Medical care v. Health care

Thomas Sowell’s book Dismantling America: and other controversial essays is a collection of Sowell’s weekly columns from the past few years.  It’s a great read, though I wish the publishers would have included the date each column was published for context.  Most I remember reading, but for those unfamiliar with Sowell’s weekly columns the dates might help.

All the essays are great.  Some are exceptional.  In one column, Sowell does an exceptional job at distinguishing health care from medical care (p. 56).

Insurance is not medical care.  Indeed, health care is not the same as medical care.  Countries with universal health care do not have more or better medical care.

Those who think in terms of talking points, instead of trying to understand realities, make much of the fact that some countries with government-controlled medical care have longer life expectancies than that in the United States.

That is where the difference between health care and medical care comes in.  Medical care is what doctors can do for you.  Health care includes what you do for yourself–such as diet, exercise and lifestyle.

If a doctor arrives on the scene to find you wiped out by a drug overdose or shot through the heart by some of your rougher companions, there may not be much that he can do except sign the death certificate.

Even for things that take longer to do you in–obesity, alcohol, cholesterol, tobacco–doctors can tell you what to do or not do, but whether you follow their advice or not is what determines the outcome.

Americans tend to be more obese, consume more drugs and have more homicides.  None of that is going to change with “universal health care” because it isn’t health care.  It’s medical care.

When it comes to things where medical care itself makes the biggest difference–cancer survival rates, for example–Americans do much better than people in most other countries.

No one who compares medical care in this country with medical care in other countries is likely to want to switch.  But those who cannot be bothered with the facts may help destroy the best medical care in the world by pursuing a political mirage.

People who present comparisons of life expectancies and infant mortality as evidence of the varying effectiveness of medical care (or even more general “health care”, which they mean to imply medical care) between countries baffle me.

To use these statistics alone assumes all else is equal.  But all else is not equal.

They don’t consider that differences in these statistics might be influenced by diet choices, exercise, number of miles driven each year (which increases chances of dying a car accident) and demographics.  For example, the U.S. is spread out geographically more than other countries and more people can afford to drive.  A result is more driving and more crashing for people in the U.S..

They also don’t consider that the methods of reporting deaths may differ by country, which might also contribute to some of the inter country differences in statistics.  For example, countries only count in the infant mortality rate those infants born after a certain week of gestation.  That week may vary from country to country.  In some countries it might be 32 weeks, for example, while in the U.S. it could be 26 weeks.  Babies born after 32 weeks have a higher rate of survival than those born after 26 weeks.  So, the real difference in infant mortality may exist only on paper.

Finally, they don’t consider the differences in effectiveness of the actual medical treatments, less wait times and more use of effective technology like MRIs.

These are big things not to consider and not considering these things doesn’t earn much credibility with me.

2 thoughts on “Medical care v. Health care

  1. I imagine demographics explains much of America’s lower life expectancies. Asians live longer than Caucasians who live longer than Africans. Since we have disproportionately more of the latter than the former, that statistic could be the driving variable between Western European and Asian country longevity compared to USA.

    It also highlights the inherent structural silliness of building a social security platform based on a tax Ponzi scheme rather than long term investments; it becomes a reverse wealth redistribution scheme from the poor to the ‘wealthy’ since the poor tend to die sooner.

    Imagine the benefit to working poor survivors of inheriting say, 30 years of 12% of wages if the payer died when he was 68.


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