What causes America's lower life expectancy?

[Ryan1985]

1. Americans don't live as long as other developed nation citizens. (https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html)

2. A new study shows that this is NOT because of obesity, traffic fatalities,smoking, etc.(http://www.bbc.co.uk/news/world-us-canada-11502938, http://www.hivehealthmedia.com/healthcare-shortens-american-life-expectancy/).

3. The researchers speculate that "the nature of our health care system - specifically, its reliance on unregulated fee-for-service and specialty care - may explain both the increased spending and the relative deterioration in survival that we observed,".

4. This unregulated fee-for-service kind of system is unique to America's semi-free healthcare system. For example in the UK, the healthcare system is 100% nationalised (ie 100% not free) and no fee-for-services exist, everything is paid for out of taxes with no insurance at all.

So my question is what causes America's lower life expectancy? Are the researchers right? Or is there a factor that they haven't thought of that causes America's lower life expectancy?

[brian0918]

#1 is a well-known skewed statistic. Our world-class prenatal care brings more babies to term than possible anywhere else. Many of them do not survive long, so that distorts the "life expectancy". Note how the statistic is always quoted as "life expectancy at birth" and not "life expectancy at age 3" or something that would avoid the skew of prenatal care. For folks who don't think "science" can be distorted for politics, here is a great example.

We also have the most accessible and available pregnancy care. Discarded babies do not count toward statistics if nobody knows about them, as would be the case in less developed countries.

Last but not least, the US healthcare system is one of the most regulated systems in the world, alongside the US financial system. To say it is in any sense "unregulated" is a complete fiction. Go out and try to start a hospital. I dare ya.

(Trying to find an article I recently read about a doctor who attempted to start a small hospital. If anyone has it, please provide the link.)

Edited November 2, 2010 by brian0918

[softwareNerd]

@Brian: The study claims to have adjusted for the birth-stats. In fact, the study did not measure life-expectancy as such. It measured the probability that an adult of age X would still be alive 15 years later.

@Ryan: The U.S. has excellent life-expectancy, and it has been improving. However, why would it be surprising to find that some other rich developed countries that give poorer people free healthcare end up having better stats? A proper study ought to compare those who have health-care in (say) Japan --- i.e. everyone -- against those in the U.S. who have healthcare.

[brian0918]

Snerd: I was referring to the CIA factbook, not to the study, in #1. Can you point to the specific text where something claims to correct for birth stats?

[softwareNerd]

Snerd: I was referring to the CIA factbook, not to the study, in #1.

Gotcha. I forgot he linked to that after I read the summary of the study, which is here.

Can you point to the specific text where something claims to correct for birth stats?

We measured fifteen-year survival rather than life expectancy because the latter can be biased by the survival experiences of a small number of elderly people, among whom coding errors are common.¹⁵ Focusing on survival also allowed us to distinguish between the experiences of specific cohorts. We explored fifteen-year survival for men and women separately because risk-factor profiles differ greatly by sex and country.

[Ryan1985]

@Ryan: The U.S. has excellent life-expectancy, and it has been improving. However, why would it be surprising to find that some other rich developed countries that give poorer people free healthcare end up having better stats? A proper study ought to compare those who have health-care in (say) Japan --- i.e. everyone -- against those in the U.S. who have healthcare.

There is specific research that compares the UK with the USA in a similar way to what you just described. One of it's conclusions is (bold mine):

"The upper crust in both countries was healthier than middle-class and low-income people in the same country. But richer Americans' health status resembled the health of the low-income English."

- http://www.washingtonpost.com/wp-dyn/content/article/2006/05/02/AR2006050200631_2.html

Edit: I'm trying to locate the original research on this and not just a newspaper article. I'm sure I've got it bookmarked somewhere.

Edited November 2, 2010 by Ryan1985

[softwareNerd]

There is specific research that compares the UK with the USA in a similar way to what you just described. One of it's conclusions is (bold mine):

Interesting. It sounds like those two studies conflict. The previous one you linked to claimed that they had adjusted for worse American obesity (e.g., Americans have more "diseases of the rich") and so on, and claimed that all that could explain it was the health-insurance model. However, this study would belie that. Anyone who has decent insurance cover (e.g.g the so called "richer Americans" mentioned in the second) can attest that provision of care is not lacking in the U.S.

Leads one to suspect that some important factor(s) are being ignored by the analysis.

[Ryan1985]

Interesting. It sounds like those two studies conflict. The previous one you linked to claimed that they had adjusted for worse American obesity (e.g., Americans have more "diseases of the rich") and so on, and claimed that all that could explain it was the health-insurance model. However, this study would belie that. Anyone who has decent insurance cover (e.g.g the so called "richer Americans" mentioned in the second) can attest that provision of care is not lacking in the U.S.

I agree that care is not lacking in the US. The US has the most per person spent on healthcare in the world. But the researchers are questioning the effectiveness of the care.

I don't understand what you mean when you say the two studies conflict. The second study also adjusts for factors such as obesity:

Even the U.S. obesity epidemic couldn't solve the mystery. The researchers crunched numbers to create a hypothetical statistical world in which the English had American lifestyle risk factors, including being as fat as Americans. In that model, Americans were still sicker.

Leads one to suspect that some important factor(s) are being ignored by the analysis.

What are they?

[softwareNerd]

I don't understand what you mean when you say the two studies conflict.

One study says that it is something about the health-care system, while the other says it isn't.

What are they?

I can't simply come up with stuff. Stories abound about how the different diets in different cultures help or hurt health, even though the effects do not always show up in obesity. Or, how people living in some province of the world are being exposed to some environmental factor: something in their water, the extra sunshine, the amount of walking they have to do, etc. It's the job of researchers to come up with the reasons. For instance, the researchers in the study reported by the Washington Post speculate that stress is what causes Americans to have shorter life-spans. I would guess that it is not the amount of attention that American doctors give their paying patients, nor the number of tests paying patients get, nor the 5-star rooms of U.S. hospitals that are causing lower life-spans, but who knows perhaps a study will show that suffering a little bit helps life-spans.

As for comparing the amount spent to the life-span, that is a non-starter. Huge chunks of the money spent on health-care has nothing to do with increasing life-spans. I gave one tiny example in an earlier thread: it costs about twice to get a newer type of lens implant for cataract patients, compared to the older type. With the older type, they often have to wear glasses, but the newer one often means they can see better than their kids! There are treatments that are more expensive than older treatments, but simply quicken the speed of recovery without even a better medium-term advantage. There are treatments that are more expensive than older treatments, and do not even quicken the pace of recovery, but merely reduce some side effects. There are tests that can be done half as frequently, and the resulting delay in spotting the disease makes no difference in longevity but only in some hard-to-quantify "quality-of-life" factors.

[Grames]

So my question is what causes America's lower life expectancy? Are the researchers right? Or is there a factor that they haven't thought of that causes America's lower life expectancy?

Immigration.

Also, remember the recent mini-scandal from Japan where many people over 100 are actually dead but not reported so their pensions can still be collected. It only takes a few lies at that age bracket to really throw off the statistics.

[Ryan1985]

Immigration.

The second study looked only at whites and white Americans have a lower life expectancy than white Brits.

I think stress could be it. Americans work more hours.