Lower American Life Expectancy is Not Due to the Health Care System
This is John Tierney, writing in the New York Times:
An American’s life expectancy at birth is about 78 years, which is lower than in most other affluent countries…. [But there is] no evidence that America’s health care system is to blame for the longevity gap between it and other industrialized countries. In fact, … the American system in many ways provides superior treatment even when uninsured Americans are included in the analysis.
Americans are more ethnically diverse. They eat different food. They are fatter. Perhaps most important, they used to be exceptionally heavy smokers…. The longevity gap starts at birth and persists through middle age, but then it eventually disappears. If you reach 80 in the United States, your life expectancy is longer than in most other developed countries.
This is a breath of fresh air, given the repetitious bashing of the US health care system that we hear almost daily.
This should be circulated widely.
Good post.
I agree with Neil.
Nearly two-thirds of health status (and cost) is a direct result of lifestyle choices. Indeed, some of this is a function of living in an affluent society. We drive cars from the suburbs to the grocery store rather than walking. We grab lunch out and swing by the drive-through on the way home because the opportunity cost to prepare food is less than we earn per hour at the office. Or, we pay someone else to prepare food because buying food out facilitates low-cost leisure activities (i.e. we hit the drive-through on the way to our kids’ soccer practice).
Other countries are following our lead — they are just a few years behind us. The obesity rates in European and even some developing countries are slowly catching up to the U.S.
I don’t agree there is much our health care system can do to alleviate drinking, smoking or grabbing a Whopper, Big Mac or Jumbo Jack at the drive-through window. That said, Americans would be more apt to modify their behavior if they had to actually bear the cost of their own decisions. That’s the one thing the public health advocates advising Congress are loath to accept – the notion that a middle-aged man who overeats, leads a sedentary lifestyle, has high-cholesterol, hypertension and pre-diabetes should bear higher costs than a 22-year old marathon runner who dines on tofu and carrot juice.
They don’t even mention violent deaths, for which our country destroys europe statistically. Murders, car crashes, etc, are all higher here, and that affects longevity statistics.
I’ve read previously that if you merely factor out violent deaths we actually reach the top of the longevity chart.
If I could ask Obama one question, I’d be…
“Mr. President, your administration and you yourself while campaigning frequently cited statistics from the WHO on the quality of our healthcare, statistics generated from a comparison of longevity. Do you honestly believe that quality healthcare is the only thing that affects longevity? Or perhaps is there room for lifestyle, genetics, and social factors?”
“Umm umm umm, you see, I’ve always said… ”
Yes, and we’ve _always_ been at war with East Eurasia.
Devon Herrick’s comment raises the idea that the debate over risk rating versus community rating should really be split into two separate debates: one concerning voluntary risk (i.e. lifestyle choices), and the other involuntary risk.
The argument that one should bear the weight of his own lifestyle choices is valid in the former, but not the latter debate, and becomes an over-generalization when the two issues are lumped together.
Insurers already do a perfectly good job of handling life-style risk. You want life insurance and you fly small airplanes? You pay slightly more.
Community rating is absolutely incompatible with providing incentives to cut voluntarily incurred risk.
Linda, I do not understand your last sentence. Employer-provided insurance is community rated, yet companies like Safeway offer incentives in the form of premium discounts in order to low-risk behaviors.
Anyway, my comment above didn’t presuppose a different conclusion for each of the parallel debates, only that they permit different arguments.
Setting aside insurance-related issues for now, there are two fundamental points made above: nature vs nurture. One’s genetic structure is inherited and therefore not alterable whereas one’s lifestyle is elective and changeable. Although the human genome has been sequenced, this information is still not generally available for application in the everyday care of patients. As a doctor, I cannot yet provide this information to patients and counsel them how to modify their lifestyles based on their genetic makeup. Therefore, best practice standards utilize already established information about diet, exercise, smoking, obesity, etc to counsel patients how and why they should make changes to improve their lifestyle. Unfortunately, however, in my experience over more than 30 years, I believe I have been largely unsuccessful in getting people to significantly change their lifestyles despite repeated counseling. Because of this experience, I have come to believe that a strong health education curriculum beginning in elementary school may be a useful approach. Used wisely, health education curricula can be designed based on current medical evidence to teach our children facts they can use in their everyday lifestyles. Using this approach, children will grow up understanding how good health choices can improve their lifestyles, reduce morbidity and mortality, reduce costs of health care to society, and enhance longevity. Using this model, I believe that Dr. Herrick’s concerns–indeed, all the legitimate concerns about lifestyle discussed above–will, over several generations, fade as chronic diseases such as hypertension, diabetes and gout are better controlled with new innovations.
It is more likely the life expectancy shortfall is due to much greater exposure to chemicals in the environment (air, water, and food) and most buildings not meeting current HVAC standards for fresh air per occupant than to health care spending. It won’t take many years for China to demonstrate the life expectancy gap between the areas of industrialization and remote non-development furnished with basic health care but deprived of chemical agriculture and industrialization. In areas of the world with the oldest people, younger generations exposed to industrialization are living shorter lives than their parents.
According to the Social Security website a using life expectancy for males at age 21 since 1940 the U. S life expectancy has risen only 2.6 years in spite of huge advances in medical care.
What has to be taken out of the equation is life expectancy at birth, since that has been dramatically altered by health care. In 1940 in the U. S. only 53.9% of males survived age 21 to 65, while in 1990 72.3% survived. This meant only a 2.6 year increase in life expectancy at age 65 (from 12.7 to 15.3), which has already been compensated for by an increase in the Social Security retirment age to 67. The balance has been more than paid for by the increase in the percentage of married women working. The data is at: http://www.ssa.gov/history/lifeexpect.html . It is clear the 2.6 year age 65 life exoectancy increase is due to Medicare
In deference to John Turney, it is likely a lack of ethnic and racial blending results in fewer complications pre-natally and at birth in real high life expectancy nations like Japan.