Is US Life Expectancy Understated?

[Arkady]

As most people know, US life expectancy is horrible, despite the US spending more on healthcare than any other nation, by a wide margin. However, one of the conservatives here pointed at that there's an argument that US life expectancy is actually just driven down by other factors that aren't really health related (commonly-cited factors being traffic accidents, suicide, and murder). One study attempted to adjust for these factors, and suggested that once you do so, you find the US is actually first in life expectancy, not 19th as the standard data would show.

It's an interesting argument, and I always appreciate it when a conservative approaches a question with numbers and scientific studies, rather than just anecdotes and rhetoric. However, there are at least two layers of problems with that approach. First and most obviously, simply throwing out traffic accidents, suicide, and murder, would be expected to disproportionately help the US. All three of those things hit the young at a higher rate than the old. And, in the US, the young are more likely to be uninsured than the old (both because of Medicare eligibility over age 65, and because older people are more likely to have the kinds of steady jobs that have health benefits). If the way the US healthcare system leaves many people uninsured results in worse care, we'd expect it to be most prominent with the young, who are more likely to be uninsured. And in the case of accidents, suicide, and murder, poor healthcare can, in fact, have an impact on the death rates. The difference between a shooting and a fatal shooting (or a car accident and a fatal car accident; or a suicide attempt and an actual suicide) is sometimes going to be the quality of the care the person receives after the fact. And with suicide you have the added issue that a medically neglected mental problem can mean more suicide attempts.

So, simply disregarding suicides, murders, and fatal traffic accidents could be expected to disproportionately extract from the life expectancy calculation things that should, in fact, be held against the American healthcare system. If we're suffering more traffic deaths, suicides, and murders in part because of failings in our medical system, we shouldn't be allowed to simply define those things out of existence for purposes of assessing our medical system.

Aside from that, though, it appears that the calculation the conservative poster was talking about was flawed to begin with. Rather than throwing out those problematic deaths and recalculating life expectancy (which would only have pulled the US up slightly, from 19th to 17th), they instead did a regression analysis involving GDP-per-capita, to try to figure out a guess for what life expectancy would have been if deaths from those causes had been equal. As you can imagine, trying to back into the answer by finding a correlation with GDP-per-capita doesn't tell you much of anything other than what countries have high GDP-per-capita. They took a lot of criticism for that and, to their credit, they don't seem to be denying the flaws... they've just fallen back to the weaker argument that whatever the flaws of their argument, it's at least suggestive that official life expectancy stats might be skewed by other factors):

http://blogs.wsj.com/numbersguy/does-the-us-lead-in-life-expectancy-223/tab/article/

http://theincidentaleconomist.com/wordpress/how-flawed-is-life-expectancy/

From "M. Simon" on the Amazon.com book review, here's a discussion of the actual formula used in the regression analysis:

Be aware that one of the most surprising conclusions in the book - that the U.S. healthcare system, when you take away injuries and accidents, actually has the best life expectancy in the world - is based on a very clever twist of the underlying data.

Instead of looking at real-world life expectancy and then taking away deaths due to injury and accident (a method that puts the U.S. at 17th) Mr. Ohsfeldt uses an equation that begins with an ESTIMATE of life expectancy BASED ON GDP PER CAPITA (a measure of how rich the country is), not on actual real-world data. Then he adjusts for injuries and accidents. Of course the U.S. remains at the top of the list, as we are one of the richest countries in the world.

Here's his equation, from the book:
LifeExpit = 50.78 + 3.020 * log(GDPPCit) - 0.077 * [mean(Trans)]
- 0.137 * [mean(Falls)] - 0.133 * [mean(Homicide)]
- 0.0326 * [mean(Suicide)] + year-effectsit

The equation includes "log(GDPPCit)", which is GDP per capita in country i, year t, and it includes factors for transportation accidents, falls, homicide, and suicide. Mr. Ohsfeldt suggests in his writing that the equation and graph are based on real world life expectancy data, which figure into the equation nowhere at all.

 

[Woolleybugger]

I wonder how the incarceration rates affect the numbers as well. We have the highest rates in the world per capita.

 

[gabriel]

well done

 

[Arkady]

Good question. That would be really hard to study, though, since presumably that "self selecting" group would have unusual mortality rates whether in or out of jail (the kind of person who is predisposed to criminal conduct in the US might be predisposed to other risk-taking conduct in a less criminal context if he lived in some less socially disfunctional country).

 

[NCmusicman]

Considering illegal aliens make up a huge percentage of jail populations... the problem is easily fixed... and we could save billions per year.

I wonder how the incarceration rates affect the numbers as well. We have the highest rates in the world per capita.

 

[Arkady]

Thanks. I like it when we can get down to actual numbers, with right and wrong answers, rather than the usual back-and-forth with mere anecdotes and emotions.

 

[Woolleybugger]

I would argue that prisoners likely have better health outcomes than they would outside because they have full coverage.

 

[Drumcollie]

As most people know, US life expectancy is horrible, despite the US spending more on healthcare than any other nation,

Well there goes this theory...that you were educated and understiood what life expectancy is...because obviously you dont

United Nations World Population Prospects 2006 Revision and 66.57 years (64.52 years for males and 68.76 years for females) for 2009 according to CIA World Factbook 2009.

United States 78.2

average was the average for the U.S. in 2006...now increased to

United States 78.37

The flaw here is in thinking that life expectancy here is horrible..when in fact it is increasing on a yearly basis and that no country in the top 5 in population has a better life expectancy rate...That tells us

1. the healthcare system in the U.S. is better than :

China
India
Indonesia
Brazil

In fact not a single country with over 150 million has a better life expectancy rate.

So Iam saying that the assertion in your statement is wrong. That we actually do better with healthcare than any large populous country In fact the closest large populous country that is doing well is Japan with a declining population ranked 10th in the world for population.

What we need to see is where countires like Europe will shake out in this financial crises and how that effects healthcare as govts go bankrupt and the citizens are dependant on govt for their healthcare.

My assessment is that rather than look at staistics accurately and point out that over the last 6 years healthcare has increased you choose to blatantly disregard facts in order make the plea for a leftist vison of healthcare. We didnt even need Obamcare to do this...the healthcare system is fine.

I assert that if we (lefty get prepared to gasp) teach our children right form wrong and decrease the rate of violence and create a system where we immigrate those who want to be law abiding citizens into this country the life expectancy rate will go up. Decreasing the crime rate, decreasing sexually transmitted diseased like HIV AIDS would bring the life expectancy rate higher . We have one of the highest amounts of people with the STD in the U.S.

The healthcare system is not flawed we do the best and are increasing..it is the morality that is failing our healthcare not the system.

 

[Arkady]

How?

 

[Drumcollie]

The impact of AIDS is particularly notable on life expectancy in many African countries; According to the UN[33] the life expectancy at birth for 2010–2015 (if HIV/AIDS did not exist) would have been:

70.7 years instead of 31.6 in Botswana
69.9 years instead of 41.5 in South Africa
70.5 years instead of 31.8 in Zimbabwe

The system is not flawed in the U.S. and having one of the largest HIV populations in the world ...morality is the culprit

http://en.wikipedia.org/wiki/Life_expectancy

 

[Drumcollie]

How?

How what?

 

[Arkady]

Why would the size of those populations be a factor in your analysis? I mean, if you prefer we can compare to the whole EU, which has a comparable population to the US and a longer life expectancy. Or we can compare individual US states, like Texas, to individual wealthy countries with comparably-sized populations, like Australia (again showing the US with a lower life expectancy). But the idea of only comparing us to other very populous countries seems completely arbitrary, like comparing us only to nations founded after a certain year or only nations starting with the letter "U". It's useful for cherry-picking, but, to put it frankly, deeply stupid for policy analysis.

Anyway, if you want to focus on improving our life expectancy not by introducing a modern healthcare system of the kind every other wealthy nation has, but instead focusing on decreasing violence and HIV infection, I suppose that's somewhere we could focus. But then the question becomes why the US has so much more violent crime and STDs than the more socialized economies of other wealthy nations. If we want to emulate the successes of places like Europe, Canada, and Japan, on those fronts, we'll have to identify what they're doing right that we're doing wrong. I've got some ideas. Do you?

 

[Arkady]

"... the problem is easily fixed." How?

 

[Arkady]

If we have such terrible morality in the US, relative to the morals in Canada, Western Europe, Japan, Australia, and other wealthy nations, how do we remedy that? What are we doing wrong that they're doing right?

I've got some ideas. For starters, I think we're poisoned by immoral religions here (most prominently evangelical protestantism), where most other wealthy nations are a lot more secular. We also have an immoral idolatry for capitalism, where most of those other nations are more circumspect about it (at least enough to have implemented socialized medicine). And that gives rise to secondary problems. For example, we work vastly more hours, on average, than a typical German. That leaves German parents with much more time to spend with their kids, teaching them morals. When your typical American is stuck at work for a crushing work-week, with little annual vacation, and long commutes further cutting into family time, is it any wonder that our kids grow up without the moral code that leads to German kids being less prone to crime and other irresponsible and antisocial behavior?

We could also approach this problem by looking at life expectancy by state, within the US, if you're uncomfortable with comparing the US unfavorably to the morality of somewhere like Europe. So, if morality is the culprit, then we'd expect the less moral US states to have lower life expectancies and the more moral US states to have higher life expectancies, right?

Currently, the following states lead the nation in life expectancy: Hawaii, Minnesota, California, New York, Connecticut, and Massachusetts. And these have the lowest life expectancies: Mississippi, West Virginia, Alabama, Louisiana, Oklahoma, and Arkansas. So, in what way do you see that first list being more moral than the second, exactly? How is Hawaii more moral than Mississippi, for example?

Well, since all the first group of states are "blue states" that voted for Obama, and all the second are "red states" that went for McCain, you won't hear me arguing the point about the first being more moral than the second. Their voting pattern clearly suggests a more morally sound population than those conservative hell-holes in the second list. And since that first pack of states also contains gay-marriage and civil-union-friendly states, that's also a strike in their favor in terms of morality. Wouldn't you agree? Or are you picturing some other morality mechanism as the culprit?

 

[Drumcollie]

Why would the size of those populations be a factor in your analysis? I mean, if you prefer we can compare to the whole EU, which has a comparable population to the US and a longer life expectancy. Or we can compare individual US states, like Texas, to individual wealthy countries with comparably-sized populations, like Australia (again showing the US with a lower life expectancy). But the idea of only comparing us to other very populous countries seems completely arbitrary, like comparing us only to nations founded after a certain year or only nations starting with the letter "U". It's useful for cherry-picking, but, to put it frankly, deeply stupid for policy analysis.

Anyway, if you want to focus on improving our life expectancy not by introducing a modern healthcare system of the kind every other wealthy nation has, but instead focusing on decreasing violence and HIV infection, I suppose that's somewhere we could focus. But then the question becomes why the US has so much more violent crime and STDs than the more socialized economies of other wealthy nations. If we want to emulate the successes of places like Europe, Canada, and Japan, on those fronts, we'll have to identify what they're doing right that we're doing wrong. I've got some ideas. Do you?

1. You cannot compare the whole EU to one country...27 countries 497 million...not one governing body on healthcare that regulates healthcare for all. The EU mandates a standard for their countries but does not run helathcare...the analysis as a camparison of equal would be a false comparison.

If we look at countries of the E.U separately

Romania 72.5......Bulgaria 73.0...Lithuania 73.0...Latvia 72.7 Czech republic 76.9 Slovenia 77.9 Estonia 71.4 Hungary 73.3 Slovakia 74.7 Poland 75.6 Portugal 78.1 are all members of the E.U. with shorter life expectancies than the U.S.

If you want to compare Australia with Texas again now a country vs state...not valid either lets compare where we rank with countries of similar size and population...we rank ahead of them all....let compare where we were in 2006 and where we are now...up 1/10

So we could compare wealthy nations, and by this then we would have define wealthy...with debt vs revenue. So then lets us compare

The UK which the debt is 360 percent of GDP

Germany which debt is 142 percent of GDP

France 182 per of GDP

Netherlands...344 percent of GDP

Belgium 266 percent of GDP

Switzerland 266 percent of GDP

Sweden 187 percent

Austria 200 percent

Norway 141 percent

Finland 155 percent...so we see that E.U. has racked up a lot of debt creating a unsustainable ability to continue to provide govt funded anything.

So we see that you do have ideas...not well thought out, nor wth a budget in mind because when you become dependent on Govt to provide for healthcare while running up debts much greater than even in nthe U.S. as a percentage of GDP one can see that the sustainability of these healthcare programs are in jeopardy.

As for Japan they would be the best guide to study, not emulate necessary because they have the best record on life expectancy. So the questions begs so how does the E.U. maintain healthcare(ok they dont) but the countries of the E.U. provide long term govt run or mandated healthcare while having debts over 100 percent GDP and many cases 2 to 3 times GDP or Luxembourg at 3443 percent over GDP? This you have failed to identify, so how?

 

[Arkady]

It would be interesting to watch you try to make it in the business world. I can just imagine -- if your company bench-marked poorly against other countries, you'd just explain how ALL the comparisons were inherently invalid, because the companies were bigger than yours, or smaller than yours, or structured differently than yours, or richer than yours, or poorer than yours. Look, everyone can find an excuse for anything. But ultimately results matter. And when it comes to results, US life expectancy is poor by the standards of other wealthy nations, despite Americans spending far more, per capita, on healthcare, than people in any of those other wealthy nations.

Also, why do you announce a plan to compare debt to revenue, and then provide a list comparing debt to GDP? And, one way or the other, where do you get your numbers? You've got the UK as 360% of GDP, when in fact it's actually in the mid-80s (well below the US):

http://en.wikipedia.org/wiki/List_of_countries_by_public_debt

As for Japan, I'm all for examining what it is they do to contribute to their very long life expectancy. It's especially interesting given the high rate of smoking and alcohol use in Japan, which are ordinarily thought to contribute to shorter lifespans. But, with Japan, one could dismiss the comparison by pointing to how very different they are from the US, demographically and culturally. A majority-Asian nation, with a cultural affinity for Sushi and rice, may have things going for it that would be hard or impossible to emulate in the US. That's why I typically focus on Canada, Australia, and the EU -- demographically and culturally, they're more similar to the US, and emulating their successes seems more realistic. Sure, there are still major differences (for example, the US has a much larger Hispanic population than the EU, Australia, or Canada, and Hispanics have longer lifespans on average), but those countries are at least majority-European-descended with a mix of other nations thrown in, which is our basic formulation, too.