Per Capita Spending and Life Expectancy

This graph is misleading. Japan, San Marino, etc. are not nations of immigrants. If you take only the US born population(in order to make a good comparison to countries like Switzerland) I would think the numbers would not be so awful. Well, the obesity epidemic also contributes to shorter life expectancy of course–junk food is abundant and cheap=hear attacks, diabetes etc are abundant and expensive:-)

1. There is no ax to grind. Go research the numbers on any independent website: the U.S. trails many, many nations in this important statistic.

2. Even sadder: many current reports contend that, due to child obesity, the current generation of U.S. grade school students could be the first generation in centuries to live shorter than their parents. How could anyone argue that, if true, this does not mean we are headed in a very wrong direction?

I’d be much more interested to see this as a regression. The fact that it isn’t displayed that way makes me suspicious.

As a scientist, what I see here is mostly an absence of trend, even when you exclude the US. This becomes more obvious when you appropriately scale the left hand variable. Eyeballing it, it appears that the expenditure of ~200 international dollars (whatever those are) per capita gets you about a year of life expectancy. Also the intercept is about 69.

In other words, if you spend nothing on healthcare, your life expectancy will be 69, and you can buy a year for 200 a person. All a gross simplification, of course, but much less of a gross simplification than the graph shown.

It’s also hard for me to care about 4 years. Out of 75.

What’s wrong is that we’re the only western nation that doesn’t guarantee its citizens the right to buy health insurance. It’s interesting that the most vocal opponents of universal healthcare are the ones protected from medical underwriting by their employers.

Nurit wrote:
“This graph is misleading. Japan, San Marino, etc. are not nations of immigrants.”

But France and Germany and the UK are nations of immigrants. Or maybe these countries are too small to serve as valid examples? Or do all of their immigrants come from healthful environs?

It is a widely held belief among my SoCal brethren that illegal immigrants are the cause of our health care woes, and any effort to increase access to health care (even when spearheaded by a Republican Governor) faces serious opposition because of this view.

To put it bluntly take out the terrible statistics from African-Americans (murders, drug useage, AIDS, etc) and these numbers get normalized.

When accounting for accidental deaths the US citizens live longer than anyone else(or at worst, a little lower than Japan).

http://tinyurl.com/3d2mkd

Not to say that our healthcare system shouldn’t be reformed, I think it should(and not in a way that moves it towards more government) but lets at least get the facts right.

When discussing health-care quality this MUST be taken into account. It is simply dishonest not to.

One nephew, when provided this info, told me it was a waste of money keeping old farts alive when younger folks needed their jobs. He’d rather have a new car. I intend to live better, if not longer, and leave nothing to nephew. Take that.

Adam says, I happen to believe that government would be most effective if its stated priority was to maximize the life expectancy of its citizens…

Is that really the government’s “priority”? Yikes!

David hits it on the head with his 3 points. The statistical difference between the the life expectancies among western nations is negligible; the graph is drawn to depict some huge difference which does not exist.

What is wrong with this picture?

Answer: The “free market”.

Getting insurance companies out of the health insurance business would go a long way to remedy the situation.

Single Payer Baby. Single Payer.

Easy. Corporate/individual greed and HMO’s.

To echo twisty –

The problem is that vested interests want to pretend that health care must be delivered through something called the free market.

Other industrialized countries, ones that have most if not all our problems with race, immigration and poverty, have significantly better health outcomes for much less spending.

It’s not a matter of “reform”.

To support this, I’m going to copy another comment that says it better than I can. It’s long but worth it.

from comments at –

http://www.marginalrevolution.com/marginalrevolution/2007/10/how-to-debate-h.html

‘American health care outcomes look much better once we adjust for race and other demographic factors’

Ah, the last defense used when defending America’s health care system, one which is sadly no more tenable than any of the other excuses for a system which sets world standards in how much is spent on it while returning results that would not make Italy or Portugal envious.

‘The researchers who were funded by several US and UK government agencies, set out to look at the social and economic factors affecting health but shifted emphasis when large differences emerged between the two countries. The study looked both at the way people reported their own health and – to guard against any bias from self-reporting – at objective biological markers of disease from blood tests. Altogether there were about 15,000 participants.

Samples in both countries were limited to whites and excluded recent immigrants, so as to control for racial and ethnic factors.

“This study challenges the theory that the greater heterogeneity of the US population is the major reason the US is behind other industrialised nations in some important health measures,” said Richard Suzman, programme director at the US National Institute on Ageing, which co-funded the research.

http://www.ft.com/cms/s/0/6c9dee06-d9ff-11da-b7de-0000779e2340.html?nclick_check=1

To keep quoting from that bastion of British socialism, the Financial Times –
‘The researchers are struggling to explain their findings. Their analysis shows that lifestyle factors – particularly the fact that Americans are more obese and take less exercise – cannot account for the whole discrepancy. though they may provide a partial explanation.

Different health systems may also be part of the story. The researchers note that the US spends $5,274 per head on medical care while the UK spends $2,164, adjusted for purchasing power. But Britain’s National Health Service provides publicly funded medicine for everyone, while Americans under the age of 65 have to rely on private insurance.

Prof Marmot suggested that, while the healthcare provided by the British state health service was not superior to the private US system, it provided important psychological reassurance.

As the researchers say in the journal paper: “To a much greater extent England has set up programmes whose goal is to isolate individuals from the economic consequences of poor health in terms of their medical expenditure and especially earnings and wealth reduction.”’

Why let facts intrude on popularly held American beliefs, since as we all know, America has the best health care system in the world, as long as you ignore actually being healthy – shockingly, the British system, the sick man of Europe, so to speak, is returning empirically better results for lower cost.

Grodge, I understand that my theory about government and life expectancy is a radical one. I simply believe that a stated mission of guaranteeing life, liberty, and pursuit of happiness is subjective and ineffective. The only objective measure of a government’s success is how long it can guarantee the most valuable commodity: time. Able-bodied life expectancy is the only objective measure.

I also believe that no government policy that is good would decrease the average life expectancy for its subjects, and vice versa.

This graph is in ‘International Dollars’ (whatever the hell that is). If it is in Euros then I would argue that the Euro is about 35% to 45% overvalued. That would bring this spike down to $3,200. Then we throw in our diverse and crime ridden population and the numbers become quite reasonable.

What is interesting is that most all of the opinions (including B.R. implicitly agreeing that America is bad by even putting this up without a comment) that are jusing this as a comment on how bad our health care system is without hardly a look at the underlying data. Very shallow, friends.

This is some funny shit watching some good old fashioned fiscal conservatives defend paying two to three times as much as necessary for similar results.

Cook County in Chicago doesn’t seem to have this problem as 90% of their dead still vote.

You’d rather be treated in a European country for cancer? Whoops.
http://www.medscape.com/viewarticle/561737

Or Canada for heart disease?
Whoops
http://www.webmd.com/heart-disease/news/20040920/us-tops-canada-in-post-heart-attack-care

Does murder have a big effect on US life expectancy? You betcha:
http://blogs.wsj.com/numbersguy/does-the-us-lead-in-life-expectancy-223/

Then they adjusted life-expectancy stats to get a rough handle on what life expectancy would have been like had the rates of these deaths been the same in all 29 countries. Their result: The U.S. would have ranked first, at 76.9 years of life expectancy — an increase of 1.6 years

Again, the US health care system delivers better results where it counts–when/where people actually USE it. Could it be cheaper? Yeah. Would a single payer system here BE cheaper? ARE YOU OUT OF YOUR MIND???

Does anyone think that the “breast cancer advocates” would not crucify a public official who supported cutting off treatment or denying certain treatments as they do in the UK? Or the multiple myeloma support groups sit on their hands here if Velcade wasn’t reimbursed, as in the UK?

Get real. Show me some examples where the gov’t stepping in has resulted in greater efficiency in services. THAT’S why us “fiscal conservatives” don’t like the idea of single-payer health care. It wouldn’t work in the US, and it wouldn’t be any cheaper.

Allow workers to get the same tax breaks as their employees to buy health insurance (or better yet, don’t have any tax breaks), allow the purchase of out-of-state, totally portable insurance products, make health insurance more like life insurance–etc.

David

http://etalli.typepad.com/et_alli/2008/01/out-and-about-o.html

Out and About on the Net with Twitter Lines Halbrook, force for civil rights, dies at 100 — She is much missed…one of God’s people who loved and is loved. Iowa University ‘E-Market’ Predicts Caucus Winners, Losers — Hillary is

Is a significant portion of the higher health costs in the US due to the amount of R&D we do vs. other countries. (The results of which benefit other nations, I might add.)

Could someone with knowledge about this weigh-in on the topic?

During a visit to my doctors office many years ago, the doctor leaned across the desk, and asked if I want to know the secret of a long life?
I replied, yes.
He said, ” Pick the right parents.”

I think he is onto something.

How about this thought. Much of the spending (and more and more of it as each year progresses) is in medicines. The US develops many (most?) new medicines and they are extremely expensive. But when the US goes to sell them to Europe, the EU says, “Sorry, we’re not paying for development costs. Only manufacturing costs etc.” Or the US develops AIDS cocktails and is told to basically give it away to those who need it most i.e., Africa (which I’m sure was the plan all along when they sunk the billions into the meds in the first place!) or the WTO or whatever will let someone else make them regardless of any patents. So the US develops the medicines and then gets stuck with ALL of the developing costs. Just a thought.

Or, it could just be that people know we have the best healthcare and they come here in their final years :)

larry, i am not an expert on whether the R&D expenditures themselves get factored in here somehow. I do know that the differences in R&D expenditures themselves, however, are not that big. my memory is that they are in the order of $200 billion per year for the USA and $175 billion for the EU.

What is missing here is the level of elective and cosmetic health care, which can make the lives of many people more pleasant, but aren’t available in health care systems in other countries to nearly the same degree.

Things are much better here than most people realize. If the US health care system did not exist in its present form, many other nations would have a hard go of it, because cases that won’t be treated by their systems often come here.

I only read about a 3rd of the posts in this thread before I had to jump in and say that people are mighty touchy and defensive about this subject.

What struck me first was cuba vs. the US. Make of it what you will (Cuba is world renowned for its production of Doctors).

Also, among the professions, it’s interesting to note that the practice of medicine has been overtaken by business administrators. The practice of law has remained in the hands of he lawyers, who direct their administrators. Once again, make of it what you will

In my prior career I was a demographer who specialized in mortality, and I can tell you that a huge chunk of the US-vs-world disparity is most certainly due to the high rate of infant mortality in the U.S.

Look at life expectancy remaining after age 1, and you’ll see this.

That certainly doesn’t make it excusable of course, especially since there are fairly cost effect measures that can be taken to lower infant mortality rate (e.g. neonatal care, basic education of the mother, efforts to fight low birth weight). BTW, there is a HUGE disparity in low birth weight by race, and low birth weight is the strongest predictor of infant mortality.

This (link below) is a thought-provoking piece (on healthcare) by Professor Mankiw that was in the NYT a couple of months back. I think the message is valuable in that we often have to unpack the numbers to see what they are really telling us. I’m not sure it’s quite so binary. Given the # of U.S. deaths due to guns, obesity, and drunken driving, I would want to control for numerous variables and disaggregate by SES before coming to some homogenized conclusion. We have our issues, but it may be more gray than the chart depicts.

http://www.nytimes.com/2007/11/04/business/04view.html?ex=1351828800&en=7ebf86b6773f35bd&ei=5090&partner=rssuserland&emc=rss

RE: Innocent Bystander

“””During a visit to my doctors office many years ago, the doctor leaned across the desk, and asked if I want to know the secret of a long life?
I replied, yes.
He said, ” Pick the right parents.””””

Sorry, IB but longivity has the worse genetic predictive power of almost anything. A correlation coefficient of about 0.02. This is from the twins study at the University of Minnesota. In fact on average identical twins die about ten years apart.

Further, from my own anectodal findings to live longer stay away from harmful substances (drugs, booze, tobacco) and pay attention to your own health care by going to the doc when you detect something wrong and changing docs if you aren’t happy. These two factors account for two-thirds of the premature deaths in people that I have known.

Another point on National Health Insurance: In England 40% of the doctors get assulted by patients at least once per year. The Brits aren’t happy.

i have to say i’m appalled at the racial ignorance in these comments, and moreover the way they are tolerated as fact.

how on earth anyone could blindly say that 10% of the population (african-americans) could account for the vast majority of these findings is ridiculous. wow.

sebs-

i completely agree. i know quite a few people who live in the US and can afford US healthcare, but routinely go to mexico when they need treatment. it’s very common in the border states.

oops. posted to fast. still responding to norman:

patient satisfaction surveys across nations generally show US patients are less satisfied than most others. specifically, less satisfied than even UK patients.

that said, most health care experts informally agree the UK has a pretty bad system. france is probably the example we would want to emulate.

I have learned a lot from these comments, but I still picture a fat American guy with an erection lasting over four hours calling for an ambulance…

We probably spend more per capita on E.D. Television commercials than Cuba spends on maternity facilities.

Yeah, that’s it. E.D. medicine expenses explain that sharp uptick in the chart when it reaches the U.S.

“Another point on National Health Insurance: In England 40% of the doctors get assulted by patients at least once per year. The Brits aren’t happy.”

Here we sue them. There they just beat the crap out of ’em.

Based on the amount spent on malpractice insurance and awards here, we’re not all happy with our healthcare here either.

Agree with OldVet. Similar expression. Fun looking at old family birth certificates and cheap hospital bills. Recently went to a vet. Cost $300, and nothing much to show for it. But vet couldn’t do much without them, so they say. They were heavily pushing insurance. God help our pets. The insurance industry will ruin pet healthcare too.

It’s interesting to play around with the numbers at the WHO.

B, you are right!

but, they look a lot like per capita health care spending for sure. no idea for what year or whether adjusted to 2007 dollars or what.

i believe the numbers if you looked at them today would be a bit tighter since the euro has shot up in value so much, but the message is pretty much the same. we spend the most, and get the least for our money.

People don’t understand our health care providers aren’t required to guarantee minimal standards of care and that the biggest gains in health care come at very little cost. Consider the recent 100,000 lives campaign coordinated by IHI (Institute for Healthcare Improvement) – that overachieved its goal of saving 100,000 US lives in one year simply by enforcing basic proper medical procedures – things which everyone knows but does not do. This is being expanded to a 5 million lives campaign

http://www.ihi.org/IHI/Programs/Campaign/Campaign.htm?TabId=2

* Patients presenting with possible heart attack still do not routinely get aspirin.

* Doctors and patient care staff do not wash their hands between patients (gloves make them invincible – especially first year residents).

* Operating rooms are too cold for patient safety for the comfort of the surgeons and the OR teams.

* Patients develop pneumonia in ICUs and other patient care units simply because their beds are not elevated.

* Patients experience adverse drug effects because the prescribing physician does not determine what other drugs patients are receiving.

* Patiens are transferred between units haphazardly – patient comes from an OR to an ICU with no bed ready. Some hospital systems such as Geisinger have reduced complications incredibly merely by designing and enforcing good handoffs from one department to another and one work shift to another.

Talk to any hospital infection control officer about his/her experiences and you might be afraid to step into a US hospital again.

The one positive note is that hospital and healthcare administrators are now beginning to take quality of care seriously as a result of Core Measures (of patient care quality), the Leapfrog initiative of purchasers of care (insurers, companies), JCAHO changing accreditation requirements to quality measures, the mandated state QIOs (Quality Improvement Organizations).

Insurance and medical liability are causing healthcare to be as expensive as it is here.

I went to the emergency room on New Years day for bronchitis, they ran tests to see if:

1.) I was having a heart attack
2.) I had a rare, genetic disease that would cause a blood clot in my lung
3.) I had a hole in my esophagus

Guess what? They found out I only had bronchitis. 14 hours after arriving I left with a prescription for antibiotics and Robitussin.

I blame two factors. One, excessive liability makes them always check for exceptionally rare problems that may cause death. Two, the insurance company was paying, so why not make some extra $?

Other countries are less litigious than the U.S., that may be one reason they spend so much less.

BTW, unless you need something sewn back on, don’t go to the ER.

Perhaps the amount spent on Health Care in the US includes a lot of fat. The fat being exorbitant profits earned by the health care industry.

I am from Canada. I know If I get sick I’ll be ok. I won’t lose all my hard-earned money on health expenses.
This is a great relief. If I was a US Citizen I would be dead from anxiety. It should be very stressful. I’m just sorry for my fellow Americans who are in this situation.

What is my point? This effects life expectancy.

Another point, immigrants spend less money on health in US. So spending should be much more even though life expectancy goes higher (if you take out the immigrants from the picture)

I couldn’t follow the “nation of immigrants” and some kind of Genetic argument. Our gene pool should be more robust, and healthier, besides putting us at a disadvantage for “Mutational” advances, a Healthy Gene pool should make us healthier, overall.

and, Doctors should get assaulted:

nothing like a little Pavlovian learning. For people who say “I think it’s broken.” get an x-ray. or “I think it’s the Flu” Drink Fluids, and get some Nyquil.

I’m very surprised that some software program, hasn’t outsourced them by now.

To paraphrase Mark Twain, before distorting the facts as you please, get them straight first.

To those who are “man enough” (with apologies to the ladies here) to confront their belief systems (a tough thing to do) I strongly suggest :

http://www.sciencefriday.com/program/archives/200712141

Discount illegal immigration, African-American statistics, the lack of regression on the graph, murders and accidental deaths all the hell you want, the fact remains that the USA has a very inefficient allocation of health care dollars compared to any developed nation on this planet.

It is truly amusing, as well as amazing, to read the tsunami of justifications aimed at defending the status quo. I guess there are a lot of people that buy the notion that any call to improve our health care cannot be anything else than an attempt by the International Communist Cabal to weaken the power of the almighty USA.

Anyone has a particular problem with the notion that our health care system COULD, MAYBE, PERHAPS, work better, with LESS waste, while providing meaningful access to more, if not all the US population?

I’ll see your High school statistics, and raise you the “origins of species”, and 600 years of genetic science….

I have honestly looked for whatever
90% genetic similarity your talking about, and besides the Genetics of Pocket book size. I’m just not seeing it… Does it involved Jews and the international bankers and the black helicopters?

I thought the Heresy in school was science. I know my High school was trying to keep me Stupid and Ignorant, at the behest of all the religious Zealots and the “Jesus Magic”.

Don’t let me stop you, from those books keeping you …..

Sorry, I’m better than this… interesting opinion Sir and good luck, if your not achieving some kind of understanding, fulfillment and happyness. If your not, in your shoes i’d try Broaden my horizons. My bet would be, that the only one keeping you down is you.

Further note: I’ve read both the Turner Diaries, and Mein Kampf… the latter was OK(as a read, but not as a philosophy), but that dude had a deteriorating case of Syphilis, and the Former, I want those hours back.

I assume this is what you’re dancing around.

A few months ago my wife had pregnancy complication. She had to undergo a routine surgery. It was conducted by her gynecologist, it took about half hour for the operation, and 5 hours or so to recover. She was out of the hospital in six hours. She is not insured so we got all the bills. Her doctor charged $1,500, the anesthesiologist charged $1,000, the hospital bill was $12,000, of which $6,000 was for the use of op. room, $4,000 for recovery room, $1,000 for anesthesiology?, and $1,000 for other small things. Maybe someone here can explain these numbers, because I can’t. This is more than annual average income for most countries in the world, and more than most people here in the US spend annually on most things.

e_b_a,
the explanation is that it is “silly money”. the hospital is not thinking of billing you. it is thinking of billing the insurance company. the insurance company already knows how much it is willing to pay for these services and will just wave the rest of the charges away, all of which has been previously agreed upon with the hospital.

the sticking point comes when there is no insurance company. you have to pay the un-negotiated prices, which can easily be 2x to 10x the “real” prices the insurance company would pay. in a way, it is almost as if they expect you not to pay. of course if you are a middle class person who can be intimidated by collection agencies, then you might just pay and end up in deep financial trouble. the hospital really seems to not care about that.

i have spoken to many people about this and have yet to figure out exactly what the rationale is for the exorbitant un-negotiated prices. one explanation is that they want to build up their losses somehow. if you ever look at hospital finances, they are always losing money. this may serve to make the case. the other is that they bill you for not just yourself, but for all the other uninsured people who did not pay their bill. so if they get a sucker who actually pays the bill, that person is paying for 3 or 4 uninsured patients. the last explanation is that they are just crooks, but that is not very kind.

Mike G:

Thanks for your comment! For what it’s worth, we have plans to revisit the topic of health care sometime later this year, although I can’t say when. With the exception of Fridays (and occasionally Saturdays) when we review the best blog posts from various business and money-related blog carnivals, there’s no set schedule we follow. What you see on the days we post is simply what we have ready to go!…

e_b_a_l:

Sebs is pretty much correct. Fees are set arbitrarily with the thought that some individual may actually pony up the full amount, but nobody ever does. There was a time when a few insurance carriers paid 80% of the fee, no matter what is was; those days are gone and all fee schedules are negotiated up front.

The mark-up is 1.5X to 2.5X the usual negotiated fee or the Medicare fee, and hosptials and doctors will almost always negotiate their fees down with you based on your ability to pay. Sebs is a bit too cynical in his surmise, but that is understandable with so much negativity out there.

My advice is to talk to the hospital billing department and see if you qualify for emergency Medicaid or other assistance. If not, then negotiate the fees down. Same goes for the doctor– he/she will be understanding especially if they are in private practice; the last thing they want is nothing for their effort.

The last thing– what the heck are you doing without insurance while your wife is pregnant?! Almost every state has very lenient needs requirements for Medicaid benefits for pregnant women– in other words, they raise the income thresholds for pregnancy care.

Good luck, my friend. The last thing you need is such a hassle when your pregnant wife is having a problem.

(My feeling is that everyone should be required to have insurance at all times– either state subsidized or not; single payer or single-payment or whatever works. But the current hodgepodge only works for insurance companies who can cherry pick the healthiest and wealthiest customers.)

Best wishes to you.

To be visually meaningful, the LHS scale should start at ZERO rather than 74.

Thanks, Grodge.

She can’t have insurance. We have no problem to pay for the services and we usually do. However in this particular case the fee is simply ridiculous so the hospital will have to eat it.

Mike G:

I know this thread is quickly becoming ancient, but I have to comment on your entry.

At any given time 40 million people do not have health insurance, which means that 40 million are not paying premiums; yet they are still vulnerable to getting sick. It may not be the same 40 million throughout the year, but the fact remains that a significant number of potential patients do not have insurance at any given time.

As you said, they get health care if its needed– they just don’t pay for it. Going without insurance should not be an option– especially for the young and healthy.

This is a problem. Those with insurance are paying more to make up for the costs for those without insurance who will still get sick and need care. If doctors and hospitals cannot choose to withhold care without payment, then I conclude that everyone should have the ability to pay at all times.

“That is not my understanding”
Too bad. Reality is not gonna change just for you.
“Although nearly 47 million Americans are uninsured, the United States spends more on health care than other industrialized nations, and those countries provide health insurance to all their citizens”
http://www.nchc.org/facts/cost.shtml

“Researchers found that 68 percent of the undocumented immigrant adults they studied had no health insurance. This compared with 17 percent of the native-born Americans, 23 percent of immigrants who had become citizens, and 38 percent of immigrants who are permanent legal residents.”
http://www.rand.org/news/press.05/11.10.html
U.S. Population in 2005 was about 280,000,000. Do the math.
If he has included the whole US population Ironman’s per capita costs are artificially low (and no E.R., visits are not health coverage anymore than a visit from the Fire department is fire insurance)