Our Nation's Health Before and
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. [1] At the same time, government health spending grew from $6.7 billion to $286 billion.[2]

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 care.

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.[3] 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.[4] In fact, the tuberculosis death rate in Massachusetts decreased from 450 to 35.6 deaths per 100,000 between 1857 and 1938. [5] 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.

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[1] National Center for Health Statistics, Health, United States, 1991 (Hyattsville, Maryland: Public Health Service, 1992), p. 140.
[2] Katharine R. Levit, Cathy A. Cowan, Helen C. Lazenby, et al., National Health Spending Trends: 1960-1993, Health Affairs, Winter 1994, p. 26.
[3] United States Bureau of the Census, The Statistical History of the United States: From Colonial Times to the Present (New York: Basic Books, 1976).
[4] 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.
[5] 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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