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.

Comments

What a fascinating article -- thank you! But I do have an observation, I think. In the last paragraph, there are some rhetorical questions about those who resist universal health care, and how they might feel about the statistics reported. I doubt that feeling is an issue here. I believe that money is the issue here. Didn't Sinclair Lewis say, 'It's difficult for a man to understand something, when his paycheck depends on his not understanding it.'?

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WRT the last paragraph, Americans would rather reduce the size of government than improve it, and have been misled for years by those who profit mightily from our current healthcare system, including our venal politicians.

"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"

This conclusion doesn't make sense. By your own logic, Medicare simply provides Americans with the *same* care citizens of other first world countries have had all their lives. So while it might explain outcomes that improve from the bottom to somewhere in the middle of the pack, it doesn't begin to explain why outcomes should jump from the bottom to the very top of the pack.

Unless that is, the American health care system, for all its faults, is delivering a better quality of care to Americans 65 and over than is received by the senior citizens of other countries.

"you're probably aware of how poorly the American system performs compared to other similar countries"

the english model: Scandal of neglect in Britain's care homes: NHS survey of 63,000 elderly residents reveals one in three are living in fear of abuse

Read more: http://www.dailymail.co.uk/news/article-2257703/Scandal-neglect-Britains-care-homes-NHS-survey-63-000-elderly-residents-reveals-living-fear-abuse.html#ixzz2HffsSXEL
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"you're probably aware of how poorly the American system performs compared to other similar countries"

the english model: Scandal of neglect in Britain's care homes: NHS survey of 63,000 elderly residents reveals one in three are living in fear of abuse

Read more: http://www.dailymail.co.uk/news/article-2257703/Scandal-neglect-Britains-care-homes-NHS-survey-63-000-elderly-residents-reveals-living-fear-abuse.html#ixzz2HffsSXEL
Follow us: @MailOnline on Twitter | DailyMail on Facebook

You shoud be embarrased. There is a difference between a lie and a mistake but worse the point is the cause of death from violence not all deaths. There are probably not too many violent deaths from cars. If you took the time to consider constructive conversation and think for yourself instead of simply poly-parotting NRA talking points you might find yourself learning something.

"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."

This is a lie.

More people die in in auto accidents than die by guns each year and drunk drivers kill more people than do murders using guns. http://www.centurycouncil.org/drunk-driving/drunk-driving-fatalities-national-statistics More people are killed each year with hammers and clubs than with rifles. http://www.newsmax.com/Newsfront/assault-weapon-deaths-statistics/2013/01/03/id/469982?s=al So, should we outlaw automobiles? alcohol? hammers? clubs? IF we did, we would save more lives than if we outlaw guns. But who cares about facts? This whole discussion is based on lies and emotion, two very dangerous basis for an important discussion.

Stating the obvious: obesity rates and mortality rates from use of guns have absolutely nothing to do with the quality of healthcare. Obesity is due to people sticking too much food in their mouths, and gun violence is caused by people pulling triggers. We already have socialized medecine in this country, it's called the emergency room. Anyone with any ailment can go to an emergency room and get treated--and most of those people who don't have health insurance never pay, thus making health insurance much more expensive for the rest of us that do pay for health insurance. Thus we have a large number of Mexican women who come across the border right before their babies are due, and go to an emergency room when it is time to deliver. Free quality healthcare plus they have a little U.S. citizen. Such a deal! As far as the European socialized medicine goes, I lived in Europe for seberal years and those statistics are wildly slewed because most people who have the means go to private doctors and hospitals where they can get quality treatment. Also those countries don't have the high rate of poverty that we do in the U.S.--once again the poverty rate has nothing to do with the quality of healthcare, but does skew the rates of things like infant mortality.

Coming from someone who obviously doesn't have a clue. Calling the use of emergency rooms "socialized medicine" exposes how little you know about how heathcare via the emergency room and universal healthcare in other countries work. Of curse, if you don't really care to have a clue then you can fight for your team as a true believer without regard for the facts.

What an incredibly simplistic analysis. American levels of obesity, teen pregnancy and violence have nothing to do with the health care system. Our infant mortality rate is virtually identical to Europe for all income levels above poverty so the problem is entirely among the Medicaid population, i.e. those already in a government run health care program. You want to attribute the higher survival rate for seniors to the government run program Medicare but ignore how much the other government run health care program is part of the problem. Obamacare, by the way, cuts Medicare and expands Medicaid.
The reason the survival rates for seniors are so much higher in the United States is because we don't ration care for them. Keeping people alive for those extra two years when they are afflicted with the diseases of the aged is enormously expensive but we as a society have decided we want to bear that cost. If you want to attribute that to Medicare fine but I don't see how that argues for nationalizing the rest of the health care system.

You make a good argument for universal healthcare yet claim to not understand that argument. I think you are really confused.

This author really knows how to compare apples and oranges.

The author compares apples to apples but also talks about oranges. Try to keep up or do you have a difficult time walking while chewing gum?

What a great article showing the problem of assuming correlation without any evidence of causation. If the hypothesis put forth was true, you would see the US rankings jump to near the top almost immediately at 65, yet you see that we remain near the bottom until almost 80, a full 15 years of Medicare coverage.

The biggest problems with the WHO rankings are the number of items that they include that have nothing to do with our healthcare delivery system. Exactly what do highest obesity rates, the highest rates of teen pregnancy, and gun violence have to do with our Helathcare system? Nothing!

The other effect you are seeing towards the right side of your graph is the result of a highly socialized medical system on older people. As a result of these socialized medical systems there is a good amount of rationing being done in these countries. A large part of our healthcare expense, is that we do not ration care for our elderly (a tought choice between two options to be sure). So while we do everything to keep our elderly alive at great expense other countries let their die as a cost savings measure.

Also, as a final note, Switzerland has among the highest gun ownership in the world and yet they are near the bottom for gun deaths.

While Switzerland has high levels of weapons in homes, these are predominantly weapons owned by the Swiss militia which resevists must keep in their homes, but they no longer keep ammo at home, and when they did, it was sealed against use unless called to duty. While private weapons ownership is allowed, the ownership is strictly regulated, and ammo is subsidized and restricted to gun ranges, other than ammo suited to hunting, and then in limited quantities as needed for hunting. Carrying loaded guns is heavily regulated - most weapons are carried for military drills and are unloaded.

The Swiss recognize that most guns are designed to kill people, and thus restrict their use by regulating their ownership and ammo to protect the public health.

ronoca: Try to keep your insults to yourself. I find myself totally disregarding anything else you say because of them. Do yourself a favor. Be civil or be quiet.

Good information but the conclusion is lacking. I have lived in a few of the countries with universal type healthcare and there is another reason why the US does better with life expectancy at the end of life instead of the middle or beginning. In the countries with universal healthcare extraordinary measures are not taken for the elderly which might give them a few more years to live; it's just too expensive. Here in the States if you have health insurance doctors will continue to treat the elderly with everything possible right up until there is absolutely nothing left to be done. This is not true in many European countries. They do have panels which weight cost to benefit and this means that an elderly person without additional resources doesn't get the same extent of treatment as if he/she were to be in the US. We tend to here to be blind to the cost/benefit analysis which is done routinely in Europe.

This is the trade off. There is limited resource and it has to be distributed in some manner. For me, I'd rather it be left up to the doctor as to when and how I'm treated and not left up to a panel deciding if my life expectancy warrants it or not.

I agree with you. I live under the Canadian system where care is rationed by waiting lists. That amounts to, in some cases, years of life wasted for non-life-threatening disorders and in some cases people have died while waiting for care. Medical care delayed is medical care denied. People on waiting lists experience an acute disorder becoming chronic, and much harder and more expensive to treat than if it had been treated in a timely manner.
Even worse, in Canada it is actually illegal for someone to pay a doctor for care if that care is covered by the health care system. You have no choice but wait your turn in a chronically under-served system, unless you leave the country. No other universal health care system in the world denies patients this right to use their own money for their own care. Furthermore, due to cutbacks, many newer treatments are not available because of costs, and so doctors won't even tell you that there are alternatives to the care you get, because it is not available in Canada. Cost-benefit studies make them stick with older methods of care. This is what will happen with Obama's IPAB.
Whatever you do in the US, don't copy the Canadian system.

Unless you are wealthy enough to travel to the US to avoid the wait and pay cash, if you lived in the US, the chances are high, over one-in-ten, you will not be able to afford health care insurance or pay out of pocket, and thus be denied access to doctors or hospitals until you are so sick hospitals are required to see you and treat you if they have an ER regardless of your ability to pay.

Millions of Americans have their health care rationed at many times the extremes of Canada. But that is something those who get socialized health care from socialist corporate managers who want free company paid health care which must be provided all employees to be tax exempt, refuse to admit to about the US health care system. But they believe that the biggest problem in Canada is wealth is not used to decide who lives, and poverty who dies.

"Millions of Americans have their health care rationed at many times the extremes of Canada. " More extreme than waiting until you die? More extreme than waiting for surgery until it won't help anymore? I am constantly being told that conditions in America re worse - they are not. They are very bad for some people, and pretty good for most people in terms of access and in terms of quality of care. In Canada, everyone gets the lowest care available. It is not a better system just because everyone is in the same leaky boat.
Americans without health care have to go to the ER for care. Guess what - so do Canadians who do have health care. We have extreme shortages of doctors such that some town hold lotteries for the few places available. Many people have gone for years without having a GP, even pregnant women. Universal health care in Canada is absolutely no guarantee of actual access to health care.
I have no idea what your last sentence means.

The kind of lazy partisanship and ideological dogma seen in this article (and it happens on the left and the right) prevents us from seeing reality as it truly is. It might help if you looked at all of the numbers in the links you provided.

What you'll see is that the most heavily socialized system (UK) is also very close to the bottom. That kind of blows your whole premise out of the water. The numbers also show that the U.S. does reasonably well (top half) when it comes to treating cancer.

It is areas like heart disease and diabetes that we do more poorly, along with traffic accidents and violent crime. This tells us things about America that we already knew, and which cannot be explained by the lack of government largesse. These are lifestyle issues.

Traffic is something that is essentially unavoidable due to the geographic size of the U.S. Violent crime deaths are overwhelmingly the result of black-on-black, drug-related gang activity. And heart disease and diabetes are a result of diet.

No amount of government-paid health insurance or socialization will stop those phenomena from happening.

If you're willing to accept political incorrectness, I would suggest it could be informative to control not only for age in these statistics, but also for race and ethnicity.

The United States is an increasingly complicated country, and one that perhaps cannot continue to function much longer. Our society is not comparable to many of the others listed, and therefore comparisons are apples to oranges.

Bottom line: socialized medicine will not make people choose healthy lifestyles. As shown by the poor performance of the UK, socialized medicine does not reduce mortality rates.

The article fails to mention that more than over half of the violent gun deaths are suicide.

I know what you mean, I work as certified nursing assistant and the reality is exactly like you said!

Just to add a brief summary: In the same report where the United States ranks last, the United Kingdom ranks fourth from the bottom.

Whoops.

"I have to wonder what people who defend the private health care system think when they see facts like these."

I think you're a partisan hack who only pays attention to "facts" that seem to justify your ideological dogma, while discarding equally true and obvious facts that ruin your argument.

Health care costs in the US are 2.5 times greater than in the UK per person, but in the UK, everyone gets pretty much the same care, while in the US, tens of millions have their care rationed until they have money, the right employer, or qualify for Medicare or Medicaid.

If the UK doubled their spending on health care, they would surpass the UK on outcomes, and still be cheaper on a per person bases than the US.

Are you arguing the US should increase its spending on health care like the UK is drastically increasing its spending by importing US health care corporate hospital chains and professional practices?

The other thing to remember is that deaths by gun violence are almost exclusively an urban issue, often a drug related issue, and unfortunately an African American related issue.

The Democratically run cities are breeding ground for gun violence. Chicago has the strictest gun laws in the country and the worst gun violence (and run completely by Democrats).

Finally, we should remember that gun violence is declining dramatically already in the U.S. British women are twice as likely to be raped, Australian women are three times more likely to be raped. British homes are more than three time more likely to suffer a "hot burglary" where the owner is present - a very dangerous situation.

I doubt having a gun is likely to help anyone and may kill others but so what about the facts. I believe a person has a choice, regardless of law or constitution, in anything, including having a gun. And I think the Founders agreed then, and that the people do now.

The criteria for whether your offering good health care includes the number of teen pregnancies and firearm deaths? How about car accidents where over thirty thousand Americans are killed. Three times as many die from auto accidents than firearms so it must be a real drag on our health care.
Where does survive ability of cancers or health issues come in?

The only mortality graph that would be relevant would be one that only includes deaths where health care could make a difference or separate graphs for each type of incident. Americans are fatter and have more gun violence, so graphs broken out on those type of criteria would make sense.

One could argue that the graph above argues in favor of the US system. Before age 70 your cause of death probably has much less to with the health care system and more to do with gun violence, drunk driving, driving in rush hour traffic, etc. After age 70, the US improves when the health system matters more.

What do violence levels and obesity rates have to do with arguing for or against our privatized health care system? Over-eating causes obesity. Statistics show that were we to take away the black-on-black male violence that plagues the country's biggest urban centers, our violence levels would be on par with other Western nations. Teen pregnancy is the inevitable result of irresponsible sexual behavior among detached, immature, stupid youths, educated and brought up in a country where radical individualism and narcissistic self-empowerment and sexual gratification reign, where young men and women are taught to express themselves at intervals not unlike animals.

So, cease with your sophomoric logic attempting to associate things that might correlate with one another but in no way cause. Our main ailments are cultural decadence marked by an inability to take responsibility for the reality we observe around us and do not like, whether liberals or conservatives we are. Stop projecting blame on privatized health care. All of the afflictions you cited would remain were we to adopt the socialist health system of Fabian wet dreams.

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Health insurance is an especially big spending item once one adds a wife and kids and the expense is getting worse. A survey by the Kaiser Family Foundation discovered lately that family health insurance rates are continuing to trend way up. Source for this article: Financial Advice

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Debates play a vital role in improving and make the up to date changes in the healthcare field without any doubt. But it is so sad in knowing the fact that how poorly the American system performs compared to other similar countries on this regards. Debating on the recent health news would help to make the awareness in public. Why are so many more Americans killed violently than in other countries? It gives more answers or facts when we look after this question.

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