"The first wealth is health"

I was reading an article by a highly regarded health economist from Harvard named William Hsiao (highly regarded is probably a vast understatement) who started his article with the following statement:

"Despite spending almost twice as much as Australians, Canadians, Japanese, and many Europeans, Americans suffer from lower life expectancy, higher infant mortality rates, and a higher prevalence of heart disease, lung disease, and sexually transmitted infections.  This reflects the deep dysfunction in the U.S. health care system."

Okay.  Really?  I can be convinced, with not a lot of effort, that the U.S. health care system (some would argue that we don't really have a system at all) deserves at least a share of the blame for the lower life expectancy and higher prevalence of heart disease, but can when we start pointing fingers at whose to blame for the higher prevalence of sexually transmitted infections, I'm not sure we can say it's because of the dismal state of our health care system.

Let me be clear.  I am not saying that we don't have major issues with the U.S. health care delivery system.  As the late Walter Cronkite once said, "America's health care system is neither healthy, caring, nor a system."  But I am not sure that the success or failure of a nation's health care system can be directly measured by its life expectancy or infant mortality rate, and certainly we shouldn't measure how effective a health care delivery system is by the incidence of sexually transmitted disease. 

Just today, I refilled a prescription for a chronic medication that I've been taking for several years (for my cholesterol).  As many of you know, I recently moved started a new position in a new city, so this was the first time I refilled my prescription on my new health insurance plan.  When I spoke with the pharmacy, they told me that the prescription would cost me about $180.  I thought that was a little strange, especially since it was listed on our pharmacy plan's drug formulary.  So, I called my health insurance hotline and spoke directly with one of the customer service representatives.  When I told her the price of my medication, she was surprised.  However, she confirmed that it was indeed going to cost me $180.  She then recommended that I go to a website, download a coupon, and pay for the drug on my own.  That is exactly what I did.  How much did it cost me? Thirty-five dollars.

I know what you are thinking.  I should feel fortunate that (1) I am only on a cholesterol medication, (2) I have health insurance, and (3) I can afford both the $35 as well as the $180.  But what does it say when there is a five-fold difference in cost and it is the self-pay that was the least expensive?  If you want to argue that point as a marker of the state of our health care delivery system, then go right ahead.

The current COVID-19 pandemic is also revealing some of the problems in our health care system.  However, again, is it the responsibility of the health care delivery system to manage public health and welfare?  If so, we should be spending our health care dollars in vastly different ways (see additional discussion on this point here).  If we are going to be measured by the prevalence of sexually transmitted infections, again we should be spending our money on things like prevention and education as opposed to treatment. 

I agree with the philosopher, Ralph Waldo Emerson, that "the first wealth is health."  When people are healthy, they are more productive members of societies, in many, many different ways.  Public health is absolutely important - it is the lifeblood of any nation.  Perhaps, in a post-COVID world, public health and health care delivery will be linked more closely together, and maybe we will invest (similar to the countries mentioned above, I might add) just as much on developing our public health and welfare systems as we do on our health care delivery system.