James Pethokoukis

Politics and policy from inside Washington

Turns out U.S. healthcare system is actually, like, really good

August 20, 2009
University of Pennsylvania researchers Samuel Preston and Jessica Ho have looked at the low-life expectancy numbers in the United States and asked the question: “Is the health care system at fault?” Here is their answer (bold is mine):
Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral or social factors. …  We find that, by standards of OECD countries, the US does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and where behavioral factors do not play a dominant role. We show that the US has had significantly faster declines in mortality from these two diseases than comparison countries. We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system.
So if not the healthcare system, then what?
But measures of population health such as life expectancy do not depend only on what transpires within the health care system – the array of hospitals, doctors and other health care professionals, the techniques they employ, and the institutions that govern access to and utilization of them. Such measures also depend upon a variety of personal behaviors that affect an individual’s health such as diet, exercise, smoking, and compliance with medical protocols. The health care system could be performing exceptionally well in identifying and administering treatment for various diseases, but a country could still have poor measured health if personal health care practices were unusually deleterious. This is not a remote possibility in the United States, which had the highest level of cigarette consumption per capita in the developed world over a 50-year period ending in the mid-80’s (Forey et al. 2002). Smoking in early life has left an imprint on mortality patterns that remains visible as cohorts age (Preston and Wang 2006; Haldorsen and Grimsrud 1999). One recent study estimated that, if deaths attributable to smoking were eliminated, the ranking of US men in life expectancy at age 50 among 20 OECD countries would improve from 14th to 9th, while US women would move from 18th to 7th (Preston, Glei, and Wilmoth 2009). Recent trends in obesity are also more adverse in the United States than in other developed countries (OECD 2008; Cutler, Glaeser, and Shapiro 2003).
Comments

I always felt the pro-ObamaCare side was being dishonest when they a) referenced infant mortality rates without recognizing differences in definition of infant mortality (a baby born three months premature here counts in our mortality statistics, but does not in many countries), and b) ignored differences in behavior that could affect mortality. Nice to see a little confirmation of this.Our health system may be expensive, but we are getting a lot for the money.

Posted by pete | Report as abusive
 

I always felt the rankings implied more than they could support anyway. The expectancy is carried out to the tenth of a year. If you round to the nearest full year, the US is tied for 37th. It’s still not the top ten, but it’s not “OMG #50!” either.

 

I saw a video piece about this yesterday on the nightly news. It got pretty good play as a big positive, and there was no effort to downplay it or to imply the results might be misleading in any way. My immediate thought was that SOMEBODY smart on the actual “care” side of heathcare was working hard to get the word out that there’s more to this debate than “insurance”. Good for them and good for us.

Posted by Elizabeth | Report as abusive
 

What would happen if the you factored out blacks in mortality stats?I remember soemthing a few years back where the US would get a major leap in life expectancy if the very early average age of death for black americans was removed.And a great deal of that is heart disease (very heavy on lifestyle choice) and violenceObama offers a solution. A final one for the elderly

Posted by GW Crawford | Report as abusive
 

Found it in a CDC documentIn contrast, the fetal mortality rate of 11.13 fornon-Hispanic black women was 2.3 times the rate for non-Hispanic white women.A lot of fetal deaths causes a major drop in life expectancy (100 in a village, 50 die at childbirth, 50 live to one hundred = mortality of 50 years!)

Posted by GW Crawford | Report as abusive
 

It’s a bit of a sham comparison to rank US healthcare vs. individual countries. On a GDP basis, each US state could represent another country.http://strangemaps.wordpress.com  /2007/06/10/131-us-states-renamed-for-c ountries-with-similar-gdps/http://strang emaps.wordpress.com/2007/07/06/135-updat e-on-the-gdp-map-of-the-usa/To make an honest comparison they could use a combination of countries that approximate the entire US GDP. According to the second link, a combo of China, the UK, Germany and Japan accomplishes that.Or using the GDP basis, compare individual US states with the WHO World Healthcare ranked countries. http://www.photius.com/rankings/healthra nks.html For instance France is ranked #1 for Healthcare on WHO’s list. So compare France & California, heck they both have world renown wineries ;-)More in the same vein — Texas = Canada, North Carolina = Sweden, etc.Judging Healthcare strictly by life expectancy/mortality rates is not apples to apples either. Missing from the debate is the fact that the US has a much higher instance of homicides and accidents than the rest of the developed nations. You are 12x more likely to be murdered in the US than in Japan (BTW – Japan is #10 for Healthcare on the WHO list). Absenting homocides & accidents the US would be ranked #1.This is great info & opinion from Steve Chapman on Real Clear Politicshttp://www.realclearpolitics.com  /articles/2009/08/16/whats_scary_about_ health_care_reform_97901.html”…..One big reason our life expectancy lags is that Americans have an unusual tendency to perish in homicides or accidents. We are 12 times more likely than the Japanese to be murdered and nearly twice as likely to be killed in auto wrecks.In their 2006 book, “The Business of Health,” economists Robert L. Ohsfeldt and John E. Schneider set out to determine where the U.S. would rank in life span among developed nations if homicides and accidents are factored out. Their answer? First place.That discovery indicates our health care system is doing a poor job of preventing shootouts and drunk driving but a good job of healing the sick. All those universal-care systems in Canada and Europe may sound like Health Heaven, but they fall short of our model when it comes to combating life-threatening diseases.Some of those foreign systems are great, as long as you don’t get sick. Samuel Preston and Jessica Ho of the Population Studies Center at the University of Pennsylvania examined survival rates for lung, breast, prostate, colon and rectum cancers in 18 countries and found that Americans fared best.The U.S. also excelled on other measures, such as surviving heart attacks for more than a year. Why? Because our doctors and patients don’t take no for an answer. The researchers attribute the results to “wider screening and more aggressive treatment.” Another factor is that we get quicker access to new cancer drugs than anyone else……..”

Posted by Siobhan Sack | Report as abusive
 

Wow! So it’s not that healthcare is bad, it’s that you murder each other at the highest level in the OECD and are obese on an unimaginable scale. And, of course, it’s not really a white problem, it’s the minorities fault. Maybe the minorities have all these problems b/c they are pidgeon-holed into minimum wage work and don’t get/can’t afford healthcare…If owning a gun should be an unalienable right in America, my GOD!, why can’t healthcare be?

Posted by the Shah | Report as abusive
 

Shah, health care is a commodity. A service. It is not a “right”. Voting is a right. Gun ownership is personal freedom.And, yes, if took out the racial factors, and factored in the high level of obesity, smoking, and drinking (a personal choice), our life expectancy would compare favorably with anyone’s. But the left doesn’t want anyone to know that.

Posted by Duke | Report as abusive
 

It turns out, according to a 2006 study, that when deaths from murder and auto accidents are factored out of the longevity data for industrialized countries, the US longevity rates are #1, not #17. Health care here is good, but we don’t do so well on murder and driving.

Posted by John Wheeler | Report as abusive
 

Dear Everybody,A meaningful alternative to Obambicare? Go to the Weekly Standard site and check out the article “Going Dutch.” Its about the reforms the Dutch, who are definitely not big fans of American paleocons, have put in place to upgrade their health care system. It’s written by Stanley Goldfarb, one of the deans at the U of Penn medical school.”The Netherlands is a liberal country. It has legalized drugs and euthanasia is an accepted social policy. Yet, to solve its health care dilemma of rising costs and inefficiency, it has turned to a health care system that sounds much more like something to come out of the American Enterprise Institute than from a nation in which the Socialist party made the largest gains in the last election. It is opting for private health insurance and competition… Can’t we learn from countries like the Netherlands where competition, incentives, and privatization are seen as the means to efficiency and high patient satisfaction?”But Obambi and his followers don’ t want a genuinely efficient health care system. They want control.Mike GallagherSeoul, Korea

Posted by Michael G. Gallagher | Report as abusive
 

people on this blog- before now with which i have never interacted- seem to enjoy purposefully skewing information to achieve a desirable response; like, if it were not for black people or hispanic people our healthcare statistics would be a lot better… that type of deduction does not work. i’m sorry, in fact, it is the epitome of ignorance.As for the actual blog, those bold faced interjections between the normal script, i thought everybody already knew that our lifestyles were a part of our healthcare problems? Not much new information there. What is new, is how many people on this blog think that because a person is fat, it shows they have chosen a lifestyle conducive of there appearance… You have not eaten in a school lunchroom recently. Nor have you driven down the road? Do you know that it is more expensive to buy Broccoli than a cheeseburger? Do you know that water is more expensive than Coca-cola (Bottle H20- i’ll distort my information a little for dramatic affect too. ha.)More so, because these schools are provided by the government, we could say it is actually the governments fault that these people are fat- we could even say, because of the stressful nature of our society, that people use alcohol (very high in calories), and food, to console their psychosis. Not to mention the other quicksand like entrapments within our society which keep people within destructive cycles- like our transportation system, duel workload households… the issues are endless. And are all part of the problem. Oh, and when I say society, i don’t mean United States, I mean our human society- because we are all basically the same from country to country, and the issues have to be fixed everywhere.

Posted by james hendry | Report as abusive
 

some basic considerations about stats (averages) will help here:there are more smokers in europe.but their health stats seem to be similar to that of european non-smokers, sincecrass differences between europe and the usa –in europe’s favor– disappear when you remove smokers from the comparison.this means that usa smokers fare horribly compared to european smokers (or, much less likely, that european smokers have much better health than european non-smokers).it’s almost sure that usa smokers fare much much worse than european ones, simply because smoking is a lower-class thing in the usa.so among usa smokers there must also be many more diabetics, drug addicts, alcoholics, reckless drivers, wife beaters, hypertension acrobats, overweighters, etc, i.e., people who do all those things that make “life worth living”TM.in other words, the usa’s “melting pot”TM not only segregates by race and class, but also by morbidity, which because of “manifest destiny”TM tend to coincide!the country indeed gives the poor and the lower middle class the “freedoom to choose”TM to be diabetics, drug addicts, alcoholics, reckless drivers, wife beaters, hypertension acrobats, or overweighters, etc; a very diverse “plethora of opportunities”TM to choose from, opportunities that these less deserving classes like to take as a combo more often than not.obviously europeans are not enjoying these basic freedoms as freely –oh freedom! as aretha would put it– (although europeans have been catching up thanks to the recent efforts for “labor flexibility”, “private pensions”, by some of their most illuminated –if venal– leaders and intellectuals).so the innocuous exclusion of smokers “for fairness” by the authors removed many of the most self-destructive poor and under-insured people from the usa data and left more affluent, better educated, more health-conscious upper-class usa people to be compared with a more random segment of the european population. not exactly fair, one would say.one has to wonder though if the authors did not know about this in advance and, if they did not, why on earth they chose not to dissect the above superior health of european smokers which the result of smokers’ exclusion made evident.

Posted by marc | Report as abusive
 

So, the USA is #1 if you eliminate the worst demographics from the statistics? Woohoo!

Uh, wait a second. That’s nothing to pat yourselves on the back about, guys. That’s just disingenuous playing with statistics for purposes of propaganda. If you remove the worst demographics from ANY country’s statistics, its overall ratings improve. Placing the USA’s doctored statistics against other countries’ undoctored statistics is a dishonest comparison.

If the USA’s healthcare system were any good, it wouldn’t have the lowest satisfaction rating or the highest cost per capita of any industrialized nation (it has both!). You also wouldn’t need to be dishonest with statistics to make it look good.

Posted by Benjamin Pyke | Report as abusive
 

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