Do Americans spend more money on the health care of the poor than the rich?

From Twitter I see this statistic:

Ratio of mean health care spending in richest quintile to mean health care spending in poorest quintile

For the United States, as reported, that ratio is 0.884 for ages 25-64, and for 65 and up the ratio has two varying estimates, from 0.87 to 0.9.

If I am understanding the numbers and presentation correctly, that indicates more health care spending on the poorest quintile than the wealthiest quintile (for below 25 however the ratio is 1.3, namely more spending on the wealthy).

I believe this comes as a surprise to many people, though it is arguably intuitive, since poor people become sick more often, and furthermore sick people are more likely to lose income.

I tracked down the source paper by Eric French and Elaine Kelly (pdf), and it does seem to be true, noting that the numbers exclude long-term care for the elderly.  By the way, that piece is full of fascinating, under-reported medical expenditure statistics, for other countries too.

A number of points suggest themselves:

1. You still might feel we are neglecting the health care of the poor, but I am not sure the majority of the American public would react that way, upon hearing these numbers.  Usually the poor get less of things, as measured by expenditures, even if they might “need” it more.  Health care is an exception to what is otherwise a pretty general rule.  I believe it should be such an exception, but to what degree?  I see a lot of pretty aggressive intuitions out there, mostly without serious justification or without any presentation of what the stopping point should be.

2. Those numbers don’t prove anything, least of all normatively.  Still, they do point my attention in the direction of wondering — yet again — if public health programs are not better than spending more on health care coverage of the poor.  Let’s stop or at least limit poor people from getting sick so many more times.

3. That poor people get sick more times, how much of this is a) poor environment including higher stress and exposure to crime, b) genes, c) inability to afford proper preventive care, d) bad decision-making, including diet, lifestyle, and exercise, and e) sickness causing poverty, and f) other factors.  I know of plenty of individual papers on these topics, but would it go over well to write an “apportionment” paper doling out the relative responsibilities?

4. How much should our decisions on the best health care policy depend on the answer to #3?  How many people are even willing to talk about this right now?

5. Why does the ratio flip so significantly toward the wealthy for younger people?  Can we use that fact to make any general inferences about the apportionment outlined in #3?  On the surface, it seems to suggest a significant possible role for d) and e), since those might affect children less.

6. What else?

The original pointer was from a retweet by Garett Jones, the tweet from Houston Euler, the Great Firewall is making direct links to them very costly right now.


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