Medicare and Life Expectancy

Brian Doherty | August 21, 2009

Radley Balko noted some good news about unprecedented life expectancy in America the other morning. Sheldon Richman draws our attention to an interesting fact about the intersection of government-paid-for health care and life expectancy:

In 1930 average life expectancy for Americans at age 60 was 74.5 years. (Infant mortality pulls down average life expectancy, hence the measure "at age 60.") In 1960 -- five years before Medicare began -- the average jumped 2.6 years, to 77.1. By 1990 -- 25 years after Medicare began -- it had jumped to 79.7 -- again 2.6 years.

Medicare did not make the upward-sloping life-expectancy curve any steeper!

For historical context, from 1900 to 1960, overall life-expectancy increased 22.4 years, from 47. 3 to 69.7.

I hasten to add that the medical system may be the least important factor in life expectancy, and one must never judge a country's health care by that measure. (Too many other factors -- lifestyle, genetics, culture -- play more important roles.) Nevertheless, it is interesting to know that Medicare did not improve the rate of progress in life expectancy that was occurring before the program started.

As Richman notes, this point is not dispositive about the value of health care systems, or even of health (and be careful not to conflate the two). But if anyone does believe that surely having the state pick up the tab for health care is going to lead to longer lives, in the aggregate doesn't seem to be much effect.

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|8.21.09 @ 6:22PM|#

Infant mortality pulls down average life expectancy, hence the measure "at age 60."

That smells funny. To exclude infant mortality they usually look at the life expectancy among those who make it to age 2 or something like that. Putting the cutoff at age 60 is going to exclude the effects of a lot of legitimate health concerns that may crop up before 60.

dennis|8.21.09 @ 6:29PM|#

Ahh, but the point was to address the effects of Medicare which is primarily for the aged.

|8.21.09 @ 6:36PM|#

My left eyes see that it didn't result in a government healthcare death panel fueled drop in life expectancy. John, can you help a brother out?

|8.21.09 @ 6:44PM|#

bben:

that's because they have been massively funded up to this point. the idea is when resources become scarce, i.e., fewer & fewer workers w/ more & more beneficiaries; panels will have to decide who gets what from a pool of shrinking resources.

Probably not the John you're looking for, but you should note that the current Medicare means that old people, who vote a lot, get to be subsidized by the rest of us. When Congress has tried to tone it down, the elderly have come out in force to stop it.

If you extend Medicare to everyone, we can't all be subsidized by someone else, because there won't be a someone else to do the subsidizing.

So the elderly are probably quite right to fear that expansion of Medicare would sacrifice their sweet deal.

|8.21.09 @ 6:47PM|#

p.s. - their's nothing really that insidious about that, other than the fact they are trying to deny it, it's just an economic reality. the evil part is taking those decisions away from the market and hand them to bureaucrats. that is evil.

Daniel|8.21.09 @ 6:51PM|#

The trouble with state-run health care is that many undesirables that disease would naturally cull out will live longer. The welfare state in all its manifestations favors the weak at the expense of the strong. Long live the strong!

|8.21.09 @ 7:06PM|#

Mr. Thacker, I know what you're saying. I get medicare myself, along with soc sec disability.
After my experiences with the soc sec administration, I can't really imagine the government handling healthcare for the estimated 45 million people needing it.

I was just being a bit snarky with John due to his loud screeching about them gosh darned death panels.

Tim Cavanaugh|8.21.09 @ 7:15PM|#

Medicare did not make the upward-sloping life-expectancy curve any steeper!

In actuarial terms, this is evidence in favor of Medicare. Or at least not evidence against it. If Medicare really did increase life expectancy, we'd routinely be paying to treat people with Rose Friedman/Karl Malden-length lives.

|8.21.09 @ 7:20PM|#

Longer life doesn't measure quality of life.

Anything in the study about the quality of life pre vs post Medicare?

|8.21.09 @ 7:29PM|#

This sort of result is actually the case with all sorts of government initiatives. Wages of blacks before and after various Civil Rights Acts. Mine disasters or people sickened by food, regardless of regulation or regulatory effect. There were and are steady trends for years in these things.

Many things have a pretty solid trend line, that if you showed people the line with the vertical numbers but not the dates, they couldn't based on the trend line tell you when legislation was passed or regulation became effective.

To some degree, this is because legislation only becomes possible to pass once the tide has already started to shift. You can't ban child labor until the middle class doesn't need it anymore. You can't mandate higher quality until the middle class can afford it, no matter the poor.

Now, someone can still argue that the legislation and/or regulation was needed to "finish the job" that the free market started and continue the trend, and that without it the trend would have stopped. I'm just not always convinced.

|8.21.09 @ 7:30PM|#

Tim Cavanaugh = reactuary!

Paul|8.21.09 @ 7:32PM|#

Medicare is a single-payer system for geezers. Ie: It's too little too late. It means they missed out on the chimeric "preventive care". If we had a comprehensive single-payer system for all citizens at birth, then our life expectancy would be like totally 4 evah!

|8.21.09 @ 8:45PM|#

Paul, everybody would be so healthy the death panels would have to base their decisions on societal necessity. The good news is, douchebags would be at the top of the list due to overabundance. Bad news is I am one and my last name starts with "A."

Michael|8.21.09 @ 8:55PM|#

|8.21.09 @ 8:57PM|#

"Longer life doesn't measure quality of life.

Anything in the study about the quality of life pre vs post Medicare?"

That "quality of life" meme always irritates the shit out of me; like other slogans such as "We've accomplished so much, but we still have a long way to go....[insert whatever oppressed group here] (we want control of the majority)," or "We just want a level playing field (meaning equality of outcomes)" vauge generalities' standards of success are never clearly defined by whatever interested party.

Such standards are always subjective to the interested group, but asking said group to define the (true) objective is an exercise in esthesiac dentition procedure.

BakedPenguin|8.21.09 @ 9:00PM|#

Anything in the study about the quality of life pre vs post Medicare?

Yeah, that's such an easy metric to add, too.

|8.21.09 @ 9:04PM|#

Longer life doesn't measure quality of life.

So the folks who, while pushing for universal health care, bring up the fact that the US has a relatively low life expectancy compared to nations with universal health care are full of shit?

|8.21.09 @ 9:06PM|#

I'm more inclined to think "Quality of Life" = "Standard of Living" as the (true) definition here, for the folks' health status deemed worthy, that is. According to Dear Leader, the invalids are dead weight to be snuffed out for the benefit of the more (upwardly) mobile.

qwerty|8.21.09 @ 10:58PM|#

I'm certainly not a statistician (and admittedly haven't RTFA yet), so please excuse me if this sounds idiotic. Wouldn't a 2.6 year gain in lifespan be considered more significant for a seventy-seven year old person than it would be for a seventy-five year old? I'm not saying it would be drastically more significant, but shouldn't this be determined on some kind of a curve rather than side-by-side comparison?

This isn't idiotic at all. In fact, it's an excellent point. During the early 20th century, life expectancy in the US shot up, mostly because we got rid of most deaths by infectious diseases. Sanitation and medical care are so good today that a 10 year old can be almost certain that he will live until 55. However, now that most causes of early death have been taken care of, raising the life expectancy now is much harder.

Our bodies simply weren't designed to live past 80 years. At this age, everything goes wrong. It is much harder to raise life expectancy from 75 to 85 than it is to raise it from 45 to 55. Therefore, the data does not indicate that Medicare is bad for health.

Now, I agree that Medicare is wrong, for the usual libertarian reasons, but the data above is not evidence for it.

Neu Mejican|8.22.09 @ 11:42AM|#

Let me make sure I get the logic here.

1) Factor X is minimally important in determining Y
2) Factor X should never be judged based on Y

3) I am gonna proceed with 2 anyway, because I don't like Factor X, conceptually.

Seems like a pretty pointless post.
What am I missing?

Both Doherty and Richman point out that the information they are sharing is meaningless or at best unimportant. So why share it?

Truly baffling.

|8.22.09 @ 11:51AM|#

qwerty is correct in the point brought up by Michael. One would expect diminishing returns from medical intervention as people age. Barring a maor discovery, one would expect the next 2.6 years to take longer. It should also be remembered that this gain was made in the middle of an obesity epidemic.

Steve

|8.22.09 @ 12:20PM|#

in the middle of an obesity epidemic.

omg, I was bitten by an obese person last night! Do I have to get a shot?

|8.22.09 @ 3:39PM|#

Tulpa,Think of the damage a herd of Obese Zombies could do!

|8.22.09 @ 4:12PM|#

"So the folks who, while pushing for universal health care, bring up the fact that the US has a relatively low life expectancy compared to nations with universal health care are full of shit?"

Yes, they are full of shit.

Life expectancy differentials have nothing to do with the manner healthcare is financed. The US is a violent society, and the life expectancy differential is mainly explained by accidental deaths (we drive more and kill more by car) and murder. (Pretty sure Ron Bailey has a column/post on that point somewhere.)

US has the top life expectancy at age 65.

Lifestyle (eating, smoking, drinking, gang-banging) and genetics are the main determinants of life expectancy, now that disease and sanitation issues have been addressed.

And IMO, the pro-universal care proponents are making a statistically invalid argument, and no one is calling them on it. Follow me here.

The premise of the argument is health care spending is determinative of life expectancy, i.e. "correlation is causation"--which anyone, who understands basic statistics, knows is invalid. Further, as the US spends more than other countries, but doesn't have the highest outcomes, so the US should change its system (to universal care) such that it spends less on healthcare, and thus bring its spending into sync with the "causation is correlation" formulae.

As a stats prof once said: those that don't understand statistics will have them used against you.

CH|8.22.09 @ 7:23PM|#

Please don't link to articles from 10 years ago to prove your point.

Neu Mejican|8.22.09 @ 7:59PM|#

US has the top life expectancy at age 65.

????

The US is ranked #42 at 78 (source:2009 CIA factbook).

Neu Mejican|8.22.09 @ 8:14PM|#

The premise of the argument is health care spending is determinative of life expectancy, i.e. "correlation is causation"--which anyone, who understands basic statistics, knows is invalid.

1)That is not the argument.
2)"Correlation is causation" is not really the problem, even if you buy into the framing you've used here. It would be a problem if people were saying "the more you spend, the higher the life expectancy," and then pointing to countries who have both higher spending and higher life expectancy, but that is not what the argument you claim is being made is. Now, when proponants say..."Country X has system Y and has a better outcome, therefore we should adopt system Y," they are using flawed logic to the extent that system Y is not the cause of the outcome. But that is not how you are framing it.

Further, as the US spends more than other countries, but doesn't have the highest outcomes, so the US should change its system (to universal care) such that it spends less on healthcare, and thus bring its spending into sync with the "causation is correlation" formulae.

This is closer to the mark, perhaps, but doesn't sound like the main thrust of the Universal Care argument. I hear the argument made more from an "access" than "outcome" framing. Universal Care is about fair access, not aggregate outcome, so it wouldn't matter if we had better outcomes, as long as a significant minority did not have access to the system.

The cost issue argument that is made is more often aimed at the way we pay doctors, not how we cover patients. Or that seems the more common argument.

|8.22.09 @ 8:48PM|#

Neu Mejican, I think what the comment meant was that if you reach 65, The US has the highest life expectancy thereafter.

I have no idea if that's true. A cite would have been handy.

|8.23.09 @ 11:56AM|#

Sorry, not first in life expectancy at 65, but higher than UK. See here for data table:
http://mjperry.blogspot.com/2009/08/life-expectancy-higher-in-us-than-uk-at.html

robc|8.23.09 @ 8:00PM|#

Our bodies simply weren't designed to live past 80 years.

The the Lord said, "My Spirit will not contend with man forever, for he is mortal; his days will be a hundred and twenty years." -- Genesis 6:3 (NIV)

robc|8.23.09 @ 8:01PM|#

Barring a maor discovery, one would expect the next 2.6 years to take longer.

Not sure this is true. As you get older, 2.6 years is a smaller percentage of your age.

robc|8.23.09 @ 8:06PM|#

Universal Care is about fair access

Everyone in the US has access. All doctors take cash.

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