvements in life expectancy were historically a leading cause of economic growth in the US (bit.ly/3Tk3Nd3). Harvard professor David Bloom and his co-authors argue that “large increases in life expectancy in China took place between 1950 and 1980”, and were a “fundamental” factor in its economic growth that took off after 1980 (bit.ly/4cLwdU1).
How will poor health outcomes impact the economic prospects of the US going forward?
According to University of California, Los Angeles, economics professor Dora L Costa, “because the economy is increasingly brain-based and health and cognition are linked, even marginal improvements in health now may have large effects on future economic growth” (bit.ly/4e8yhGO).
Although affordability of health care is a “very big problem” for American voters at the moment, it is the growing gap between the US and China on health outcomes that will prove to be unaffordable for them in the long run. Poor health will make Americans poorer through rising health care expenditures and declining economic potential.
Where exactly is the problem?
Life expectancy depends on the probability of survival at various ages. Infant mortality rates in the US have been low — 32 in 1950, 5 in 2023. The problem is with its persistently high adult mortality rates (deaths before 60 years per 1,000 people alive at age 15). In 1950, they were 206 in the US and 462 in China — in 2023, they were 108 and 82 respectively (World Population Prospects: The 2024 Revision, United Nations). China brought down its infant mortality rates (from 127 to 5 between 1950 and 2023) as well as adult mortality rates significantly, hence its advantage in life expectancy over the US.
Presidential candidates in the upcoming US elections should tell voters how they plan to make America healthy — and possibly great — again.
The author is Founder and CEO of UHC360.
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