Health Care

Americans' Lifespans High Without Single-Payer or Nanny State Health Interventions

Lack of single payer hasn't seemed to hinder superior progress made in terms of life expectancy gains in the U.S. since UN records start in 1960.


Americans spend more on healthcare than any other people in the world, yet U.S. life expectancy lags behind that in many a rich country. This discrepancy between expenditure and outcome, leftists at home and abroad argue, could be addressed by moving toward a single payer system, which would "save money, cover everyone and help us live longer." The U.S. healthcare system needs to be reformed, but is even more government intervention in our healthcare the answer? Let us first look at the data.

In 2014, Americans spent $9,400 per person in 2011 dollars adjusted for purchasing power. That's the most in the world. In second place came Monaco with $7,302. Scandinavian countries, which are often held up as examples to be emulated when it comes to life expectancy, spent less. In 2014, Denmark, Norway and Sweden spent $4,782, $6,350 and $5,218 per person respectively. In 2015, the average life expectancy in the three countries was 80.35 years, 81.66 years and 82.28 years respectively. In the United States, it was mere 79.16 years.

The United States has been drifting away from a free market in healthcare for decades. Obamacare is merely the latest, though arguably the most ambitious, attempt to regulate American healthcare so far. Still, the left feels that Obamacare did not go far enough. So, would a single payer system lead to better health outcomes in America?

Not according to Jonah Goldberg, who notes, "A recent study by the Institute for Health Metrics and Evaluation measured life expectancy by county across the United States. In 2014, a child born in Summit County, Colo., could be expected to live 86.83 years. The life expectancy of a child born in Ogala Lakota County in South Dakota, seat of the Pine Ridge Indian Reservation, is nearly 20 years shorter."

I think Goldberg is onto something when he writes that life expectancy discrepancies have more to do with lifestyle than insurance. If all of us ate well, exercised regularly, and stopped drinking and smoking, the U.S. average would go up. Other changes would make us better off still. Goldberg notes that once fatal car crashes and murders are removed from calculations of life expectancy, the United States has the "world's best life expectancy numbers." Whether that's true or not (there is some controversy about the methodology used in the original study), there is more.

Consider the Human Progress chart above. As you can see, the United States started from a considerably worse position, when the United Nations began collecting national life expectancy statistics in 1960. In that year, American, Danish, Norwegian and Swedish life expectancies were 69.77 years, 72.18 years, 73.55 years and 73.01 years respectively. During the following 55 years, life expectancy in the four countries rose by 13.45 percent, 11.32 percent, 11.02 percent and 12.72 percent respectively.

As can be seen, the United States has outperformed Scandinavia in terms of life expectancy gains over the last five and half decades. As a consequence, the gap between the two has decreased. The left might claim that U.S. life expectancy gains coincided with the creation of Medicare and Medicaid programs, even though there is some well-known research that does not support that conclusion.

Be it as it may, the lack of a single payer system (and, perhaps, other more draconian interventions in the health market that can be found in Scandinavia) does not seem to have hindered the superior progress that America's healthcare system has made in terms of life expectancy gains so far.

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  1. “The United States has been drifting away from a free market in healthcare for decades.”

    This is one of the things that drives me crazy in health care discussions. The Left acts as if before Obamacare, health care was the wild west, with people dying in the streets. The reality is that government was ALREADY spending one of every two health care dollars! Regulations fostered HMOs. Government linked insurance to employment. And believe it or not, there were huge government programs (I think they were called Medicaid or Medicare, or something like that.) But the Left sets the parameters of discussion, and the right — too eager for more government, more graft, or too lazy for a true intellectual argument — continues to sit idly by.

    1. Yup. We have not had free market health care since the 1950s.

      It was cheap enough for people to pay cash for medical care and was the best in the World.

      After 1965, Medicare and Medicaid began dominating the US health system causing costs to go up and more and more people on these government run programs. We now have so many people on government programs that there is no chance for this market to work without government interference or most people being kicked off and back to free market healthcare.

      1. Of course if some of us were born in the 50’s we’d be dead shortly after birth. Technology does come with a price.

      2. It’s weird to hear someone say “We have not had free market health care since the 1950s” as if that were describing a decline toward a worse state of things. Which, I assume, the writer means.
        Of course, the writer almost certainly does not want to describe what improved since then. And, definitely, would not want to cite any numbers and discuss what major events in the health economic realm occurred, both here and in the democratic socialist economies of Europe.

        That would really be shooting yourself in the foot.

        1. I’m making over $7k a month working part time. I kept hearing other people tell me how much money they can make online so I decided to look into it. Well, it was all true and has totally changed my life.

          This is what I do…

    2. Insurance companies give profits to rich people, and they way they make profits is by denying care. So that means that people are indeed dying in the streets so the rich can get richer. Until we have single payer across the board, hospitals will continue to stack the dead bodies of the poor like cord wood. Drive by any hospital and you will see them. Stacks and stacks of bodies. All so that the rich can steal their immoral profits.

      1. I took your advice and drove by my local hospital today. Sure enough, there they were in the back. Stacks and stacks of dead bodies. I even saw a couple of rich people sitting around, laughing, smoking cigars, and counting their money. Oh the humanity!

        1. people do contain lots of minerals that can be recycled after death and lets not forget about soylent green

          1. Gold teeth! Don’t forget the gold teeth!

      2. I was not rich enough to get some of them profits either. Stacks of bodies and money only for rich people!

        I would give you an economics lessons but you clearly do not even understand what hospitals do, how they allocate care, and how they raise capital.

        1. Please report to maintenance stat, your sarcasm detector needs to be calibrated.

          1. Nah, your sarcasm broadcaster needs replacing. You absolutely failed at conveying sarcasm.

            But hey, it made you seem like SUCH a smart fellow, that post! In fact, you might just be the next Bill Maher, you’re so smart!

            See, THAT was sarcasm. Learn from me. BOW TO ME! KNEEL BEFORE ROBB!

        2. sarcasmic is often sarcastic.

      3. My wife works at a hospital. She says they mulch up those dead bodies and the rich people sell the mulch as fertilizer to India. VERY profitable. Oh, and the Indians then hand roll cigars and send them to the rich people as a thank you. It’s quite the little circle of life.

        1. Finally the truth.

      4. “Insurance companies give profits to rich people.” Actually, I think you could have stopped right there. Even if rich people profiting resulting in a longer lifespan for the average American, some progressives would still likely be against it.

  2. One reason for lower life expectancy in the USA is more freedom than these socialist countries. People are allowed to make more choices in the USA and some of those choices are bad causing earlier death.

    Besides, who wants to live into your 80s but are not very mobile. People talk about higher life expectancy like its a great thing. Has anyone met these people? Some are alive but are confined to beds. Being old is not all its said to be.

    1. Wow! This is the closest I have ever seen of an informed truth-teller on Reason. Hats off to you!

  3. Quit drinking and smoking? Why would you want to live longer? That’s crazy talk!

    1. Don’t tell anyone, but people who die early from drinking and smoking use fewer health care dollars over the course of their shorter lives than people who live healthy life styles. Living healthy actually costs they system more money! Shhhhh! It’s a secret!

      1. but people who die early from drinking and smoking use fewer health care dollars

        Hmmm-maybe that’s why European countries spend less on health care-they all smoke like chimneys and drink like sailors compared to us American puritans. But wait, they live longer too-that can’t be!

  4. Life expectancy raised because of more reliable food sources and because of hygiene. That’s it.

    That’s. It. Has NOTHING to do with paying doctors so they can live in luxury and send their kids to college. You eat right and you keep your environment reasonably clean, and you will live to be 85. Unless you do something ridiculously stupid, like becoming a vegan…

  5. Scandinavia was also, until recently, almost entirely mono-ethnic (is that a word?). The US is one of the most diverse countries on the planet. It would be silly to believe that doesn’t affect life expectancy figures.

    1. Observing any differences in race is racist!

      1. How about observing the observation?

    2. Didn’t someone once observe that Swedes living in the USA live longer and are wealthier than those in the old country?

      1. Yep. He was a Swede.

    3. It is also worth noting that Sweden’s population is about about 3% of that of the USA.

      It’s easy to have a welfare state if you have a small country full of Swedes and a Lutherans.

      1. And if you don’t pay for defense…

        Funny thing is, apparently it isn’t all that easy to have a welfare state. Sweden is failing miserably with theirs.

        1. Love that deep and numbers-driven, factual and comprehensive analysis. You know, the kind of thing “libertarians” have a penchant for.

        2. Sweden does not belong to NATO, but rather has a policy of armed neutrality (Like Switzerland).

          They do not expect anyone else to defend them and feel under no obligation to defend anyone else. They spend everything they believe is necessary to defend themselves.

  6. Maybe it is the healthcare that is killing people.

    1. Just look at any hospital, full of sick and dying people.

  7. If all of us ate well, exercised regularly, and stopped drinking and smoking, the U.S. average would go up.

    If Reason/Cato were actually interested in finding out what is happening, they might actually dig down into data and try to discover facts and not just memes. The discrepancy in life expectancy is not so much directly by county as it is by income – and that has a lot to do with medical care access. Further, ‘life expectancy at birth’ is the most generic misleading macrostat possible. It mixes a slew of unrelated death factors – and defacto weights them by age.

    Why not look at life expectancy at age 65 by top-50% income and bottom-50% income?
    For those who turned 65 in 1977 (born in 1912), remaining LE for the top-50% was 15.5 years. For the bottom-50% it was 15 years.
    For those who turned 65 in 2011 (born in 1946), remaining LE for the top-50% was 21.5 years. For the bottom-50% it was 15.5 years.

    IOW virtually ALL of the increase in life expectancy – for the population where medical access factors are significant – for the last 40 years – has occurred solely for the top-50%. The bottom-50% are merely paying a lot more for healthcare and dying the same as before. And over those 40 years, a slew of countries have moved ahead of that lower half – Thailand/Mexico/etc. So that lower half isn’t even benefiting from our supposedly vaunted ‘best in world’ health infrastructure.

    1. And yet, people over 65 have had Medicare that entire time.

      1. I’m not advocating ANY particular policy. Just dismissing the BS rahrah that concludes this article – hindered the superior progress that America’s healthcare system has made in terms of life expectancy gains so far.

        Whatever we have – sure as hell ain’t superior for at least 50% of the population. It just costs a lot more. So if the free market can’t deliver, there is very sound reason why that 50% will look for an alternative. Only the Reason/rahrah crowd should be surprised at that.

        1. As an aside – and from a different source with no income breakout – life expectancy at age 65 in 1950 was 14 years. In 1960 was 14.3 years. So maybe Medicare adds a year – except for the higher income.

  8. Hasn’t it been pointed out before that when controlling for accidental death, the U.S. vaults to #1 on the life expectancy chart?

    And hence, shorter left expectancy probably isn’t health care related.

    One of the best things we can do for raising our life expectancy is a gasoline tax. 😉

    1. That’s not true either. Yes ‘life expectancy at birth’ includes a whole bunch of premature deaths like infant diarrhea, teenage car crashes while texting, young adult homicides – but that just means its a crappy stat. If people make it to age 50 or so, they die for pretty much the same reason – senescence – everywhere in the world. Only the particulars of which aging-related disease or combo proves fatal varies. ALL of those diseases are the primary focus of pretty much all medicine outside pediatrics. So life expectancy beyond those ages is a good outcome indicator of the health system.

      And for that demographic, the US overall brings up the rear of ‘developed’/wealthy countries. Japan and France are easily the best – Spain/Italy/Australia are the second tier (comparable to top-50% here). The rest are kinda glommed together. Our bottom 50% are a bit below Turkey/Mexico/Thailand/Poland (except ours spend 5x more than theirs).

      1. People over the age of 50 don’t work, drive cards, or get murdered?

        1. Not more so than anywhere else. Or maybe you live in one of those cities where AARP is code for ‘them dastardly drug gangs doing driveby shootings’.

          1. Yes. They do. That’s the point.

          2. Here’s a ’cause of death by age’ site –

            age 25-34 – OD, suicide, car accidents, homicide, other injuries, endocrine disorders
            age 35-44 – OD, suicide, heart disease, car accidents, homicide, liver disease
            age 45-54 – heart disease, OD, lung cancer, suicide, liver disease, hypertension, diabetes. Homicide is #23 (between kidney disease and hepatitis)
            age 55-64 – heart disease, lung cancer, lung disease, diabetes, liver disease, stroke, hypertension, 4 other cancers – then suicide as the first ‘non-medical’. homicide is #37 (between MS and alzheimers)

            Pick your age where people are dying from old-people stuff. 50 seems about right to me.

            1. lol.

              The issue of dispute is that people did of accidental death more often here than elsewhere. Not that old people die more often of disease.

              And of course they do. The single best predictor of traffic death, for instance, is population density… which is low here for a first world country.

              1. Your claim is disproven by the actual FACTS. Homicide for one is damn near irrelevant as an incremental cause of death – IN THE US – by before age 55. It is simply stupid to then pretend that homicide is really very very significant here at that age compared to elsewhere. It is irrelevant here. It is irrelevant there. It is irrelevant everywhere. Likewise traffic accidents – and all the other stuff that you want to pretend is unique to the US (which they AREN’T anyway beyond maybe age 25). You actually think that car accidents are unique to the US. Yeesh? Get out of your parents basement.

  9. If you take out the criminal element and the more miles driven by americans out life span is better than most nations with health care

  10. There has NEVER been a free market in healthcare. Until you can get over that Libertarian imagination you have no business talking about healthcare. Having your barber pull your teeth is not healthcare. A community making sure a local Dr had a comfortable life so they continued to work in their community while everyone paid what they could afford is not free market. After that came insurance which Libertarians like to claim is anti-free market.
    The healthcare issue is making me move further away from those who claim libertarianism. You’re actually corporate collectivists not objectivists.

    1. A community making sure a local Dr had a comfortable life so they continued to work in their community while everyone paid what they could afford is not free market.

      Maybe it’s not a free market but how is it much different than doctors being salaried and letting their employer do the business side of things? Those communities also paid for the doctor’s medical education so it is basically a long-term contract that was initiated at arm’s length. That sort of system is a fuckload better for primary care services than what we have now.

  11. But I want my free stuff! Someone told me I was entitled to things, despite all biological experience on planet earth to the contrary.

  12. Whenever you read such commentary on Reason, you have to take away several notches of credibility.
    Does this commentator have any idea what occurred in 1966? Most likely, you dear reader, don’t either.

    Well, let me help you. The steepest jump on that curve just so happens to coincide with the introduction of the ONLY single payer system in America: Medicare. That America started from further back and still hasn’t caught up to the western democratic socialist systems (although, not all are single-payer the western democratic socialist systems are single-payer) is due to the fact that it started late with the introduction of affordable healthcare and limited access to such a benefit to the otherwise most vulnerable category of citizens from a medical care standpoint: seniors.

    It makes you wonder: Is the title of “policy analyst” at the Cato Institute equivalent to “dummy” or “policy propagandist”?

    1. Medicare hasn’t done much even for life expectancy at age-65. Maybe added an extra six months – of extra dying time rather than extra living time.

      What changed life expectancy at BIRTH was the EPSDT (preventive/screening care for children and pregnant mothers) program of Medicaid and the end of Jim Crow and the introduction of the vaccine schedule (diptheria, tetanus, polio, measles, rubella, etc) across schools in the 1960’s. Those three are what reduced infant mortality in the US by more than 50% from 1960-1980. That sort of mortality change has a MASSIVE effect on a ‘life expectancy at birth’ curve. Europe did not have a post-WW2 baby boom (so their benefit from any childhood program is less sharp) AND they generally started immunizing kids earlier than the US.

      1. The math of how it works:

        ONE child who doesn’t die because of some childhood disease has roughly the same effect on a ‘life expectancy at birth’ curve as 70-140 seniors who get expensive treatment for one thing and survive until they are diagnosed with something else.

  13. Life expectancy in Scandinavia will be falling soon.
    All of the new-Swede-Jihadis blowing themselves up will reduce the overall life expectancy.

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