Healthy people, goes the popular doctors' joke, are simply those haven't gone through enough medical testing. Excessive diagnostic evaluations with fancy body scans or blood tests will always find something amiss. Call these searches what you like—defensive medicine to ward off lawsuits, useless procedures to line doctors' pockets, patient-initiated testing from the worried—but observers like Peter Orszag, director of the Office of Management and Budget, estimate they contribute a good chunk to the estimated $700 billion in wasted annual health costs.
Taken another way, however, the joke hints at the nature of illness in the modern world. In 2006, Harvard economist and Obama adviser David Cutler calculated what we get in return for our health care spending. Over the past 50 years, we've increased per-person lifetime health care costs by roughly $70,000, and the average lifespan has jumped seven years. The trends show that it's getting harder to save lives; in the 1970s, we got an extra year of life for only $7,400, but by the 1990s, each ran more than $36,000 (in inflation-adjusted 2002 dollars). That makes sense, since we've picked all the low-hanging fruit, so to speak. And though it's getting more expensive to buy life, Cutler puts the money in context. "According to virtually any commonly cited value of a year of life," the economist writes, "the increased spending has, on average, been worth it."
Policymakers tend to speak glibly about the oceans of cash depleted by wasteful spending. But there's another way to frame the explosion of medical costs: We now recognize and treat problems that were previously hidden or never diagnosed—which is a good thing. Consider these sample statistics, all from generally reliable federal agencies: One percent of the population has celiac disease, causing anemia and other problems, one in 150 children tests positive for autism spectrum disorders, 2 percent to 5 percent of adults have an eating disorder, 20 percent of children are overweight, one in 22 pregnancies is complicated by a minor or major birth defect, and 10 percent of people have asthma. The list goes on. In the past, people just lived with these problems. Today, for better or worse, we do not simply let them go—and that costs more and more money.
It's tempting to complain that Americans today are wussy hypochondriacs, overmedicated and overtreated for all kinds of imagined disorders. Some of them no doubt are. But, to take my personal experience as an example, many aren't.
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