US Medicine -- Best In The World

Supporters of government medicine often quote a statistic that shows life expectancy in the US lower than most European nations with government-run health systems.  But what they never mention is that this ranking is mainly due to lifestyle and social factors that have nothing to do with health care.  Removing just two factors - death from accidents (mainly car crashes) and murders - vaults the US to the top of the list.  Here, via Carpe Diem, are the raw and corrected numbers:

lifeexpectancy

The Mark Perry post linked above has links in turn to the study itself and its methodology.  You may have seen stats that say that, using raw data, the US has the best life expectancy once you reach age 65.  This is just another way of correcting out higher accident and murder rates, as these tend to affect younger folks.

My guess is that if one corrected for other lifestyle issues and environmental factors that increase the incidence rates of things like heart disease in the US (discussion here), then the US lead would be even more stark.  If one takes the left at its word that the US starts in a health care "hole" with poor diet, obesity, environmental problems, etc., then the US medical care system, despite starting in a hole, is able to still raise US life expectancies above other countries.

One big reason is cancer survival rates, which dwarf those in Europe.  It is at such leading and expensive edges of medicine where one might expect the US system to get much better results, and it does.

But it is often said that this is only for the rich -- that the poor in the US don't benefit.  Well, this is a difficult proposition to test, as income mobility (which is very real in this country no matter how much the left denies it) makes correlation of income (say by quartile) and life expectancy impossible.  During a person's lifetime, they might inhabit several different quartiles.

A proxy I think the left might accept is one  of race.  If one assumes that African-Americans are among the systematically disenfranchised in the health care system, then it should show up in their stats.  The results are something that gives ammunition to both sides of the debate.

cancer

Clearly, there are two tiers, as African Americans have poorer cancer survival rates than white Americans.  But, for many types of cancer, African-Americans have higher survival rates than they would in many European countries.

This is the endless do-loop of inequality debates.  Is inequality OK if it results the folks lower on the totem pole being better off than in a more egalitarian society.  For me, the answer seems obvious.  Absolute well-being seems far more meaningful than relative well-being.  But I am not necessarily in the strong majority on this.  I had a professor that used to poll his class -- he would ask them if they would prefer a society where the gap between rich and poor was narrower but where the poor were, on an absolute basis, worse off than in the less equal society.  He reported the vote almost always split about 50/50.  (of course the is a purely utilitarian formulation of the question.  Adding in individual liberties issues makes the question far more stark, as to achieve an egalitarian society one must give up both wealth and liberty.)

  • http://politicalcalculations.blogspot.com/ Ironman

    Here's an old post (from 2007) that has a dynamic table version of the natural life expectancy data - you can sort the data in the table by clicking the column headings, which makes it easy to either find a particular country's data or to rank the countries from best-to-worst or vice versa.

    As for the U.S. life expectancy data, the U.S. data is negatively skewed by the relatively poorer health of its significant black (~12%) and non-white Hispanic (~12%) populations. Survival rates for both these minority populations within the U.S. for many chronic health conditions is below that for whites. As a result, U.S. life expectancy figures tend to be pulled lower compared to those of other nations that don't have such a significant portion of their populations made up by those of African or non-white Hispanic descent (such as Japan, Iceland or Sweden to name three examples.)

    While you're correct to cite the role of environmental and cultural factors as having some influence, and income as having greater influence, here's the primary reason why we see such a disparity in longevity by ethnicity and race within the U.S. (Follow the links at the bottom of the post for the entire series as it relates to the black population of the U.S - the data indicates that the same factors apply to the non-white Hispanic population, although I have yet to develop a similar companion series.)

  • http://thebastidge.blogspot.com thebstidge

    Two more factors:

    1. Immigration brings adults to this country with poor medical history and existing conditions such as early childhood malnutrition, contributing to lower life expectancy. The measuring point is death, so there is no telling how long the individual has been in this country.

    2. Infant mortality is measured VERY differently in this country. If the fetus exits the mother's body alive, or able to be revived, it is a live birth in the United States of America and by any rational measure of common sense. The definition of live birth in other countries, however, is vastly different and has a large component of ass-covering. Premature babies (and potentially others) are not counted as live births unless they live for a certain period of time outside the mother's womb. In some cases for an entire day.

  • ben

    Do not take for granted that all the extra spending on healthcare in the US actually buys you something. That is not a given in healthcare. In New Zealand, public health expenditure in the nationalised system has approximately doubled in the last 10 years, yet no more operations are being performed and productivity is through the floor.

    I suspect part of the explanation for this result is this: at any given time within the bureaucracy, there is competition for a fixed pool of funds. An extra dollar for your department necessarily comes at the expense of another. Without a market to allocate these funds, allocation is decided by lobbying and political clout.

    What is the effect of a cash injection into this sort of system? It is to raise the returns to investment in lobbying, and accordingly a greater proportion of time and effort is devoted to capturing those new funds, taking resources away from healthcare. I suspect a large proportion of any additional funds is frittered away in this sort of competition, a kind of monopolistic competition where all surplus is consumed by fixed investment in lobbying leaving little extra for healthcare.

  • Dr. T

    "African Americans have poorer cancer survival rates than white Americans."

    This is true, but not because they are more susceptible to cancers, less able to fight off cancers, or less responsive to therapy. The problem is cultural: too many African-Americans avoid going to a doctor until a problem is severe. When the problem is cancer, they come in with more advanced and more widespread cancers at later stages. Unsurprisingly, there are more treatment failures and more deaths.

    I was a physician at the VA Medical Center in Memphis. When I asked some of the African-American patients why they waited so long to come in, they invariably said that they don't trust doctors, not even VA doctors. I asked why, and they said that they and their older relatives had been badly treated by private doctors, and they all mentioned the US Public Health Service debacle in Tuskegee from 1932-1972, where the USPHS diagnosed syphilis in 400 black men and left them untreated to observe the course of the disease (which was completely unnecessary because we've known about untreated syphilis for centuries). That US government, pseudo-public health experiment is still killing African-Americans today.

  • Anonymous

    I'm glad that the figures bear this out, but the fact remains that arguing about un-Constitutional legislation's fiscal favorability is still arguing about the favorability of un-Constitutional legislation. The fact that we've gotten this far proves that legality takes an implicit back seat in voting to redistribute wealth.

  • http://www.ilovebenefits.wordpress.com ilovebenefits

    Thank you for posting this information. It is an interesting result when you remove the two factors (accidents and murders). This is something that to my knowledge is not exposed elsewhere. http://www.ilovebenefits.wordpress.com

  • Current
  • joshv

    Coyote, coyote - five year survival rates are pretty much meaningless - a statistical conflation of actual treatment efficacy and diagnostic timeliness. It's impossible to tease out whether or not an increase in five year survival rates is due to the fact that you are catching the cancers earlier, or treating them more effectively.

  • IR

    joshv,

    What's the difference how the result is achieved? Whatever we doing seems to be better than whatever they are doing in other country. This is the point of the statisitc.

  • joshv

    IR: We could simply be diagnosing the disease early, and having absolutely no success treating it. If you come up with a new test that allows you to find breast cancer 1 year earlier than was previously detectable and then apply that test to the general population, you are going to see an increase in five year survival rates no matter how effective your treatments are. Even scarier you might see in increase in five year survival rates even if your treatments *decrease* life expectancy.

  • http://thebastidge.blogspot.com Thebastidge

    I guess I was being prescient in my point # 2 above:

    At my town hall meeting last night, they brough up this very point, saying that America lags behind Sweden, Cuba and various other socialist paradises specifically in infant mortality.

    I had to call bullshit VERY loudly on that. Fortunately, several hundred other people did so with me, though I was the first.

  • HS

    My dad died of cancer. The hard question is... if you can pay to add another year or two to your loved one's life but spend everything in the process, would you do it? Thank God I never had to answer that question, but I came close. I don't want the government answering that question for me.

  • Corossus

    "You may have seen stats that say that, using raw data, the US has the best life expectancy once you reach age 65."

    No doubt that adjusting for age helps to "correct out" accidents and murder in the U.S life expectancy, which disproportionately affect younger groups. But age 65 is also the qualifying age for Medicare, thus those who make it to that age do indeed have lower risk for accidents and murder AND qualify for health insurance. I won't lay claim to being able to separate out these two effects on life expectancy at age 65. An article that took advantage of the age specificity and universal nature of Medicare estimated the effects of insurance acquisition on morbidity and mortality.

    Full citation...

    Frank R. Lichtenberg (2002) "The Effects of Medicare on Health Care Utilization and Outcomes," Forum for Health Economics & Policy: Vol. 5: (Frontiers in Health Policy Research), Article 3.
    http://www.bepress.com/fhep/5/3

    Abstract

    http://www.bepress.com/fhep/5/3/

  • Pieter

    Once you start picking and choosing your metric, it's very easy to rearrange rankings. Consider what would happen if, instead of removing the effects of murder and car crashes which are big killers in the US, we left them in and removed suicide and alcoholism, which are even more reasonably classified as "lifestyle" choices since the person killed is actually the one making the choice. I've not checked the data, but I imagine removing suicide and alcoholism wouldn't have a big impact on US life expectancy, but it would make countries like Sweden -with 3 months of continuous darkness- look even better, since suicide and alcoholism are major causes of death there. There's only a few dozen countries even in the running for longest life expectancy, and there's easily dozens of ways that might appear to be reasonable ways to correct it. When there's more choices of metrics than objects to be compared, it's easy to manipulate rankings. That's why, in a situation like this, it makes sense to stick with the raw data when trying to make comparisons.

    Similarly, it makes little sense to say that US health statistics need to be adjusted to reflect that there's a large Hispanic population without trying to make a similar adjustment to European figures to reflect the larger Muslim population. (This is a response to other posters, not a criticism of Coyotes post which didn't make this error.)

    This demonstrates why it's important to focus on that there's many countries all quite close to each other in health care outcomes, but with the US being a real outliers in spending, either as a percentage of GDP or even more so in absolute terms per capita.

    I'm also going to comment on your final point about equality and freedom. In my experience, the overwhelming majority of people on the left believe that increased equality leads to more freedom, not less. This is the basic principle of democratic government: that if we are all treated equally, then we can all be free. We are all much more equal than in the days of aristocracy and slavery, and we are also all much more free. The inequalities and injustices of modern capitalism are much milder, but, for example, the enormous inequality in wealth between me and the owners of the Walt Disney company mean that their opinion prevails over mine on retroactively extending copyright privileges 70 years after the death of an author, an idea for which there is no legitimate economic justification. After 9/11, I had to wait in a long line for lengthy security checks at Newark airport, while employees of major companies had a separate check in system. These are just two examples where wealth wins legal privileges.

  • Zachriel

    The analysis by Ohsfeldt & Schneider was a simplistic regression and they admit it was not meant to be taken quantitatively.