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Life expectancy vs health expenditure over time (1970-2014) (ourworldindata.org)

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[–]jesuschristthe3rd 16ポイント17ポイント  (4子コメント)

Seems like the US diverged around 1977, any special event or law happened at that moment that could be some kind of catalyst to this nonsense?

[–]youareafuckingdick 22ポイント23ポイント  (0子コメント)

The Health Care Financing Administration (now Centers for Medicaid/Medicare services) was created to manage Medicare and Medicaid separately from the Social Security Administration in 1977 ... It was also right after a huge recession, when a lot of "reforms" were made under Carter with Congressional leadership from Ted Kennedy.

Not saying the Democrats did it, or that closer-to-universal health care is to blame ... But a lot of reforms were made in that timeframe that simultaneously expanded access, heaped on bureaucracy and kept the private insurance apparatus well-protected.

[–]mick4state 6ポイント7ポイント  (0子コメント)

If you watch Robert Reich's "Inequality for All" he identifies the late 1970s as the time where things started to get worse. It's likely they're all related.

[–]yes_surely 5ポイント6ポイント  (1子コメント)

That's the year the US published it's low fat diet guidelines.

This meant more carbs, less fat. Health spending changed as the diet changes impacted mid- and late- life medical needs of baby boomers and their parents.

Some food for thought:

http://www.pbs.org/wgbh/pages/frontline/shows/diet/themes/lowfat.html

[–]Amagi82 0ポイント1ポイント  (0子コメント)

It's astonishing how closely the obesity epidemic tracks with the low fat diet guidelines.

[–]d-qn[S] 8ポイント9ポイント  (0子コメント)

By Max C Roser in the excellent Our World In Data

[–]Jackmack65 22ポイント23ポイント  (0子コメント)

This chart is one of the best visual explanations I've seen of how the American health care system truly excels at fulfilling its design purpose. Keep in mind that our system, such as it is, prioritizes by design entirely different outcomes than countries that have national health care systems.

The American system is designed to maximize shareholder and other financial stakeholders' returns to publicly-traded insurance and pharmaceutical companies and hospital systems, and then to maximize financial returns for owners of other health care companies. In that system, one of the measures of success is rising per-capita spending with little change in health outcomes, and particularly longevity. Given that increasing longevity is a particular threat to insurers' financial performance, flat longevity and increased per-capita spending is exactly what one expects to see.

In other countries, the design priority is to maximize health outcomes in the most financially efficient way, and so there, the key success metric would be increasing longevity with flat to decreasing per-capita spending.

Given that, the data's a pretty compelling indicator that the American health care system is excelling in pursuit of its key objectives.

Edit: added "owners of" to "maximize financial returns for owners of other health care companies" for clarity

[–]dbhus21 8ポイント9ポイント  (1子コメント)

In the United States our lawmakers make sure that those funding their campaigns get paid first and the scraps left over go to the citizens.

Like the affordable care act, it's not affordable and it provides no care. Barely anybody can afford the premiums.

[–]youareafuckingdick 1ポイント2ポイント  (0子コメント)

But our health insurance industry is protecting us against the Red Menace better than ever before.

[–]FroztySplitz 2ポイント3ポイント  (1子コメント)

These figures are surprisingly real. Healthcare Economists suggest that the reasoning behind this data is that Americans are morbidly obese. The US is so wealthy that it is literally the cause of our deaths.

Fun fact of the day: 50% of healthcare spending is used up by only 1% of Amercians. Almost all of this spending is on terminal patients. These patients typically die within a year of their peak healthcare spending.

Isn't this all so ironic?

[–]danmunro 0ポイント1ポイント  (0子コメント)

Not accurate. 1% of population only accounts for about 20% of healthcare spending. It takes 5% to get to about 50% of healthcare spending.

[–]ThaDanishBear 2ポイント3ポイント  (11子コメント)

Not that easy to compare life expandancy versus healthcare costs. Healthcare costs relate to the elderly, so should just compare health care costs to number of people above 65, or something like that. In addition, these numbers should be corrected for inflation. I'm just happy about people living longer and choosing to spend money on their health. That is a pretty resent change. Just my opinion...

[–]MortimerAdler 14ポイント15ポイント  (7子コメント)

The figures are adjusted for inflation and Purchasing Power Parity. And in fact, many/most of the countries studied that pay less and live longer than Americans do not have to choose to spend money on their health, because whether or not to go to a doctor/have hospice care/get surgery is not a financial decision that has to be made in states with national healthcare

[–]apennypacker 0ポイント1ポイント  (6子コメント)

And yet, those are not at all the contributory reason to the difference in life expectancy. Take out murders, accidents and automotive deaths, and you will find the life expectancy of the US rather similar to the rest.

Studies are cited in this article: http://www.forbes.com/sites/theapothecary/2011/11/23/the-myth-of-americans-poor-life-expectancy/#3fde66923b35

[–]MortimerAdler 2ポイント3ポイント  (5子コメント)

The argument being made isn't life expectancy, it's life expectancy compared to health expenditure. The US pays more than twice the average and reaps little benefit from it, that's the point.

[–]dameprimus 0ポイント1ポイント  (4子コメント)

You can't compare the quality of healthcare in that way. The argument apennypacker and the article are making is that given a specific medical condition - you are better off receiving healthcare in the US than in any other country. This is true for the most common types of cancer. And I would expect it is true of the majority of medical conditions, but I would have to find the data.

The other benefit is innovation - the US has developed a large fraction of drugs, medical technology and medical techniques.

Life expectancy takes into account other factors like poverty, homicide, activity level - things that the healthcare system cannot affect. It doesn't make sense to measure healthcare using life expectancy.

[–]MortimerAdler 2ポイント3ポイント  (2子コメント)

You're right, those are great points. Life expectancy doesn't give enough insight into quality of healthcare (though I'd argue that it does give some insight). Although, Age-standardised IHD mortality rates between high income countries does indicate a consistent trend in better patient outcomes in countries other than the United States. So when looking at the mortality of coronary events among rich countries, US treated patients fare worse. Though that isn't adjusted for lifestyle factors, the rich European countries have higher smoking and drinking rates with comparable BMIs.

I couldn't find the paper I had in mind that did adjust for lifestyle factors but [here's a WHO paper on health system analysis internationally](www.who.int/healthinfo/paper30.pdf) which ranks the US 37th in the world, behind Costa Rica and Dominica under the metrics of health outcomes, responsiveness, and financing.

[–]dameprimus 0ポイント1ポイント  (1子コメント)

The WHO paper is interesting, and the American healthcare does come up short on things like access, fairness etc. But this is (at least to some extent) a separate issue from the quality of the care itself.

The Cardiology paper is also interesting, but it doesn't answer the question I posed. It is epidemiology: how is health on a population level? It doesn't tell us - if I have an MI right now, would I be better off teleporting myself to France? I don't know how reliable this paper, it does attempt to answer the question: http://www.tctmd.com/show.aspx?id=125079 The US seems to have a less healthy population to start off (with higher mortality post MI), but after adjustment the US, France, Sweden and the UK are all similar (with the US appearing relatively better with respect to coronary/stroke mortality compared with all cause).

I didn't exactly expect that outcome - perhaps management of MI has been going on for long enough that other countries have similar levels of care as the US, but with diseases with recent developments and newer treatments - the US comes out ahead.

Theorizing aside, epidemiology is incredibly hard. Policy is even harder. Anyone who says that data is clear regarding what policies are good and which are bad, is either a genius, or doesn't understand the complexities of the problem in the first place.

[–]MortimerAdler 1ポイント2ポイント  (0子コメント)

Finally some thoughtful dialog on Reddit, here's a Washington Post article presenting some academic research on infant mortality rates in the US.

In fact, infant mortality rates among wealthy Americans are similar to the mortality rates among wealthy Fins and Austrians. The difference is that in Finland and Austria, poor babies are nearly as likely to survive their first years as wealthy ones. In the U.S. - land of opportunity - that is starkly not the case: "there is tremendous inequality in the US, with lower education groups, unmarried and African-American women having much higher infant mortality rates"

It depends on your definition but I would define a quality health system to be one that doesn't have massive inequality rather than one that has superior care for the wealthy

[–]plummbob 0ポイント1ポイント  (0子コメント)

You can't compare the quality of healthcare in that way.

Its comparing how much we're paying for comparable quality ...... We might have somewhat better treatment for cancer or whatever, but its not 2 or 3 times better than in, say, Denmark.

US has developed a large fraction of drugs, medical technology and medical techniques.

Its questionable that your premiums and deductibles are really going to that.

I mean, most novel medications or procedures are publicly funded through fed or state grants to universities, research hospitals, device makers and drug companies.

[–]mfb- 0ポイント1ポイント  (0子コメント)

The average age in several of the listed countries is higher than in the US. In particular, Germany and Japan are among the countries with the highest average age and also the highest fraction of people above 65. Both spend less on healthcare and have a higher life expectancy than the US.

You can also compare costs for similar procedures, e. g. how much does a hip replacement cost in the US vs. how much does it cost elsewhere. The results are ridiculous.

Stupid automoderator, this thread is 2 years old, you cannot participate in it even with www. link

[–]bluefootedpig -1ポイント0ポイント  (0子コメント)

things like a broken arm can lead to early death without treatment.

Also, many children die shortly after birth, and any complications in childbirth would also matter.

I think there is more to length of life than simply dying of old age, granted that is where a lot of cost comes from.

[–]qwerty2020 0ポイント1ポイント  (0子コメント)

I made a drawing about this once here

[–]jwoliver 0ポイント1ポイント  (0子コメント)

If we managed to achieve the same life expectancy, I wonder how far to the right the line would go. Not expecting a hockey stick.

[–]islander238 -2ポイント-1ポイント  (10子コメント)

Funny that the US gets bashed for the healthcare dollars they spend vs outcome. Notice that the vast majority of those countries at the top have a virtually homogenized racial population. In the US, I bet if you broke it down, one would see that the difference between the white population dollars vs outcome is way different than for Latinos, Blacks, Natives etc. Whites largely have much better access to healthcare meaning checkups and secondary care than other races. Many times the primary care they get is ER care which is expensive and does not solve their true health care needs. If we want to get those dollars vs years to a better place, we must equalize our healthcare system so everyone has access to primary care on an ongoing basis. In my opinion, that can only be done with universal healthcare. Everyone in our nation gets real healthcare, and the society pays less for it.

[–]IDanceWithSquirrels 5ポイント6ポイント  (1子コメント)

While I agree with your conclusion, I don't understand what race has to do with that? Your argument sounds more like a differentiation between poor/rich, rather that race.

[–]almostOut88 1ポイント2ポイント  (0子コメント)

In the us state I live in I get better Healthcare by being poor(and unemployed) then when I was working full time and paying 100s of dollars a month. I'm white....I'm getting real tired of the race card being thrown in everywhere.

[–]FroztySplitz 0ポイント1ポイント  (0子コメント)

The actual numbers are closer than you think. I was surprised as well, when I saw that while in the past, race was a major factor in life expectancy, almost all races are converging to the same expectancy in the US in the modern era.

[–]JoJoRockets52 0ポイント1ポイント  (0子コメント)

Definitely not a race thing.

[–]EnderWillEndUs -4ポイント-3ポイント  (5子コメント)

Pretty sure Australia, Canada, Netherlands, Germany, and more, all have a very comparable ratio of race to the US, if not more so.

[–]demintheAF 7ポイント8ポイント  (4子コメント)

US: 37%

Germany: 8.5%

Australia: 8% (including less than 1% Aborigine

Netherlands: 17% (9% of non-European origin)

Canada's data is a little more complex, but 2% First Nations, 9% African, Asian and South American, and 26% "mixed background".

http://www.infoplease.com/ipa/A0855617.html

[–]EnderWillEndUs 6ポイント7ポイント  (0子コメント)

Thanks for looking into that, I guess I was wrong. It certainly is a valid point then.

[–]jesuschristonacamel 0ポイント1ポイント  (0子コメント)

That's a pretty shitty site to make any comparison on. As a south Asian, the first thing I did was to look up India's ethnic makeup, only to see "indo aryan" and "dravidian" as the only two ethnic groups they have, while some other countries have a whole list of related ethnicities treated as distinct groups. They're incredibly arbitrary as to how they group ethnic groups.

[–]ctmu 0ポイント1ポイント  (1子コメント)

btw very reputable site you got there...

[–]Butsuri 1ポイント2ポイント  (0子コメント)

65.1% were born outside the country and came to live in Canada as immigrants.

65.1% of the visible minority population is foreign born. "Only" 20.6% of the population are first born immigrants.

[–]sh4k4 -3ポイント-2ポイント  (0子コメント)

It would also be useful to see other countries with similar life expectancies, for comparison.