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Our Nation's Health Before and
by Sue A. Blevins
After Government Health Care
Conventional wisdom maintains that Americans are living
longer because of government spending on health care programs
such as Medicare. True, Americans are in fact living longer
than they were before Medicare was enacted in 1965. The
average life expectancy for males increased from 66.6
to 72 years between 1960 and 1990. 
At the same time, government health spending grew from
$6.7 billion to $286 billion.
But how do we know that there is a cause and effect
relationship between increased government spending and
increased life expectancy? One way to answer that question
is to examine our nation's health prior to the birth of
government health care programs. If life expectancy had
been increasing before government health care programs
were enacted, then it is false to claim that Americans
are living longer because of government spending on health
Trend data show that Americans' life expectancy had
been increasing consistently over the years, long before
government paid our nation's health care bill. For example,
in Massachusetts the average life expectancy for males
increased from 38.3 to 66.7 years between 1850 and 1950.
This increased life expectancy was due primarily to improvements
in infant mortality. In Massachusetts, some 131 infants
died out of every 1,000 live births during 1850. By 1950,
the infant mortality rate had decreased to 22.8. However,
life expectancy for those who reached age 40 has not changed
dramatically over the years: On average, a 40 year-old
man lived another 27.7 years in 1900, 31.2 years in 1950,
and 31.9 years in 1970.
It is also worth noting that the National Institutes
of Health was not established until 1930. Yet many diseases
had fallen substantially before immunizations or therapies
became available, including cases of whooping cough, measles,
scarlet fever, and tuberculosis.
In fact, the tuberculosis death rate in Massachusetts
decreased from 450 to 35.6 deaths per 100,000 between
1857 and 1938.  Yet, the first
specific anti-tuberculosis therapy was not in general
use until after 1938. This is clear evidence that the
prevalence of a disease declined dramatically long before
government paid for health programs, including research
and health insurance.
 National Center for Health
Statistics, Health, United States, 1991 (Hyattsville,
Maryland: Public Health Service, 1992), p. 140.
 Katharine R. Levit, Cathy
A. Cowan, Helen C. Lazenby, et al., National Health Spending
Trends: 1960-1993, Health Affairs, Winter 1994,
 United States Bureau of
the Census, The Statistical History of the United States:
From Colonial Times to the Present (New York: Basic
 Thomas McKeown, M.D. "Determinants
of Health," In The Nation's Health, edited by
Philip R. Lee and Carroll L. Estes (London: Jones and Bartlett
Publishers, Inc., 1994), pp. 6-13.
 H. David Banta, M.D. "What
is Health Care?" In Health Care Delivery in the United
States, edited by Anthony R. Kovner (New York: Springer
Publishing, 1990), p. 10.
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