The Great and Terrible News about American Health Care

If you've been paying attention to debates on health care over the last few years, you're probably aware of how poorly the American system performs compared to other similar countries. We're the only advanced industrialized democracy that doesn't provide universal health coverage to our citizens, and though there are many variations in those systems ranging from the completely socialized (as in Great Britain) to the largely private but heavily, heavily regulated (as in Switzerland), they all do better than we do on almost every important measure you could come up with.

That's the big picture. But a new report from the National Research Council and the Institute of Medicine compared the United States to 16 similar countries (mostly in Europe but including Canada, Australia, and Japan) on a range of health measures has some fascinating details. Unsurprisingly, the United States comes out at or near the bottom on most measures of health. We have the highest infant mortality, the highest obesity rates, and the highest rates of teen pregnancy. And given our current debate about gun violence, this is one data point that will inevitably be noted in stories about this report (this graph and a few others can be found here):

Why are so many more Americans killed violently than in other countries? It isn't because we're just a bunch of barbarians, and it isn't because we get in more fights. The reason is simple: guns. If two French or Spanish or Japanese guys have a dispute, it doesn't end with one shooting the other.

But there's something else in the report I want to highlight. This is the graph that jumped out at me. It shows the rank of the United States on mortality from all causes at different ages:

We're at or near the bottom for everyone up until you get to people in their 70s. And then our rank jumps up near the top. So an American who's 20 or 40 or 60 is more likely to die in a given year than his or her peers in any of these countries, but an American who's 70 or 80 or 90 is less likely to die than his or peers in almost all of these countries. And why might that be?

Without question, there are many factors that contribute. For instance, we have more poverty and higher income inequality than any of these countries, and it may be that by the time you get to age 70 and beyond, many people at higher risk for disease and death due to poverty, violence, and so on have already died, leaving a population more skewed to the wealthy and healthy. But the factor that likely makes the greatest contribution is simple: Medicare. Americans over 65 have the benefit of guaranteed, affordable health coverage, which Americans under 65 don't have. Once you get on Medicare, you go from having no health security to having as much health security as someone who lives in one of the other countries.

I have to wonder what people who defend the private health care system think when they see facts like these. Do they assume it's all lies, part of an international egghead conspiracy to bad-mouth America? Do they actually believe that if we can just get our health care system more privatized, then we'll find that there's some magical privatization threshold we can pass where all our problems will be solved, despite all the evidence showing that the more private a health care system is the worse it performs? I really don't know.

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