March 25, 2008

The Behavior Gap

Justin Katz

Let me say right up front that access to healthcare must be improved and expanded, although it goes beyond the scope of this post to delve into the different understandings of the whats and hows of that mandate. Even were that goal to be achieved quickly, however, I suspect that the life expectancy gap between rich and poor would continue to increase, because I think the behavioral explanations play a large role and would bleed into matters of access:

While researchers do not agree on an explanation for the widening gap, they have suggested many reasons, including these:

¶Doctors can detect and treat many forms of cancer and heart disease because of advances in medical science and technology. People who are affluent and better educated are more likely to take advantage of these discoveries.

¶Smoking has declined more rapidly among people with greater education and income.

¶Lower-income people are more likely to live in unsafe neighborhoods, to engage in risky or unhealthy behavior and to eat unhealthy food.

¶Lower-income people are less likely to have health insurance, so they are less likely to receive checkups, screenings, diagnostic tests, prescription drugs and other types of care.

As you can see, New York Times reporter Robert Pear offers four examples, evenly split between behavior and "the system," but the former can be as numerous as the attributes of life. Here's another, which touches on an area about which I've written copiously (from an article to which I linked yesterday):

Hymowitz points out that all classes of Americans once followed the same life script of marriage before children. When divorce rates started soaring in the 1970s, everyone was fleeing their marriages. But then the classes started diverging. The Economist cites statistics that show among college-educated women married between 1990 and 1994, only 16.5 percent were divorced 10 years later. Among those with a high-school education or less who married in those same years, about 40 percent were divorced after a decade.

Advocates for government-propelled fixes tend to believe that forcing an expansion of access to a service will yield equal gains across groups, but that's certainly not true. Ask yourself: Would a class with a higher percentage of smokers, poor diets, and divorce be more or less likely, on average, to make full use of even completely prepaid medical services?

As I said, our healthcare system is most definitely in trouble, but change must begin with the culture.