Is Lack of Government Health Care Responsible for Low U.S. Life Expectancy?

Ronald Bailey | September 22, 2009

The mantra of would-be health care reformers is that the U.S. spends much more on health care than other industrialized countries, yet America ranks below average on major health indicators, including infant mortality and life expectancy. 

Well, yes. Reformers generally imply that our dysfunctional and expensive health care system is to blame. Not so fast, say University of Pennsylvania demographers Sam Preston and Jessica Ho. In a recent study they conclude:

Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral or social factors. This paper presents evidence on the relative performance of the US health care system using death avoidance as the sole criterion. We find that, by standards of OECD countries, the US does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and where behavioral factors do not play a dominant role. We show that the US has had significantly faster declines in
mortality from these two diseases than comparison countries. We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system.

 Citing the Preston and Ho study, New York Times science journalist John Tierney notes:

But there are many more differences between Europe and the United States than just the health care system. Americans are more ethnically diverse. They eat different food. They are fatter. Perhaps most important, they used to be exceptionally heavy smokers. For four decades, until the mid-1980s, per-capita cigarette consumption was higher in the United States (particularly among women) than anywhere else in the developed world. Dr. Preston and other researchers have calculated that if deaths due to smoking were excluded, the United States would rise to the top half of the longevity rankings for developed countries.

Back in 2008, I cited some of the same evidence and arguments in my column, "Accidents, Murders, Preemies, Fat, and U.S. Life Expectancy." After listing our many unhealthy proclivities, I optimistically concluded:

Taking all these unhealthy proclivities into consideration, the American health care system is most likely not to blame for our lower life expectancies. Instead, American health care is rescuing enough of us from the consequences of our bad health habits to keep our ranking from being even lower.

To repeat, Preston and Ho conclude:

The question that we have posed is much simpler: does a poor performance by the US health care system account for the low international ranking of longevity in the US? Our answer is, “no”.

See Preston and Ho study here and Tierney's insightful column here. 

Comments

Attorney|9.22.09 @ 5:07PM|#

So, Dr. Ho says No.

|9.22.09 @ 5:11PM|#

Preston and Ho are racists.

|9.22.09 @ 5:17PM|#

This can't possibly be the case. I mean greedy insurance companies and heartless doctors watching people die and selfishness and greed greed greed greed szkkkkkkzszzkkkzzzz

creech|9.22.09 @ 5:20PM|#

Didn't the U.S. rate #1 in health care professionals taking the time to explain their diagnosis, attitude towards their patients, and other factors that make the experience "care" instead of mere "treatment?"

Bertha Lewis|9.22.09 @ 5:20PM|#

It's a comspiracy perpetrated by the white devil!

|9.22.09 @ 5:27PM|#

In this study the US ranks 1st, when accidents and murder are adjusted out of the figures.

http://blogs.wsj.com/numbersguy/does-the-us-lead-in-life-expectancy-223/

Joshua Holmes|9.22.09 @ 5:30PM|#

You don't even need to get this technical about it. America has more per capita fatal car accidents and more per capita murders than other OECD countries. Factor those out, and the US suddenly leads the OECD in life expectancy.

Don't get me wrong, fatal car accidents and murders are serious problems that need to be solved. But they're not health care problems. It's not like the French are suffering as many gunshot wounds, but their superior health care is healing them instead of letting them die on the streets. The French just don't suffer as many serious gunshot wounds.

As for infant mortality, we all know by now that each country defines this metric differently, so the numbers aren't entirely comparable.

The American health system still needs serious reform, but we should at least be clear about what it can and can't do.

|9.22.09 @ 5:40PM|#

So will this change the debate? Or will it be like the last 15 times a study showed that the plain average of age of death is not a telling metric.

Janeane Garafalo|9.22.09 @ 5:41PM|#

In this study the US ranks 1st, when accidents and murder are adjusted out of the figures.

That's racism, straight up.

|9.22.09 @ 5:47PM|#

So, our healthcare system is busted due to high crime rates?

I KNEW it.

$|9.22.09 @ 5:52PM|#

That's racism, straight up.

If only.

These stat-cloudy ways of not mentioning that there are only about thirty-five black guys in Europe do get tedious.

Obama|9.22.09 @ 5:55PM|#

So, our healthcare system is busted due to high crime rates?

This is why the new health care bill has strict gun control provisions, lower speed limits, and lots of money for ultra-safe high-speed rail.

|9.22.09 @ 5:56PM|#

Don't get me wrong, fatal car accidents and murders are serious problems that need to be solved. But they're not health care problems.

Odd, then, that the Centers for Disease Control are constantly doing studies on murder and gun violence.

|9.22.09 @ 6:14PM|#

Isn't the government already heavily involved in murder and automobile regulation? What gives?

|9.22.09 @ 6:17PM|#

ultra-safe high-speed rail

Having mastered low-speed rail, i think this sounds like a magnificent idea.

|9.22.09 @ 6:32PM|#

Instead, American health care is rescuing enough of us from the consequences of our bad health habits to keep our ranking from being even lower.


This begs the question - you have to assume the ranking is valid (i.e. objective, not subjective or political) for the argument to stick.

I contend that the ranking given by the World Health Organization cannot be any different in its premises than any other statistic given by a political bureaucracy, like the CPI or the unemployment rate. If people simply cite the ranking without looking at the premises behind the statistic, then the ranking is meaningless, does not matter if the US was No. 1.

J D|9.22.09 @ 6:34PM|#

So... Americans die sooner because... we have more freedom to choose our lifestyles?!

Dave T|9.22.09 @ 6:51PM|#

Surely this study was funded by the health care lobbyists!

Raskolnik|9.22.09 @ 6:55PM|#

It's true that life expectancy alone is a poor indicator of quality of, or access to, health care. On the other hand there are many other statistics- cost of care, access to a primary care physician, use of emergency facilities for non-acute conditions, infant mortality, bankruptcy due to healthcare cost, etc.- that also indicate that something is out of sorts in the American health care system. Life expectancy alone does not prove that something is wrong with US health care, but by the same token the fact that American life expectancy is more complex than the numbers indicate doesn't mean that everything is just fine.

Furthermore, the real critique posed by health care reformers is not of the performance of the health care system on average, but rather its accessibility and propensity for bankrupting patients. The performance of the US system is fine- it's its cost and accessibility that pose long-term challenges to both the health of American society and its bottom line.

max hats|9.22.09 @ 7:26PM|#

Okay, so if everything you say is true, then we are paying the most for merely average returns instead of bad ones. We are paying Mercedes prices for a Hyundai.

. . .if deaths due to smoking were excluded, the United States would rise to the top half of the longevity rankings for developed countries.

Michael Ejercito|9.22.09 @ 7:41PM|#

Furthermore, the real critique posed by health care reformers is not of the performance of the health care system on average, but rather its accessibility and propensity for bankrupting patients. The performance of the US system is fine- it's its cost and accessibility that pose long-term challenges to both the health of American society and its bottom line.

If the U.S. adopts price controls, bankruptcies will decrease.

|9.22.09 @ 7:55PM|#

max hats-

Gubmint. Of course, that includes all the rent seeking allopathic jihaddist scum like the AMA and, of course, licensure.

max hats|9.22.09 @ 8:11PM|#

The inconvenient fact remains that we pay much more on health care per person than countries with actual outright socialized healthcare do, and with far less to show for it.

David|9.22.09 @ 9:46PM|#

An other interesting study:

http://www.nber.org/papers/w13429

« It is commonly supposed that a publicly funded single payer health care system will deliver better health outcomes, and distribute health resources more fairly than a multi-payer system with a large private component.

Health status is similar in both countries. But Canada has no more abolished the tendency for health status to improve with income than have other countries. Indeed, the health-income gradient is more prominent in Canada than it is in the U.S. The need to ration when care is delivered "free" ultimately leads to long waits or unavailable services and to unmet needs. In the U.S. costs are more often a source of unmet needs. But costs may be more easily overcome than the absence of services. »

anonymous|9.23.09 @ 12:06AM|#

@max hats (from the report):

"For the major sites of lung, breast, prostate, colon, and rectum cancers, US survival rates were the highest of any of the 18 countries investigated. Cancers first diagnosed on the death certificate (5% in Europe and 1% in the US) were excluded from analysis; if they had been included, the US survival advantage would have increased."

Being #1 in cancer survival among developed countries is "less to show for it"? Did your wife cheat on a cancer patient or something?

Abdul|9.23.09 @ 7:27AM|#

For four decades, until the mid-1980s, per-capita cigarette consumption was higher in the United States (particularly among women) than anywhere else in the developed world.

I thought the big news was that we used to smoke more than the French did. Who'd of thunk it?

|9.23.09 @ 9:15AM|#

Government run health care - the so-called "public option" - presents serious challenges for us. The private sector and competitive market forces are the best means to meeting health care needs. Watch this video from the U.S. Chamber http://www.friendsoftheuschamber.com/media/

Michael Ejercito|9.23.09 @ 12:14PM|#

The inconvenient fact remains that we pay much more on health care per person than countries with actual outright socialized healthcare do, and with far less to show for it.

One problem is that the police arrest doctors for overprescribing pain medication .

Syd Henderson|9.23.09 @ 2:15PM|#

Dr. Preston and other researchers have calculated that if deaths due to smoking were excluded, the United States would rise to the top half of the longevity rankings for developed countries.

And if they left out deaths due to heart disease, alcohol and diabetes, I bet we would rank real high, right?

Logfile|9.24.09 @ 2:32AM|#

And if they left out deaths due to heart disease, alcohol and diabetes, I bet we would rank real high, right?

If the intention is to make an apples-to-apples comparison between health care systems and their effect on the life expectancy of a population, then you have to control for cultural differences.

|10.8.09 @ 9:12PM|#

some basic considerations about stats (averages) will help here:

there are more smokers in europe.

but their health stats seem to be similar to those of european non-smokers,
since

crass differences between europe and the usa –in europe’s favor– disappear
when you remove smokers from the comparison.

this means that usa smokers fare horribly compared to european smokers (or,
much less likely, that european smokers have much better health stats than
european non-smokers).

it’s almost sure that usa smokers fare much much worse than european ones,
simply because smoking is a lower-class thing in the usa.

so among usa smokers there must also be many more diabetics, drug addicts,
alcoholics, reckless drivers, wife beaters, hypertension acrobats,
overweighters, etc, i.e., people who do all those things that make “life
worth living”TM.

in other words, the usa’s “melting pot”TM not only segregates by race and
class, but also by morbidity, three things that because of "manifest
destiny"TM tend to coincide!

the country indeed gives the poor and the lower middle class the “freedoom
to choose”TM to be diabetics, drug addicts, alcoholics, reckless drivers,
wife beaters, hypertension acrobats, or overweighters, etc, a very diverse
“plethora of opportunities”TM to choose from, opportunities that these less
deserving classes like to take as a combo more often than not.

obviously europeans are not enjoying these basic freedoms as freely –oh
freedom! as aretha would put it– (although europeans have been catching up
thanks to the recent efforts for “labor flexibility”, “private pensions”, by
some of their most illuminated –if venal– leaders and intellectuals).

so the innocuous exclusion of smokers “for fairness” by the authors removed
many of the most self-destructive poor and under-insured people from the usa
data and left more affluent, better educated, more health-conscious
upper-class usa people to be compared with a more random segment of the
european population. not exactly fair, one would say.

one has to wonder though if the authors did not know about this in advance
and, if they did not, why on earth they chose not to dissect the above
superior health of european smokers that the effect of the smokers’
exclusion made evident.