I don’t think most people define inequality as sick vs. healthy

Tyler Cowen has a post up highlighting work  from Benjamin Ho and Sita Nataraj Slavov discussing inequality in health care from “an alternative perspective”:

The haves are those who enjoy great health into their 90s. The have-nots are those who suffer from serious health problems and do not live to see adulthood. As we pointed out in a recent study, among those Americans who were born in 1975, the unluckiest 1 percent died in infancy, while the luckiest 1 percent can expect to live to age 105 or longer. Now let’s fast forward to those born in 2012. The bottom percentile of this cohort can expect to survive until age 18. At the other end of the spectrum, the luckiest 1 percent can expect to live to age 108. That’s a much bigger gain in life expectancy among the have-nots than among the haves. Of course, life expectancy is but one measure of health and well-being, but understanding these trends offers a more complete picture than considering income alone.

These findings run counter to headlines noting a widening gap in health outcomes between different demographic groups. For example, a study led by Jay Olshansky of the University of Illinois at Chicago recently demonstrated that the gap in life expectancy between less educated and more educated Americans has widened considerably.

Actually, I don’t think these findings are counter to each other at all.

If we want to define inequality as the difference between healthy and unhealthy, then it’s not surprising that most of the gains in health care outcomes have been in the unhealthy. After all, healthy people have little room to move. Someone who lives to 105 is doing pretty darn well. I’m shocked we were even able to squeeze another three years out of them.

But an infant who dies has a lot of room for improvement. Maybe we can cure something inoperable in the past and give them a few decades. Or, we could improve care for something like cystic fibrosis. There’s no more polio, almost no epiglottitis, etc. These things will increase life expectancy a whole lot. I’ve covered this before.

It’s almost by definition that most of the gains in life expectancy have to come from the bottom end of the health spectrum. That’s where there’s room for improvement!

So if you define the have-nots as “sick” and the haves as “healthy”, it’s not surprising that “inequality” is decreasing. But most of us aren’t talking about inequality that way. We’re talking about a system where those who have more resources fare better than those who do not. And with respect to that definition, inequality isn’t decreasing.


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