A new book, The American Health Care Paradox: Why Spending More Is Getting Us Less, offers an interesting take on why the United States’ huge investments in health care doesn’t translate into better health. Vox did an interview with the book’s authors.
The paradox that we outline is one that a lot of readers will be familiar with: that the United States has very high health-care costs, and in many cases middling — and sometimes lousy — health outcomes when you look at certain metrics. These are metrics — like infant mortality and life expectancy — where, when you look across developed nations, we’re really at or near the bottom.
People cited this paradox before our book, and tried to explain it in any number of different ways. That included rationales like, “Well, U.S. health outcomes are bad because too few people have insurance” or “because prices are just high.”
What our book tries to do is offer another reason that hasn’t been talked about much in health policy: maybe “health spending” isn’t telling us the whole story. Maybe we need to look at a broader summary of what resources nation puts in to support population health.
To do this, we included social services spending in our study, which captures things like housing, food assistance, and job training. The ratio of health to social-service spending was more predictive of several outcomes than health spending alone. This led us to suggest that social-service spending — and, more broadly, attention to the social determinants of health — could be a missing piece in the health reform discourse.
In explaining the concepts in the book, the authors make a very interesting and provocative statement.
To address the problem of over-medicalization of health we need to actually get to the way people relate to their own health, no matter how wealthy they are.
What?!? “Over-medicalization of health”?!?
What do they mean by that?
Think about shoulder pain or back pain. It’s very common in the American public to think “What kind of MRI do I need? What kind of specialist should I go to?” as opposed to thinking “Hm, maybe the briefcase I’ve been carrying around is too heavy. Maybe I’m not sleeping well. Maybe I haven’t hit the gym for the last three weeks.”
It strikes me that this is extremely relevant to the status of addiction treatment, especially as the Affordable Care Act takes effect.
What we have is a chronic disease approach that hasn’t been executed perfectly, but has avoided over-medicalization and it is facing growing pressure to medicalize. It’s also interesting that physicians treat their addicted peers with a model that avoids over-medicalization, but we’re losing support for similar approaches with the general public.
It’s also seems to me that Recovery Management does a good job of seeking to address these social determinants.
I also just saw a very relevant quote on Recovery Review from David Best.
So this question about community recovery capital is partly about stigma and discrimination – whether professionals (in the addictions and related field) believe that people recover and act accordingly. If you are in a system where all the addiction money is spent on substitution therapies, on detox and on counselling, your system does not believe that people recover!