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


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