Sorry: Boosting social-service spending doesn’t cut health-care costs – New York Post

In a recent New York Times op-ed, former Treasury Secretary Robert Rubin and Mount Sinai Health System president Ken Davis argue that “one reason the United States spends more on health care than any other nation” is that “we spend far less on social services like food stamps, free school lunches, and public housing.” Effective social programs “provide access to good nutrition, clean and safe shelter and a subsistence income, which are critical to avoiding disease.” If spending on “social programs were more in line with other developed countries, our health-care costs would fall.”

They cite a RAND study of a Los Angeles program that offers supportive housing to homeless adults with complex medical, behavioral and substance-abuse problems. The program slashed their use of hospital services by 75 percent and social-service and health-care costs by 20 percent, even after counting housing expenses.

Pointing to correlations between social conditions and medical outcomes — the “social determinants of health,” as they’re known — has become more common in recent years.

According to a recent National Academy of Medicine paper, such conditions are responsible for 80 percent to 90 percent of healthy outcomes, with quality and access to medical care accounting for only 10 percent to 20 percent.

Managing public health via social services flows naturally from this: “In the spirit of social justice,” a key World Health Organization report declared, a panel was set up to see “what can be done to promote health equity.” Team Obama agreed, by working to shift US health care away from consumerist principles.

Of course, the “social determinants of health” are part of the reason for existing public programs.

But attempts to expand them by citing health benefits have sprawled into liberal wish-lists, involving everything from city planning to anti-discrimination laws — all linked only tenuously, at best, with health.

These advocates make little effort to disentangle correlation from causation and apply even less rigor when it comes to cost-benefit analysis. For example, malnutrition and poor sanitation undoubtedly contribute to disease in the Third World, but solving these social problems would not reduce health-care spending. As countries get wealthier, people spend a larger share of their incomes on medical care.

The US exemplifies this, and our high rates of obesity, diabetes and cardiovascular disease (double those in Europe) further illustrate the limits of the progressives’ argument. Broad social problems don’t account for our relative ill health.

In 2010, for instance, only 26 percent of Americans lived in households with incomes under $40,000, versus 33 percent in France and Germany, 40 percent in the UK and 53 percent in Italy and Spain. In 2018, only 3.9 percent of US workers was unemployed, compared to 7.9 percent in the European Union.

Nor are rates of hunger measurably different: 3 percent of the US population was undernourished in 2016, the same as in the EU. Rates of homelessness are significantly lower in the US than in Australia, Canada, France, Germany or the UK.

Though social services tied to medical care can occasionally help curb costs, few major expansions pay for themselves. The RAND study focused on a program deliberately targeted to an unrepresentative cohort with the most extreme physical and mental-health needs. Their use of public services averaged $38,146 in the year prior to the housing provision.

Within a decade, the Congressional Budget Office projects, federal health-care entitlements will exceed all federal discretionary spending combined. Yet, in all but a few cases, the taxpayer cost for individuals’ food or housing would outweigh any reduction in the government’s medical expenses.

Meanwhile, there’s much to be gained by improving existing programs. As David Stockman, Reagan’s director of the Office of Management and Budget, once noted, the US takes a “pork-barrel approach to social welfare.”

Spending on food stamps soared from $17 billion in 2000 to $65 billion in 2018, under pressure from agricultural lobbyists, but with little regard to the nutritional value of the food.

As a result, the impact of social-service expansions on health are often unimpressive. A randomized clinical trial of the federal school-breakfast program found it actually increased obesity.

Yes, prevention is better (and more cost-effective) than the cure. But when it comes to the impact of government programs on public health, Hippocrates offers the most appropriate advice: “First, do no harm.” Adapted from City Journal.