Tricky Truths in the Health Care Debate

Economist Greg Mankiw recently took aim at three misunderstood truths in the health care debate. Consider the truths:

1. Canada, a country with national health insurance, has a longer life expectancy and a lower infant mortality rate (measured in deaths per 1,000 births) than the United States.

2. Forty-seven million Americans lack health insurance.

3. Health care costs account for an ever-growing share of American incomes.

Whether the U.S. health care system should look more like Canada's is a big open question. Mankiw asks us to look at these three truths more closely to see how much clarity they actually add to our national debate on health care. Read his column to learn more.

Discussion Questions

1. According to the column, how do the incidences of accidents, homicide, and obesity in the United States help to explain the differing life expectancies in Canada and the U.S.? How would changing the U.S. health care system address the incidence of accidents, homicides, and obesity in America? Can you think of alternative policies that might close the life expectancy gap by reducing the incidence of accidents, homicide, or obesity?

2. According to Mankiw, the prevalence of low-birth-weight babies in the U.S. contributes to its relatively high infant mortality rate (infant mortality is universally higher among low-birth-weight babies than it is among babies born at normal weights). What factors explain the higher rates of low-weight births in the United States? Will an overhaul of the U.S. health care system address the number of low-weight births in the U.S.? What alternative policies might reduce the number of low-weight births in America?

3. Approximately 47 million Americans (of about 300 million total) lack health insurance. For what reasons does Mankiw argue that this number significantly overstates the problem of the uninsured in the United States? How do uninsured people receive care under the existing health care system? What policies might provide insurance to the group of American citizens who simply cannot access health insurance? How would national health insurance change the pool of the uninsured and the cost of treating them?

4. Why do we spend a larger share of our incomes on health care than previous generations? Clearly, health care is a normal good (increases in income lead to increases in the quantity of health care we demand). But is it also a luxury good (increases in income lead to relatively large increases in quantity demanded)? Is the growing share of income that we devote to health care a bad thing? In what way are increasing health care costs associated with increasing health care benefits? Read this David Leonhardt column for more on this topic.

5. Hopefully, a closer look at the three truths above will help to clarify the debate over health insurance in the United States. That said, understanding how a change to our health insurance system can or cannot influence these outcomes doesn't point to a specific policy prescription. What do you think?