U.S. Life Expectancy: We’re Number 1
Tyler Cowen passes along a reader comment that,
The difference in life expectancy between the US and Netherlands is often referred to as an example of how superior semi-socialized health care increases life expectancy. At birth, someone living in the Netherlands can expect to live 2.35 years longer than someone born in the US, but at age 65, the difference is reversed, and someone living in the US can expect to live 0.4 years longer than someone living in the Netherlands. This difference can be explained by assuming that semi-socialized health care is better for young and worse for old people, or, at least as likely, different policies are not the main cause of the difference.
Cowen merely observes that, “One interesting feature of this data is that it can be used to argue for a number of different points of view.”
His readers immediately pounce to point out that, at age 65, Americans in fact have semi-socialized medicine. Indeed, the Medicaid system is arguably less semi and more socialized than that in the Netherlands.
Moreover, health care isn’t the only factor in life expectancy since all manner of things can kill you: crime, war, accident, diet and exercise behavior, etc. And, sure enough, a commenter points to an interesting post over at “slightly left of center” Angry Bear this morning pointing out that, when we control for traffic fatalities and homicides, “The US jumps from 15th on the list with a life expectancy of 75.3 to 1st with a life expectancy of 76.9.”
Maybe I’m missing something, but 76.9 wouldn’t be 1st on the list, it seems like it would be 8th.
In any case, it would be hard to correct for all the other differences in lifestyles between the various countries. For example, I thought the Japanese smoked a lot, but there they are at the top of the list.
What you’re missing, Furhead, is that they’re talking about the Standardized Mean column.
I still subscribe to the “Lies, Damn Lies, And Statistics” mantra.
Oops. Haste makes waste.
But yeah, what I meant to get at with my second statement was basically what you said. The data was “corrected” all right.
So, are these AEI guys arguing that we need more gun control and we need to stop designing dangerous transportation systems?
No Triumph, I think what they’re saying is our news media and politicians need to stop misleading the public with inapt comparisons of complicated data sets.
But that’s just crazy talk.
I have to admit that I don’t see the point in controlling for traffic fatalities and homicides either, seeing as how people die in car accidents and get murdered…
If you’re trying to figure who lives longest, it doesn’t. If you’re trying to compare health care systems, however, it makes sense to exclude extraneous data.
They’re not AEI guys; it’s a study (or, rather, a PowerPoint talk on said study) by two University of Iowa professors that AEI has put on their site.
Now we know why they tried to rush the healthcare debacle. Reality is refuting the Obama Administration’s lies. Just two week a go, Kathleen Sebelius stated on The Daily Show that “we live sicker and die younger than any developed nation.”
If the healthcare takeover was such a good idea, would the Secretary of Health and Human Services need to tell lies to sell it?
I think the take-away for me is that all these people in all these countries have nice, long lifespans. Some with more private-market medicine, some with more socialized medicine.
It’s just that some of us pay twice or three times or four times as much.
Because hospitals don’t treat the victims of accidents and gunshot wounds?
I didn’t know the affiliation of the authors.
However, the chart appears on page 22 of The Business of Health,[.pdf] published by AEI in 2006. A crisp clean copy of the book can be yours for only $25!
As far as I’m concerned, if the AEI is spending money to publish their work, they’re “AEI Guys.”
Sure, and we’ve got great trauma centers. But a huge percentage of these people are DOA. It very much skews the comparative data.
That’s a more salient point, I think. Our system is not efficient in the aggregate. But most of us with good insurance would rather have that than rely on the government.
.
The problem is that if you’re like most people you don’t have the insurance, your employer does. And because you’re not the one actually dealing with the insurance companies you assume that things are fine.
But employer-provided insurance is a fading reality. More and more of you will end up in the individual policy world where I live. And let me tell you something: it’s a very different place.
The ONLY reason I’m able to get health insurance at all, at ANY price, is a regulation that requires companies to accept group policy participants. I had to form a corporation. This alone will cost me thousands that will never be counted as a health care cost.
Without that government policy there is no chance I could get insurance at all. So stop the knee-jerk anti-government rhetoric and look at the reality. Go look at individual policies in various states. Think about how secure you’d be with your wife and kids on such a policy — a policy that can be capriciously cut off at the whim of the insurance company.
Most of you are still living in a paternalistic lala land, with your company playing daddy. The real world is very, very different.
FWIW, the Angry Bear post is by “reader Sammy” not one of the regular posters.
This “corrected” life expectancy is an interesting concept. That the US is much higher in homicides is no surprise; I am surprised that the traffic fatality is much higher than, say, Canada. As Alex points out the death rates from homicide and traffic accidents don’t just reflect gun-ownership/use, driving habits, etc., but also the quality of trauma care. It’s almost certainly true that Canadians get shot at a lower rate than Americans, but it’s quite possible the death rate overstates because trauma care is inferior in the US.
I thought everyone (well, every wonk) agreed though that life expectancy has lots of issues and the more correct wonkish metric to use is Potential Years of Life Lost (by which the US comes near the bottom of the pack among OECD countries).
Surely you can correct different in accident/homicide rates without excluding them altogether. Accidents are the fifth leading cause of death in the United States. Surely it’s worth examining whether there’s an impact from the level of trauma care across countries?
I’m not sure how you do a cross-national study accounting for all the variables, but it may be possible. Excluding them entirely, though, focuses on ordinary health care.
It still doesn’t correct for lifestyle differences, such as diet and exercise habits, but it accounts for a major variation.
Perhaps the weakest part of reader Sammy’s post at Angry Bear is where he tries to argue that the US doesn’t have by far the most expensive health care. He argues that sure in the US we pay by far the most per capita, but what if you look at GDP? But if you look at his own chart it’s clear that we pay by far the most on healthcare as a percentage of GDP.
Reynolds nails it. 75 or 77 isn’t the issue. It’s the cost. What the numbers show is that the folks who are demagoguing the life expectancy are – well – demagogues.
What I’d like to see is a study of various survivability ratios – such as “55 year-old male is diagnosed with colon cancer – where does he live longer?”
“America! We have the highest life expectancy, except for all the crazy driving. Oh, and the murders.”
(Truth be told, the country-to-country differences are not all that large, but it is kind of depressing.)
Why only exclude accident/homicide rates if you’re trying to isolate health care? Eating habits, exercise, various other forms of accident (industrial for instance), proximity of carcinogens in the environment (natural or anthropogenic) and so forth should also be removed if the idea is to look at health care in isolation.
This analysis has the look of cherry picking to it … let’s pick the rates that give us the answer we want. For that matter, comparing life expectancies between countries tells us very little even without making exceptions. There are far too many variable for it to be useful.
Precisely. I think one could find a set of corrections that would make the country of your choice come out on top. The approximate 4% difference between highest and lowest in the raw data could easily be ‘corrected’ away.
A couple of other weird things about this study:
Why average data from 1980 to 1999? Why not just use the most recent year for which the data is available for all countries (2005; if you exclude the UK 2006; to see the data download the spreadsheet here).
Why did they not exclude suicides?
And of course the big one: Why invent a new measure and contrast with naive life expectancy rather than look at the standard Potential Years of Life Lost (PYLL)?
Smells like cherry-picking to me.
I think that there is also a cultural difference between USA and NL about expectations of medical intervention as people reach a certain age. This is not the insurers denying a hip replacement for a patient at advanced age, this is about the patient deciding not to have invasive treatment at that point in life. (I am basing this on anecdotal evidence, but people here do seem less inclined to accept all medical procedures at all costs)
It should also be pointed out that the US uses different standards for what counts as infant mortality than other countries which skews the numbers.
http://health.usnews.com/usnews/health/articles/060924/2healy.htm
These international comparisons are worthless unless they control for ethnic and racial variance in the host populations.
Freedom allows for people to take greater risks and we can certainly expect that they will. As we are generally a freer people than most anyone else in the world it is reasonable to expect that we have more people taking more risks than the rest of the world. These risks can be rock climbing, drag racing, carrying a gun, smoking cigarettes, playing football, eating at Burger King every day, or any number of events whose inherent morality or legality would inhibit any agreement between many of us, making any further discussion moot.
As one would expect, given the meaning of the word risk, sometimes the choices made don’t work out all that well, and not just for the risk taker. The only way to change this is to reduce risk, and the only way to do that is reduce freedom. Is that what we want?
Charles:
In what specific ways are we freer than Europeans?
I suppose I’d have to ask which Europeans, but comparing our freedoms to those of Great Britain — perhaps our closest and freest European ally, off the top of my head here’s ten I would start with:
1. We can own guns.
2. We have the right to defend ourselves.
3. We have the right to defend our property.
4. We have the right to remain silent and to not incriminate ourselves.
5. We have a written constitution that limits the power of government, in theory at least.
6. We are not a destination for “libel tourism.”
7. We are not subject to the
Common MarketEuropean Union and its statist edicts.8. We do not have to wait up to six years to get a new government.
9. We do not have to accept a substandard NHS, yet.
10. We do not have a state religion whose titular head is the head of government.
I won’t get into the freedoms that come with a higher standard of living.
And this is not meant to be an exhaustive list.
Also, don’t overlook the fact that some Western countries won’t allow truth as a defense against a charge.
Charles:
1-2-3 Short version: guns. A British subject of course has the freedom to walk the streets with far less fear of being shot. Most European countries allow gun ownership. While I lived in Italy I’d see hunters out every day in season, popping away ate boar and hares and pheasant.
4. Pretty sure this is the case in most EU nations.
5. The Brits have common law that performs the same function, and some EU nations have constitutions.
6. I’ll grant this one.
7. A Brit has very little to do with EU rules. And we have law-making at state levels which are far more intrusive than the EU.
8. But we do have to wait a minimum of 4 whereas they can rid themselves of a government more quickly. Incidentally their governments are generally more professional and competent than ours.
9. 29% of the US is government insured. The rest are subject to the whims of insurance bureaucrats. If we lose a job we lose insurance. We can be easily bankrupted by medical expense. Europeans have universal health care. This is hardly a plus for the US.
10. Meh. That only applies to the UK and it’s an irrelevancy in people’s lives. Our government is far more the servant of organized religion than most EU governments.
Now, on the other side:
a) Most European governments turn a blind eye to casual drug use whereas we fill our prisons with non-violent offenders. They are free to smoke a joint, we can go to prison.
b) Europeans are free to change jobs and keep their health insurance, unlike Americans. Europeans have no fear of medical bankruptcy.
c) Most European governments have decriminalized prostitution. Unlike the US where prostitutes are criminals and therefore far less likely to be AIDS-tested. In the US two consenting adults can be arrested.
d) Some European governments have decriminalized or legalized assisted suicide, unlike here in the US where end of life choices are dictated by the government. Or become the subject of bizarre congressional witch hunts.
e) Europeans can travel to Cuba, we cannot. Not that I care particularly.
f) European governments ensure that workers can take vacations and have pregnancy leave. Employees have a right to take some time off — unlike in the US where an extra day of sick leave can mean you’re fired. And that you lose your health insurance.
g) Most gay Europeans can marry and have all the rights of straight citizens.
h) Gay Europeans can serve in the military in most cases, without fear of being summarily ejected and deprived of rank and benefits for telling the truth.
I do not think a case can be made that Americans are more free.
Gee, you forgot to factor in the involuntary euthansia practiced in the Netherlands. I think it’s generally accepted that 1 of 11 of all deaths there are cause by government medical people involuntarily euthanizing them.
If we think that “Infanticide” won’t quickly morph into “Consulticide”, or “Econocide” we’re naive.
Innocent life, when inconvenient, is to be disposed of, after giving first giving it a nice good sounding label, “Healthcare”
Think “Abortion” It’s for the children!
DL:
Can you provide a link to a reputable source for that rather extreme notion?
Gee, you forgot to factor in the involuntary euthansia practiced in the Netherlands. I think it’s generally accepted that 1 of 11 of all deaths there are cause by government medical people involuntarily euthanizing them.
You really don’t have a clue what you are talking about. Or maybe you confuse involuntaty euthanasia with non-voluntary euthanasia -which still would leave your figures rather high though. Care to elaborate? Preferably with a link to some trustworthy and current figures?
Two weeks ago a very very good friend of mine died. 49 Years old, two kids, cancer. She tried to enjoy every minute she had, right till the week before she died. But I was so happy for her that she had the choice to die amongst her loved ones when she knew that all that was left was days where the suffering and pain would prevent her from having any worthwile interaction with her environment.
Last year the husband of my basketball teammate died. Cancer. When the end was near he suffered so much. The day he would be euthanized he asked every half hour wether the doctor had allready arrived, because all that was left for him was pain and misery.
Our neighbour died 5 years ago. Cancer. He felt so comforted by the thought that he could choose for euthanasia when the pain and suffering would become too much for him. He died in the arms of his beloved wife before that, and she is so glad that he at least didn’t suffer more than he could handle.
We have court cases against doctors because their administration of pain medication may have caused people to die a few hours too soon – but the patients weren’t able to agree with the treatment anymore.
But all those people got every chance in our medical system. They didn’t have to pony up hugh soms in advance before treatment could begin, nobody went bankrupt to finance the necessary medical bills, no hospital or medic had to inquire about their ability to pay for tests and treatment. And nobody had to worry about wether the hospital/doctors would stop treatment too soon if the bills weren’t paid.
Dutchmarbel:
Exactly. Americans don’t have a right to a painless death. We have to die in agony to satisfy religious nuts.
So Michael;
Christophobia is what’s keeping us from Abortion , infanticide, fratricide and geriatricide?
What a pity?**, and what an asinine asseveration.
**(sarcasm)
I looked some figures up and compared the mortality in various age groups between the Netherlands and the US. The USA figures are from 2006 (CDC didn’t have more recent ones afaics) and the Dutch numbers are from 2008.
in the Netherlands 12.17% of deaths in 2008 were younger than 60. In the USA 21.29% of deaths occured before people are 60. Our health system seems to favour more people reaching their 60’s.
I have enjoyed the quality of comments here.
Angry Bear puts up posts by readers and guests in an attempt to provide ‘points of view’ that speak to notions about what is true, which is why I suggested the ideas rather than the statistics. Our own people in statistics would have needed the data to comment thoroughly, and some did on general stats as well.
The idea was to address information floating around that is believed to be true and to take a look. Sammy is a regular and has a point of view that is ‘conservative’ and non-expert but of value.
The study used is not definitive of anything major, and the authors never claimed so…it was hosted at AEI, but as you can see here it is an easy thing to use it as if it was definitive. More detailed criticisms can be had elsewhere, but I thought the post timely. A lot of time went into discussion in 2007, but was less timely in the media.
Thanks for the comments.