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Does the U.S. Get Value for Its Health Care Dollars? – Part 2


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Evidence continues to mount that we waste much of the money we spend on health care through too many duplicative tests and treatments, overpriced pharmaceuticals, administrative costs for dealing with multiple payers and selling me-too insurance policies with minute differences in coverage that few consumers can decipher anyway.

Indicators of health and well-being in America are dismal. We need only look at the county comparisons available on a website sponsored by the Robert Wood Johnson Foundation called County Health Rankings & Roadmaps to understand how badly some counties are faring. The rankings compare counties within a particular state on several health metrics. What differences you’ll find! Social determinants of health are clearly at work.

They are also at work in Japan, one of those Axis countries an editor once told me had nothing to teach Americans about health. It turns out Japan has much to teach us about improving health – a point that was reinforced in a booklet called Being Old & Healthy in Japan, sent to me by the International Longevity Center-Japan (ILC-Japan), an organization started by the late Dr. Robert Butler, an American gerontologist who promoted productive aging.

In many ways, Japan scores much higher than the U.S. when it comes to the health of its population. Life expectancy has doubled in the last 100 years from age 44 to age 83 compared to 78.5 years in America. And Japanese people have achieved longer lives while spending less on health care than Americans.

Part of the reason for Japan’s success may lie with its relative lack of income disparity. In contrast to America, ILC-Japan reported that the average income per Japanese person does not vary much by age. Academics who study social determinants of health often point to wide income gaps between the wealthy and those further down on the economic ladder as a reason for poor health outcomes in the U.S. (This is especially true for very elderly women who find themselves with very little to live on. The median income for older women receiving Social Security is only about $15,000.)

Other differences may stem from where elders live. Japanese elders are more likely to live with family members than their American counterparts. In 2010, about 13 percent of seniors in Japan lived alone compared with 27 percent in the U.S. A comparative study by U.S. researchers from the University of Michigan and other universities, including one in Japan, found that older people in Japan are more likely to receive more economic and emotional social support from their living arrangements, which may contribute to a greater sense of wellbeing.

“Aging has more benign meaning in Japan,” researchers said. Eastern religions “characterize maturity as a socially valuable part of life – a time of ‘spring’ or ‘rebirth.’” The Japanese also value older people perhaps more so than we do. For instance, in the U.S. there’s no such thing as Respect for the Aged Day, a national holiday in Japan which began in 1947.

Compare that with the image of older people fostered in the latest U.S. debates over Medicare and Social Security. Politicians and others have portrayed the elderly as sucking up income and resources from younger generations, while focusing new policies on how much to cut the programs that so many depend on.

Like the U.S., the Japanese are struggling with a growing number of people who have dementia, which is expected to nearly double in the next 15 years. ILC-Japan advises that strategies for dealing with this disease are urgently needed. America will need them, too. As the Japanese figure out how to cope with a major side effect of longer life spans, perhaps we can learn along with them.

More Blog Posts by Trudy Lieberman

author bio

Trudy Lieberman, a journalist for more than 40 years, is an adjunct associate professor of public health at Hunter College in New York City. She had a long career at Consumer Reports specializing in insurance, health care, health care financing and long-term care. She is a longtime contributor to the Columbia Journalism Review and blogs for its website,, about media coverage of health care, Social Security and retirement. As a William Ziff Fellow at the Center for Advancing Health, she contributes regularly to the Prepared Patient Blog. Follow her on twitter @Trudy_Lieberman.

Tags for this article:
Aging Well   Pay for your Health Care   Minority Health and Health Disparities  

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