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Healthcare in the US has consistently been one of the most unfriendly places for middle age and elderly people. Life expectancies for 40 and 65 years olds have has made very little progress in the US compared to other high income countries for 20 years from 1980 to 2000, and is only now beginning to catch up with the average rates of growth in other high income countries. Life expectancies for 80 year olds are much better, but the US has been losing ground to other high income countries.
Yet the opponents of health care reform have the nerve, the brass, the swank, the depraved ignorance and dishonesty, to say that reform will result in neglect of older people. The US long neglected middle age and older people to an extent that has not been tolerated in other high income countries. Actual historical data and evidence, as opposed to ignorant bloviating, indicate that health care reform would make the US more like Australia, France, Switzerland, even Canada (take your pick) and will produce LONGER life expectancies for older people in the US; the absolute opposite of what opponents of health care reform claim.
Below is a summary of the performance of the US with respect to life expectancy over the last 45 years or so for people age 40 and over.
In 1960 40 year old men had less than average life expectancy among high income countries, and women in the US had about average life expectancy compared to other high income countries. After a spurt of growth in life expectancy to about, or above average, during the 1970s, progress in life-expectancy came to standstill compared to most of the high income countries. The growth rate in life expectancy started catching up to the high income country average in the mid 1990s for US men, and after the late 1990s for US women. But the life expectancy in 40 year old women now lags FAR behind the average of other high income countries.
In 2003, for 40 year old men, the US ranked 16 of 22 high income countries, behind. Australia (2), Switzerland (3), Canada and Sweden (tied for 5), France (11), and the Netherlands (12).
In 2003, for 40 year old women, the US ranked 19 out of 22 high income countries, behind Switzerland (2), France, Australia and Spain (tied for 3), Canada (7), Sweden (8), the Netherlands (17), and Portugal (18), and The US life-expectancy in the US is about the same as in the dreaded UK
In 1960, 65 year old women in the US had one of the highest life expectancies among high income countries. The growth in their life expectancy relative to other high income countries has been similar to that for 40 year old women. As of 2006, their life-expectancy was 15 among 22 high income countries. Among countries with higher life expectancies for 65 year old women are France (2), Switzerland (3), Australia (6), Canada (7), Sweden (10), and Germany (14). The progress in life-expectancy for 65 year old women over the last 25 years has been horrifically bad compared to other high income countries.
In 1960, 65 year old men in the US had about average life expectancy. After a spurt of growth in the 1970s, putting their life expectancy above average, the rate of growth in the life expectancy in the US slowed to below average, and 65 year old men in the US have about average life expectancy compared to other high income countries.
For 80 year olds in the 1960s, men and women in the US has among the highest life expectancies, along with Canada (for men and women), and Norway (men). Life expectancies showed rapid growth from the late 1960s through the end of the 1970s and then remained at a near standstill compared to other high income countries until around 2000, when they started growing again. Eighty year olds in the US still have relatively high life-expectancies compared to other high income countries, but have lost ground.
For 80 year old men, in 2003, the US was tied for 2 with Canada, behind Japan (1) and just ahead of Australia and New Zealand (tied for 4) and France (6).Eighty year old women have lost ground, as in other age groups. The US ranked 5 in 2003, behind Japan (1), Canada (2), and Australia and France (tied for 3).
Common patterns can be seen in the time series of life-expectancies that seem to be due to several factors. For example, Canada shows some short run variations that parallel those of the US, which indicate some common factors operating in North America. However, the US shows medium term trends that seem to be unique: an increase in life-expectancy relative to the average of other high income countries from the mid 1960s through the late 1970s, then stagnation relative to other high income countries for the 1980s and 1990s, then a recovery in growth in life expectancy in the early (men) or late (women) 1990s.
I believe that the period of stagnation in US life expectancies occurred during the heyday of the attempt to introduce more poorly regulated competition into the US health care system, due to various forms of ‘managed competition’ in the health care market, the introduction of HMOs,(1,2) and the introduction of physician self-dealing in medical enterprise such as lab tests, physician-owned specialty outpatient clinics and inpatient hospitals (3).
I’m tempted to speculate that the renewed increase in life-expectancies occurred after the popular backlash against HMOs and other poorly designed attempts to ‘for-profitize’, and incentivize health care, which forced more controls on competitive behavior, but I have no data to support that. To be honest, the renewed increase in life-expectancies for older Americans after the early to late 1990s may be due to something else.
Several countries have been better on average at increasing life expectancy over the last 20 and ten years for most of these age groups: Australia, France, Japan (current champion for older men and women) and Switzerland.
Australia and Germany are countries that have had comparative effectiveness programs that opponents to health care reform claim will result in death to the elderly, but they have consistently performed as well or better than the US for most of these age groups, including the 80 year olds. Germany still does not perform well in absolute terms, but its life-expectancies have been steadily increasing at a greater than average rate, and are now approaching the average for high income countries.
The fact is, the US has had the most free market (and most poorly or unregulated free market), the most rapaciously competitive, and most costly system for health insurance and health care among high income countries, and its performance at increasing the life expectancies of middle age to very old people has been very bad for most the 1980s and 1990s, and only beginning to emerge from being disgraceful and the very worst among high income countries. Older Americans have lost ground in life expectancy compared to other high income countries.
Please contact your government officials, and the media, and tell them to give the US population the facts, stop ignorant and dishonest propaganda against health care reform -stop false propganda that endangers the welfare of middle age, elderly and very old, Americans.
Tell the media to stop passively broadcasting the fantasies and nonsense of ignorant political operatives, hacks and office-holders and extremists.
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Details
The high income countries used in this analysis are Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Luxembourg, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, Switzerland, United Kingdom, United States.
The rankings for life-expectancies for 2003 and 2006 are for all countries that year, including the US. Where data were missing for non-US countries, data lagged one or two years were used (giving an advantage on aveage to the US, which always used the latest available data). Tied rankings are listed as first rank of tie (rather than averages). So, a two way tie for second place produces the rankings for the first four places as 1, 2, 2, 4.
Data are from OECD Health Statistics 2007 and 2009.
You can download 65 year old life-expectancies for free.
Order complete data with 40 and 80 year old life-expectancies, or get for free at subscribing library. Journalists should be able to download all the data from OECD for free.
http://www.oecd.org/document/30/0,3343,en_2649_34631_12968734_1_1_1_37407,00.html
(1) Managed Competition: The Future, Not the Past
By Martin Sipkoff
Manage Care Magazine
http://www.managedcaremag.com/archives/0308/0308.enthoven.html
(2) How Managed Competition Controls Costs: The CALPERS Experience
By Ray LaRaja and Jeremy Rosner
Progressive Policy Institute
http://www.ppionline.org/ppi_ci.cfm?knlgAreaID=111&subsecID=137&contentID=1985
(3) Did Warren Burger Create the Health Care Mess?The 1975 antitrust decision that gave you physician-owned hospitals.
By Timothy Noah
Slate
http://www.slate.com/id/2223841
(found via Ezra Kelin blog)
7 Comments
Thanks, wesgpc. This is exactly the kind of concrete comparison data that we need to counter the bullshit claim that “we have the best healthcare in the world, at least for the insured.”
The 40 and 65 year old cohorts represent the groups where the effects of bad life choices such as obesity, smoking, and lack of exercise begin to catch up to people. Where a good healthcare system would have begun management of these is back when people were in their 20s and 30s. 80 year olds are a group apart. They have essentially already beaten the odds, exceeding average life expectancy. They have done this usually through a combination of good genes, good diet, good exercise, and less exposure to environmental toxins. They benefit too from our social safety nets of Social Security and Medicare, safety nets unavailable to younger Americans.
To some extent, that is my hypothesis also -these are cohorts whose lifestyle choices resulted in increases in chronic disease that resulted in a higher prevalence of expensive and deadly disease, such as diabetes and lung cancer in middle age.
However, comparison with other countries is instructive. If you compare the risk profile of Australia to the US, for example, they drink about as much, smoke about as much, and with a ten year lag, are getting about as fat as us. They like meat, like us. But you see no horrific flatlining of life expectancy for women in Australia at all, not even now. Their experience is very unlike that of the US. If life-style explained it all, then there should be some similar movement in the US and Australian life expectancies. But there is none. Australia shows steady inexorable progress from a relatively low life expectancy 25 years ago.
Studies have been done on the white-black gap in life expectancy in the US. They look at the different risk profiles of blacks and whites in the US that takes into account different smoking, drinking habits, certain racial differences (black women do get more aggressive breast cancer when young than whites) HIV, etc. Those differences do not explain the differences we see between races and sexes.
So, I partially agree. I need to find a way to summarize this stuff graphically, so people can see the pictures.
Switzerland is another country that has some unpromising lifestyle profiles, but again, there was no flatlining of life expectancy for women. Like Australia, you saw steady prgress. Japan has a relatively low life expectancy for older people 30 and 40 years ago, and a very serious smoking problem among men, yet it made steady progress and surpassed the US recently, and is increasing its advantage.
So, I think while the dramatic increase in middle age health risks such as obesity did play a role in the US, that cannot be the whole story.
I have read that young women in the US smoked more which will exacerbate most health conditions, but especially high blood pressure, heart disease, and of course COPD. Obesity at younger ages makes for earlier onset of diseases associated with it, like diabetes, hypercholesterolemia, and heart disease. So this might explain the health outcomes in the US.
Again, I partially agree. No one has done a formal study to relate life-expectancy to profiles of health risks, so we can argue about it a long time until some one does a study.
But I checked the health risk profiles of the US and Australia over time to check, and I confirmed by memory that they are quite similar over time. Australia does lag the US by about a decade in some areas. Prevalence in obsesity is one -Australia was the first country to follow the US up the obesity scale, and did so by about a decade. The rise and decline in women smoking prevalence in Australia lagged that in the US by about a decade. Australia had extremely high cigarette consumption by smokers (but not the insanely high consumption that existed in the US until the mid-1970s), the Australians consume significantly more booze per capita. So under the hypothesis that health risks explain all of the differences, using Australia as an example, we should see the same leveling off in life-expectancy due, for example, to women’s smoking, rise in obesity, etc in Australia as the US but lagged by about a decade. But in my opinion we don’t see that pattern.
As for intermediate clinical measures such as blood pressure, I prefer to not consider those to be part of the fundamental health risk profile, since they are outputs as well as inputs to the health care system. So, I am thinking of health risk profile in terms of about half a dozen or so health habits that do not quickly change as a function of health care practice and access.
There is a study, that I need to look for, the gives good evidence that for people with the same health status, measured in terms of diagnoses and clinical indicators, in the US and UK, people in the US have more adverse health events.
So, I do not give much ground here. I think you are to quick to attribute all of the difference to health habits. I will admit though that there are some areas where the US may be uniquely wretched compared even to places like Australia where people like the good life almost as much as in the US. Lack of exercise and poor diest are the two most promisting candidates for unique US wretchedness, but they are difficult to measure, and very few international comparisons.
Also as mentioned in the post, there are short run parallel jigs and jogs in Canadian and US life expectancies that may be due to specific North American health risks and medical practice, but these do not seem to me to throw either country off of each’s own medium term trends.
But you can download an excel file and grapth the data for Australia, Canada and the US and see what you think.
The lags could be quite significant. Factors like obesity and smoking don’t affect a person’s health immediately in most cases but often decades down the road. It is one of the reasons that it is difficult to convince people to change lifestyles because they don’t feel bad then and for many “decades away” is the same as never. Nor is something like obesity a one size fits all. Australians, for example, could still be getting more exercise or eating a somewhat better diet than Americans and still be getting more obese. The health status of women in the US has been known though for a while and as far as I have heard much of the convergence with men has been attributed to the adoption of bad habits similar to those in the male population vis a vis diet, exercise, and activities like smoking.