The American medical system has the latest technology, the
greatest variety of new drugs and unparalleled resources. But anyone who
thinks we're getting something great for our dollars inevitably encounters a
two-word rebuke: infant mortality.
The United States is the richest nation on Earth, but it comes
in 29th in the world in survival rates among babies. This mediocre ranking
is supposed to make an irrefutable case for health care reform. If we cared
enough to insure everyone, we are told, we would soon rise to the health
standards of other modern nations. It's just a matter of getting over our
weird resistance to a bigger government role in medical care.
But not every health issue is a health care issue. The reason
boxers are unusually prone to concussions is not that they lack medical
insurance. Doctors may treat head injuries, but it's a lot easier to prevent
them. Absent prevention, we shouldn't blame the medical industry for
punch-drunk fighters.
Like life expectancy (the subject of a previous column), infant
mortality is a function of many factors. The more you look at the problem,
the less it seems to be correctable by a big new federal role in medical
insurance -- and, in fact, the less it seems to be mainly a medical issue at
all.
No one denies the problem. Our infant mortality rate is double
that of Japan or Sweden. But we live different lives, on average, than
people in those places. We suffer more obesity (about 10 times as much as
the Japanese), and we have more births to teenagers (seven times more than
the Swedes). Nearly 40 percent of American babies are born to unwed mothers.
Factors like these are linked to low birth weight in babies,
which is a dangerous thing. In a 2007 study for the National Bureau of
Economic Research, economists June O'Neill and Dave O'Neill noted that "a
multitude of behaviors unrelated to the health care system such as substance
abuse, smoking and obesity" are connected "to the low birth weight and
preterm births that underlie the infant death syndrome."