Chymorrhea

To this day, I fail to understand the major tenet of the socialist medicine ideology, that is, higher mortality of the lower socioeconomical classes is determined by the subpar medical care they receive. Hence, socialists say, we must strive to close the gap between the rich and the poor by providing better healthcare to the latter group. 

From the very first glance, the thesis seems quite baseless as it is a very well-known fact that the contribution of healthcare to life expectancy is marginal at best. Therefore, any differences in mortality between the rich and the poor are probably better explained by baseline differences in health status (which, in turn, may be due to lifestyle choices, stress, and so on) rather than by inequalities in health care. Indeed, this mortality gap is as “surprising” as the one we would note between trained athletes and overweight couch potatoes.

This self-evident truth has recently been confirmed in a large, European, survey of health inequalities published in the New England Journal of Medicine :

In Europe as a whole, deaths from conditions amenable to medical intervention account for 5% of inequalities in the rate of death of any cause. [1]

Even more of interest is the finding that reduction of poverty, by itself, does not reduce inequalities in health, highlighting the fact that the problem is not one of access to health ressources, but of education, and maybe even of intelligence. 

Within western Europe, there is little evidence that among-country variations in the magnitude of inequalities in health are related to variations in political factors. For example, Italy and Spain have welfare policies that are less generous and less universal than those of northern Europe, but they appear to have substantially smaller inequalities in mortality [...].

We also found no evidence for systematically smaller inequalities in health in countries in northern Europe. This is surprising, because these countries have long histories of egalitarian policies, reflected by, among other things, welfare policies. These policies provide a high level of social-security protection to all residents of the country, resulting in smaller income inequalities and lower poverty rates. [...] Lifestyle-related risk factors have an important role in premature death in high-income countries and also appear to contribute to the persistence of inequalities in mortality in the northern region.  [1]

This important study shows that any medical intervention aimed at reducing the gap in health between different socioeconomical classes is doomed to failure and will achieve nothing more that diverting scarce resources from treatments that benefit to the whole of society.

1. Mackenbach JP, Stirbu I, Roskam AJ, et al. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358(23):2468-81.