How appalling the American health care system is

1. The top chart above (data here) shows both: a) unadjusted life expectancies for the U.S. and other OECD countries, and b) standardized life expectancies which are adjusted for the effects of premature death resulting from non-health-related fatal injuries. For unadjusted life expectancy, the U.S. ranks #14 out of 16 countries, but for the adjusted standardized life expectancy the U.S. ranks #1.

Take out the murders and the car crashes and the US seems to get very good results indeed from its health care system.

Assuming that is true it\’s a wonder that it\’s not more generally known really.

16 thoughts on “How appalling the American health care system is”

  1. “Assuming that is true “: quite an assumption. Blogs are no doubt a poor guide, but whenever I’ve seen an American blogger or blog commenter wrestling outraged with the suggestion that some other countries have longer life expectancies than the USA, I have formed a firm impression that they are not trying to explain the discrepancies so much as explain them away. One clue is that they’ll settle on one phenomenon (e.g. the US propensity to mutual slaughter) and, if that seems to do the trick to their satisfaction, stop there. No other effect is investigated. For what it’s worth, my own inclination would be to bin the idea of “life expectancies” when it comes to this topic – they are just predictions after all – and attend strictly to the life-spans of those who have died each year – which aren’t predictions but are as close to facts as you’ll get in the medical world.

  2. It’s an interesting concept. The paper is here, as the source link in your linked post is broken.

    Murder fatalities are at best tangentially related to healthcare outcomes (since a fairly high% of people who’ve recently been potentially-murdered will be reluctant to seek gold-standard medical care, as will the people around them at the time), but I’m not sure it’s legitimate to make the same claim for transport fatalities.

    If one country is excellent at acute trauma care but relatively poor at chronic care based around expensive drugs (*cough*UK*cough*), then that’s an area where its healthcare system is quite likely to make a significant difference to that statistic.

    (it’s also worth noting, though tangential to your point, that the use of five-year cancer survival in the paper is a little dishonest. Among the insured population, people in the US undergo far more frequent medical tests than other countries, because of the way incentives work in this system. While this does mean that cancers may be treated more quickly and thus effectively, a more important effect on the data is that – even when the cancer is completely untreatable and medical intervention has no benefit at all on when and how you die – the average time between diagnosis and death is longer and so the stats look better).

  3. I’m sceptical about this. The data come from this presentation.

    Table 1.3 tells us that the USA has 22.6 deaths per thousand from homicide and transport accidents, whereas Japan has 8.9 .

    To get an estimate on life expectancy of the effect of this, assume that each of these deaths costs 50 years of life. Then the effect is 1130 life years per thousand in the USA – equivalent to 1.13 years off life expectancy, and 445 life years per thousand in Japan.

    But table 1.5 gives a calculation of life expectancy adjusted for fatal injury rates. The adjustment increases life expectancy by 1.6 years in the USA, and decreases it by 2.7 years in Japan, a swing of 4.3 years. Compare that with the swing of 0.685 years I estimated. (I suppose they’ve standardized the adjusted data to give the same overall life expectancy, hence some countries see a fall.)

    So either there are a huge number of fatal injuries in the USA from causes other than homicide and transport, which the presentation doesn’t think to mention, or table 1.5 is wrong.

  4. Riffing on what dearieme said, it seems almost certain that even if they’d survived, homicide victims would still have died younger than the median American (given the race and income discrepancies in deaths from natural causes)…

  5. Life expectancies are not really forecasts – ie they aren’t adjusted to take into account a likely lengthening of life expectancy.

  6. These life expectancy figures are for 1980-1999. US life expectancy has stagnated since then while other countries have continued to improve. The US is now down to 38 on the UN life expectancy table.

  7. In which our blogger notes that the US is a fucking dangerous place, and uses this to celebrate its expensive healthcare….

  8. I saw a reasonable explanation for a chunk of US underperformance, which is the US had a vast number of smokers in the 1960s and 1970s (rich, before health risks widely known).

  9. The unhealthy lifestyles that Americans generally lead is a big contributor to stagnating life expectancy figures. Fatty foods, minimal exercise, etc. Even world-class medical treatment is going to struggle to compensate for this.

  10. Apples and Oranges.

    Ann Coulter says that in the US they count deaths of babies as proper deaths, rather than waiting a bit after the birth, just in case. Hence the huge fuss there about partial birth abortions where the aborters go to a lot of trouble to stop the baby crowning, rather than letting it out and then offing it.

    On the other hand there seems to be there’s much more state killing in the UK. LCPs and DNRs. In most US states that would be criminal & counted as an unnatural death.

    Taken together, these make the US LEAB seem to be lower and its level of violent death to be higher.

  11. LCP and DNR equivalents (“the patient is nearly dead, so we will make them as comfortable as possible and not give them additional traumatic treatment”) exist everywhere in the world where medicine is practiced.

    It’s Tea Party silliness to assume they’re unique to NHS Death Panel-ery, and even sillier to assume they’d be counted as unnatural deaths elsewhere.

    *If* the UK had Swiss-style assisted suicide legislation, you might have a point, but it doesn’t.

  12. John B

    LCP and DNR equivalents…exist everywhere in the world

    LCP doesn’t exist in the US, ‘equivalent’ or otherwise & if you want DNR you have to get a No Code bracelet or tattoo.

    I know, I lived there half my life.

    Piss off back to the Guardian.

  13. The US does of course operate hospices, mostly paid for by Medicare, where DNR orders are common.

    Terminal care options in the USA include “Terminal Sedation” and “Withdrawal of Life Support”. How is that not equivalent to the LCP?

  14. dearieme: “mutual slaughter” my ass; I have plenty of relatives and friends in the US, and my kind of people don’t kill each other.

    Heck, they even live in nice enough neighbourhoods that they don’t have to kill the other kind of people.

    The fact that the other kind of people just punch out their kind of people, as well as my kind of people, rather than killing them in the UK, doesn’t mean that the US medical system is any worse than the UK medical system.

  15. Just talked to an American independent insurance agent* who worked a booth at the World Senior Games.

    Of course, most of the seniors competing and winning are Americans. I wonder how they manage that with such a poor healthcare system?

    Anyway, the agent was stunned at the number of non-Americans who would come by her booth to gratuitously remark on the negatives of the American healthcare system. The irony escaped them.

    * If you don’t have adequate insurance in the U.S., you can buy it. An independent agent is one that isn’t trying to sell you one specific company’s product.

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