U.S. Health System Pretty Decent Longevity

[Bob]

Interesting Article with twists I had never thought about



New York Times

September 22, 2009
Findings
To Explain Longevity Gap, Look Past Health System
By JOHN TIERNEY
If you’re not rich and you get sick, in which industrialized country are you likely to get the best treatment?

The conventional answer to this question has been: anywhere but the United States. With its many uninsured citizens and its relatively low life expectancy, the United States has been relegated to the bottom of international health scorecards.

But a prominent researcher, Samuel H. Preston, has taken a closer look at the growing body of international data, and he finds no evidence that America’s health care system is to blame for the longevity gap between it and other industrialized countries. In fact, he concludes, the American system in many ways provides superior treatment even when uninsured Americans are included in the analysis.

“The U.S. actually does a pretty good job of identifying and treating the major diseases,” says Dr. Preston, a demographer at the University of Pennsylvania who is among the leading experts on mortality rates from disease. “The international comparisons don’t show we’re in dire straits.”

No one denies that the American system has problems, including its extraordinarily high costs and unnecessary treatments. But Dr. Preston and other researchers say that the costs aren’t solely due to inefficiency. Americans pay more for health care partly because they get more thorough treatment for some diseases, and partly because they get sick more often than people in Europe and other industrialized countries.

An American’s life expectancy at birth is about 78 years, which is lower than in most other affluent countries. Life expectancy is about 80 in the United Kingdom, 81 in Canada and France, and 83 in Japan, according to the World Health Organization.

This longevity gap, Dr. Preston says, is primarily due to the relatively high rates of sickness and death among middle-aged Americans, chiefly from heart disease and cancer. Many of those deaths have been attributed to the health care system, an especially convenient target for those who favor a European alternative.

But there are many more differences between Europe and the United States than just the health care system. Americans are more ethnically diverse. They eat different food. They are fatter. Perhaps most important, they used to be exceptionally heavy smokers. For four decades, until the mid-1980s, per-capita cigarette consumption was higher in the United States (particularly among women) than anywhere else in the developed world. Dr. Preston and other researchers have calculated that if deaths due to smoking were excluded, the United States would rise to the top half of the longevity rankings for developed countries.

As it is, the longevity gap starts at birth and persists through middle age, but then it eventually disappears. If you reach 80 in the United States, your life expectancy is longer than in most other developed countries. The United States is apparently doing something right for its aging population, but what?

One frequent answer has been Medicare. Its universal coverage for people over 65 has often been credited with shrinking the longevity gap between the United States and other developed countries.

But when Dr. Preston and a Penn colleague, Jessica Y. Ho, looked at mortality rates in 1965, before Medicare went into effect, they found an even more pronounced version of today’s pattern: middle-aged people died much more often in the United States than in other developed countries, but the longevity gap shrunk with age even faster than today. In that pre-Medicare era, an American who reached 75 could expect to live longer than most people elsewhere.

Besides smoking, there could be lots of other reasons that Americans are especially unhealthy in middle age. But Dr. Preston says he saw no evidence for the much-quoted estimates that poor health care is responsible for more preventable deaths in the United States than in other developed countries. (Go to nytimes.com/tierneylab for details.)

For all its faults, the American system compares well by some important measures with other developed countries, as Dr. Preston and Ms. Ho enumerate. Americans are more likely to be screened for cancer, and once cancer is detected, they are more likely to survive for five years.

It’s been argued that the survival rate for cancer appears longer in America merely because the disease is detected earlier, but Dr. Preston says that earlier detection can be an advantage in itself, and that Americans might also receive better treatment. He and Ms. Ho conclude that the mortality rates from breast cancer and prostate cancer have been declining significantly faster in the United States than in other industrialized countries.

Americans also do relatively well in surviving heart attacks and strokes, and some studies have found that hypertension is treated more successfully in the United States.

Compared with Europeans, Americans are more likely to receive medication if they have heart disease, high cholesterol, lung disease or osteoporosis. But even if the American system does provide more treatment for more sick people, couldn’t it do something to reduce its workload?

When I brought up Dr. Preston’s work to Ellen Nolte and C. Martin McKee, two prominent European critics of the American system, they suggested that he was taking too limited a view of health care. They said the system should take responsibility for preventing disease, not just treating it.

Dr. Preston acknowledges that the United States might do more to keep young and middle-aged people from getting sick, but he says it’s not clear that other countries’ systems are more effective.

“The U.S. has had one spectacular achievement in preventive medicine,” he says. “It has had the largest drop in cigarette consumption per adult of any developed country since 1985.” If Americans keep shunning cigarettes, the longevity gap could shrink no matter happens with the health care system.

[Steve James]

This longevity gap, Dr. Preston says, is primarily due to the relatively high rates of sickness and death among middle-aged Americans, chiefly from heart disease and cancer. Many of those deaths have been attributed to the health care system, an especially convenient target for those who favor a European alternative.

There is a good insight connected to a false premise and conclusion. It's true that Americans are killing themselves because of their diets. Good premise. It suggests that Americans change their dietary habits --to a European or Asian model, perhaps. However, until Americans change their diets, they will be dying at higher rates during their middle-ages. This means they'll be hospitalized, and have to pay, etc., etc., and need health care. Of course, there is no single "European alternative" being suggested, especially not a "single payer" plan.

Even if it's the diet, the Europeans still have health care systems. So, if we got healthier, as healthy as Europeans, the stats would change; however, we'd still need at least as much health care as the Europeans who don't have our problems. Health, health insurance and health care are different issues. It's true that, because (some) Europeans are healthier, they don't need the same amount of health care; and, consequently, can afford to insure their citizens better. But, the fact that we get sicker more is not sufficient to argue that we don't need to improve our health care insurance. Our hospitals and actual health care facilities are, in general, very good.

[Darth Rock&Roll]

My view is that this is such a huge issue because as a society, we have yyet to deal with not being afraid of teh ultimate journey, IE: our own deaths.

Almost every health system has you living in fear of your own death.

why? who gains from the general populace being afraid of dying or being afraid of dealing with disease?

There are flaws in our social perspective that are greater than any of the flaws in our health care systems.

Health care gets better every year. And will continue to do so.

we should not try to extend our lives so far that we do not make room for our young to have decent productive lives.

[qiphlow]

My view is that this is such a huge issue because as a society, we have yyet to deal with not being afraid of teh ultimate journey, IE: our own deaths.

i agree wholeheartedly with this.

[GrahamB]

People are still afraid of dying, even in countries that have a national health service.

[qiphlow]

People are still afraid of dying, even in countries that have a national health service.

i know! you'd think they'd be HAPPY to die, what with all the drawbacks of an evil socialist (read: terrorist) healthcare system.

[Darth Rock&Roll]

death is the great equalizer of all things.

we all slip into it and fade from memory.

Entire,mighty civilizations are lost and completely forgotten.

It's the most amazing aspect of life in my opinion.

[Steve James]

Yes, death is the great equalizer; and there's not much anyone can do about it. Well, except save lives. In fact, a person can keep saving lives until the day he dies. Someone could argue that "what's the point?" But, then the real question is "what's in it for me?" I don't have a rational answer --if the premise is "everything dies." Otoh, even a blade of grass doesn't give up trying to live because it's inevitable that I'll cut it down over and over. Imo, that's the most amazing aspect about life.

Yeah, death is "The" big adventure ... after life. And, as everybody knows, everybody that's born gets to experience it. So, impho, I can wait; and I'm happy for the company, too. I just met an old friend whose wife died 2 weeks ago. She was diagnosed with cancer (didn't ask where or what type). She developed an infection, however, and died 3 months later. She never even got the chance to have chemo. It was 3 months from going to work everyday to the funeral home. If I thought I had only three months, I wouldn't even think of committing suicide. I'd try to squeeze out 3 and 1/2. Ymmv.

[Chanchu]

http://www.politico.com/livepulse/0909/ ... ml?showall

If you don't buy yer Obama care- your going to the crowbar hotel

[marcdunord]

some basic considerations about stats (averages) will help here:

there are more smokers in europe.

but their health stats seem to be similar to those of european non-smokers, since

crass 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 stats 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, three things that 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 that the effect of the smokers’ exclusion made evident.