Three articles caught my eye recently regarding America’s health care dilemma.

This LA Times article reports on the declining quality of the end-of-life period of many Americans:

Life expectancy soared over the last part of the 20th century as treatments for major diseases improved and infectious diseases were quelled by vaccines and better treatment. The most recent data, however, hint that life expectancy is no longer growing. According to a new study, we may spend more years sick than we did even a decade ago. [.  .  .]

According to the analysis, the average age of morbidity – which is defined as the period of life spent with serious illness and lack of functional mobility – has increased in the last two decades. For example, a 20-year-old man in 1998 could be expected to live an additional 45 years without at least one of these diseases: heart disease, cancer or diabetes. That number fell to 43.8 in 2006. For women, the expected years of life without a serious disease fell from 49.2 years to 48 years over the last decade. [.  .  .]

"There is substantial evidence that we have done little to date to eliminate or delay disease or the physiological changes that are linked to age," the authors wrote.

Meanwhile, a part of that problem is the result of the fact that many Americans have no idea what – or how much – they are eating:

Nearly 90% of respondents to a Consumer Reports telephone survey thought they were eating right — saying that their diet was either somewhat (52.6%), very (31.5%), or extremely healthy (5.6%).

But when they were asked about what they actually eat, far fewer seemed to be in following a healthy diet.

For instance, of the 1,234 people surveyed, only 30% said they eat five servings of fruit and vegetables every day, just 13% step on the scale every morning, and a meager 8% monitor their daily calorie intake. [.  .  .]

bout a third of those who said they were a healthy weight actually had a body mass index (BMI) in the overweight or obese range (30% and 3%, respectively).

"It’s likely that Americans are thinking about health more, and that’s a good thing," said Keith Ayoob, EdD, RD, of Albert Einstein College of Medicine. "Still, nine out of 10 think they’re doing pretty well, and to that, I’d say let’s talk again."

So, asks this Dana P. Goldman/Darius N. Lakdawalla article, what would be the best investment to generate significant improvement in the health of Americans?:

The first step is to invest–not in the healthcare system, but in education. We should take the $120 billion it might cost for universal coverage, and use it, instead, to provider earlier education and to improve the quality of education. Better-educated people live longer, are less likely to be disabled, and engage in healthier behavior.

For nearly 40 years, distinguished health economists led by Michael Grossman have observed that more-educated people have much more powerful incentives to protect their own ‘investments’ in education by practicing healthier habits and reducing their risks of death. They also are better at self-managing chronic diseases. And, unlike universal coverage, more education has other valuable benefits to a person and to society. Less crime, less divorce, and higher earnings–can universal health insurance promise that?

The second place to invest is prevention. Primary prevention has the capacity to slow or reduce the rising prevalence of chronic disease, and simultaneously attenuate the downstream spending that is associated with it. Equally importantly, however, prevention leads to a life with less disability and more years of an active lifestyle. It simply makes a lot of sense to avoid disease in the first place, rather than try to treat it later.