Life, liberty, and the pursuit of healthcare?

The Affordable Care Act — "Obamacare" — was signed into law in 2010 and promised the largest overhaul of the U.S. healthcare system since the 1960s. Designed to provide medical care to uninsured Americans, it has been widely decried as an unwarranted intrusion into the affairs of private businesses and individuals.

However, an independent comparative study of healthcare systems in six Western countries, published last month in Social Science and Medicine, supports a move away from privatized medicine toward state-sponsored healthcare systems. In her research, Dina Maskileyson of Tel Aviv University's Gershon H. Gordon Faculty of Social Sciences found that privatized medical care in the U.S. has contributed to greater wealth-health inequality than state-sponsored healthcare systems in Sweden, the U.K., Israel, Germany, and the Czech Republic. According to her new study, the wealthiest older people in the U.S. surprisingly suffered from worse health than the poorest older people in the other countries reviewed. Moreover, household wealth has a far more powerful effect on the state of an older person's health in the U.S. than in any of the other countries.

"The positive association between household wealth and health is about twice as strong in the U.S. than in the other countries examined," said Ms. Maskileyson. "In the U.S., every additional percentage point in household wealth increased physical health by about twice as much as it did in the other countries. Among the six countries, household wealth was the most important factor in predicting health outcomes of older Americans."

Using a statistical model estimating individual-level data for 41,533 individuals aged 50 and older, Ms. Maskileyson drew her information from the Survey on Health, Ageing and Retirement in Europe (SHARE), the U.S. Health and Retirement Study (HRS), and the English Longitudinal Study of Ageing (ELSA). She decided to focus on total household wealth instead of income because household wealth reflects the cumulative and dynamic nature of economic well-being that is especially relevant for older citizens and retirees who do not receive a monthly salary but rely on medical care substantially more than younger sectors of society.

According to the study, the U.S.'s private-based healthcare system not only produced poorer health outcomes and increased the wealth-health inequality gap, it also left the wealthiest Americans, with access to the "best money can offer," still worse off than the poorest citizens in the U.K., Germany, Sweden, and the Czech Republic.

"The fact that Israel in recent decades has shifted from public to private healthcare — the opposite direction of other developed countries — reinforced my motivation to examine how differently funded healthcare systems may influence population health and health inequality," said Ms. Maskileyson. "Dangerous trends of privatization in the Israeli healthcare system may lead to an increase in total national expenditure on health by promoting expensive health services, like those in the U.S. that only wealthy people can access."

"I hope policy makers in the United States and Israel look to the experiences of other countries for guidance," said Ms. Maskileyson.

Ms. Maskileyson is currently researching health disparities among immigrants in the U.S.

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