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Who is healthy?
From MR comments:
Japanese Americans have the longest measured life expectancy on this planet. Mormons live 10 years longer on average than Europeans. Black men in the US live 8 less on average than Hispanic men...they [Americans] can get “cheap” European care if they like, just create extremely bad American HMO insurance, or don’t buy health care at all and go to Public hospitals. The reason the European systems are cheaper is not that they magically have less costs, it is that they give the consumer much less health care. Of course the people in the US that go to public hospitals in the US are not the same kind of people that consume government health care in Europe. This makes the health outcome different, even if the quality of the health care is not.
Link here. Another reader writes:
The single largest group (30% of all the [un]insured) are Hispanics. Hispanics have the same (actually slightly higher) life expectancy as the average American.
Life expectancy statistics are tricky, but these claims hold up under the scrutiny of Google. More importantly, the claims "sound right wing" but actually they provide the best argument for single-payer health insurance to be found: "The link between health and health care is murky, so let's just save money on our health system."
That is another example of Stories You Won't Often Hear.
I've yet to see a fully convincing answer. Of course this is not the kind of low-cost, government-run system we would end up with in the United States, but we can still debate whether Europe should switch to some other system, and for the time being perhaps the answer is no...
Should they simply wait for the day when health care matters more than it currently does?
Posted by Tyler Cowen on March 6, 2007 at 07:38 AM in Medicine | Permalink
Comments
Tyler, sometimes you're a complete breath of fresh air. So many other commenters (probably including fellow professors at GMU) would take this opportunity to offer up bromides against single-payer. Thanks for keeping an open mind.
Posted by: eriks at Mar 6, 2007 8:33:06 AM
surely the relevant comparison group for Mormons would be Europeans who don't smoke or drink, not Europeans in toto?
Posted by: dsquared at Mar 6, 2007 8:34:14 AM
Who don't smoke or drink, and live close to spectacular ski slopes.
Posted by: kharris at Mar 6, 2007 9:11:00 AM
"we can still debate whether Europe should switch to some other system"
I think Comedy Central will give you a six-episode deal on that pitch.
Posted by: nick s at Mar 6, 2007 9:14:00 AM
I have found that spending less money on things always has a way of reducing your costs.
Posted by: Matt at Mar 6, 2007 9:24:07 AM
The obvious conclusion is tax subsidies for health care are in turn subsidizing American lifestyles. If you give an American an extra marginal unit of health, he/she is more likely to spend it on another big mac, on a basketball game at 30, or on a golf game at 70 than on purchasing an 85th year.
Why is that economic discussions of health always favor life expectancy over utility?
Posted by: DK at Mar 6, 2007 9:26:54 AM
I recently heard that 1 of every 5 dollars is spent on healthcare and that that number would be rising. I have also seen the statistic that increasing the life expectancy in the USA has a marginal cost of 1 million per person and in poor African countries this number might be closer to a marginal cost of $100 per person, Has anyone seen other statistics of the marginal life expectancy cost in other countries? If you think of (assume) that quality of healthcare has the outcome of increased life expectancy (you would hope but my meaning is to ignore the other benefits) At what level should be set our marginal healthcare spending? It seems that at some points in life you could spend an unlimited amount but you are still going to die some time. I a government sets spending at what level should it set marginal spending or would it consider setting a budget without thought of marginal cost/benifit?
Posted by: Vincent at Mar 6, 2007 9:31:19 AM
dsquared wrote:
"surely the relevant comparison group for Mormons would be Europeans who don't smoke or drink, not Europeans in toto?"
Absolutely correct. And precisely why the following (often repeated) argument is specious:
~~European states spend less per capita on healthcare than the United States but have longer life expectancy and lower infant mortality. Therefore, the U.S. should adopt a European-style system of financing and administering healthcare, which would simultaneously reduce costs and improves quality~~
The fact is that health outcomes are greatly influenced by lifestyle factors that vary between countries and populations within countries, and that are unlikely to change whether one's healthcare bill is paid by the government or by Aetna. It may or may not be a good idea for the U.S. to adopt a European style system, but simple minded comparisons of lifespans doesn;t shed any useful light on the question.
Posted by: sd at Mar 6, 2007 10:21:21 AM
Of course this is not the kind of low-cost, government-run system we would end up with in the United States
Indeed. Consider that Professor Krugman and others have recently been touting the low cost increases in the VA as a model, together with the recent news and complaints. I see two possible explanations:
1) The VA's cost limitations were achieved with a reduction in care quality that is meaningful and bad, and the VA should not be held up as a model; realistic and efficient care would increase like Medicare instead.
2) The VA reduced spending model was precisely the same sort of fairly efficient, low-cost, government-run system as in Europe that would actually be better. However, the recent complaints and resignations demonstrate that such a model is politically infeasible in the USA.
And of course any discussion about whether "Europe should switch to another model" glosses over the differences among the various systems. The UK NHS is quite a bit different from France's model, which incorporates user fees and private insurance.
Posted by: John Thacker at Mar 6, 2007 10:22:02 AM
Here's a comment from the linked post, for example, about the VA system:
I think Krugman is on more solid ground than you give him credit. If the feds run the program the way they run the VA medical system, I won't have any complaints.
That may be true, but apparently too many of the American people *will* have complaints.
Posted by: John Thacker at Mar 6, 2007 10:23:41 AM
Walter Reed isn't a VA hospital. It's an Army hospital run by the Army and not the VA. That's why the Secretary of the Army resigned and not the Secretary of Veterans Affairs. Two completely different organizations.
Posted by: jon at Mar 6, 2007 10:42:26 AM
” the claims "sound right wing" but actually they provide the best argument for single-payer health insurance to be found: "The link between health and health care is murky, so let's just save money on our health system."”
Well, perhaps. But my main point is that the Krugman crowd can’t have it both ways. If they want cheap European healthcare they have to accept less heath care. It was not “another reader” who pointed out that the largest uninsured group in the US seem to live as long as whites. The two points I made are related.
The left cannot simultaneously fret about the 40 million uninsured AND about the low costs of European healthcare. The kind of health care the poor uninsured in the US can get in pubic hospitals is close to the European one, far less access and comfort, but probably no large loss in terms of life expectancy.
So what are Americans buying with their extra health dollars? Luxerty/comfort/quick access is certainly a large part. Just because this does not translate into longer life does not mean we should dismiss it. I know perfectly well that having a separate room in the hospital for my mom will not make her live longer, but I might want her to have it anyway.
Secondly it is possible that American are getting longer lives, if we control for worse lifestyle and perhaps genetic differences (even among white Europeans there seem to be large differences in this regard).
Posted by: Tino at Mar 6, 2007 12:37:57 PM
The trade-off for cheaper health care is not generally lower life expectancy, it is lower quality of life. You just have to look at the long waiting lists for knee operations, etc. in the UK and Canada to see what the trade off is.
Posted by: JFP at Mar 6, 2007 1:57:25 PM
I am skeptical that Aetna or the government paying the bill has no effect on lifestyle. If the US Government were paying the bill for Americans perhaps lawmakers would have some ground to stand on to push policies that have socitey wide health effects. For example instead of widening roads with impunity, perhap people would consider a more walking friendly society, understanding that we all pay the price for our fellow citizens not getting minimal amounts of exercise each day. Private insurance makes it hard for people to realize that public programs encouraging better nutrition, vaccinations, water saftey etc can have direct effects on your health care costs. As it is though people think they do not pay for the poor when in fact they do through higher hospital bills and diseases showing up because they have been allowed to fester in untreated populations.
Posted by: KRoth at Mar 6, 2007 2:03:18 PM
Uhh Tyler,
maybe you should provide some links comparing US health care with European health care?
Before making or posting such sweeping statements?
Surveys like these for example:
2006 International Health Policy Survey of Primary Care Doctors
Primary care doctors in the U.S. are less likely than those in several other countries to be able to offer patients access to care outside regular office hours or to have systems that alert doctors to potentially harmful drug interactions. U.S. primary care physicians are also less likely to receive financial incentives for improving patient care, according to the Commonwealth Fund 2006 International Health Policy Survey published today on the Web site of the journal Health Affairs.
2005 Commonwealth Fund International Health Policy Survey of Sicker Adults
A new international survey supported by The Commonwealth Fund finds that one-third of U.S. patients with health problems reported experiencing medical mistakes, medication errors, or inaccurate or delayed lab results—the highest rate of any of the six nations surveyed. While sicker patients in all countries reported safety risks, poor care coordination, and inadequate chronic care treatment, with no country deemed best or worst overall, the United States stood out for high error rates, inefficient coordination of care, and high out-of-pocket costs resulting in forgone care.
Mind you, that doesn´t mean that European health care systems are perfect. However they don´t look that bad compared to the US system.
Posted by: Detlef at Mar 6, 2007 2:06:31 PM
The trade-off for cheaper health care is not generally lower life expectancy, it is lower quality of life. You just have to look at the long waiting lists for knee operations, etc. in the UK and Canada to see what the trade off is.
Posted by: JFP at Mar 6, 2007 2:06:51 PM
"The link between health and health care is murky, so let's just save money on our health system."
Between group comparisons are misleading here, since groups differ for any number of identified and unidentified cultural, social, and genetic reasons. No one ever claimed health care was the only variable affecting health or that a group with health care that gets drunk and sky dives every weekend should have a higher lifespan than a group without healthcare that watches PBS and eats celery every weekend.
The real comparison of interest is how does health care affect health either within groups or when all the groups are examined as one population.
Posted by: Jason Malloy at Mar 6, 2007 2:29:33 PM
The trade-off for cheaper health care is not generally lower life expectancy, it is lower quality of life. You just have to look at the long waiting lists for knee operations, etc. in the UK and Canada to see what the trade off is.
Amen JFP. I was just about to post a rant against Tyler for letting life expectancy be the totality of his post. We could radically reduce our health expenditures if we chose to only spend it on life extending procedures and chose to ignore life enhancing benefits. Any monkey could reduce health spending via waiting lists and denied service and denied and delayed technological improvements, which are guaranteed if reducing costs is politicians most important issue.
Posted by: happyjuggler0 at Mar 6, 2007 2:29:54 PM
John Thacker appears perfectly willing to propagate any misinformation that casts aspersions on the VA. Good job John.
Additionally Walter Reed has been substantially outsourced to a subsidiary (IAP) of the great bogeyman that is Haliburton.
Posted by: crack at Mar 6, 2007 3:11:09 PM
A big analytic distortion here is end of life health care. You can extend life at the front end by care that makes sounder organisms for one price. Or you can extend life (a little) by spending (asymptotically) at the end. The second mode is largely cultural and skews the whole cost/benefit who pays analysis.
Posted by: footloose at Mar 6, 2007 3:18:00 PM
The trade-off for cheaper health care is not generally lower life expectancy, it is lower quality of life. You just have to look at the long waiting lists for knee operations, etc. in the UK and Canada to see what the trade off is.
Tyler Cowen posted about European health care systems. I didn´t know that Europe consisted of the UK and Canada only? Sorry about mentioning continental Europe.
Posted by: Detlef at Mar 6, 2007 3:44:53 PM
Wouldn't the hispanic mortality numbers be pretty strongly affected by selective migration?
Posted by: albatross at Mar 6, 2007 5:07:51 PM
Tyler Cowen posted about European health care systems. I didn´t know that Europe consisted of the UK and Canada only? Sorry about mentioning continental Europe.
I only referenced UK and Canada, because they are the only systems I know anything personally about. However, the same point applies to all systems. If you hold down health care spending, you will get a lower quality of life.
Posted by: JFP at Mar 6, 2007 5:37:32 PM
JFP,
I only referenced UK and Canada, because they are the only systems I know anything personally about. However, the same point applies to all systems. If you hold down health care spending, you will get a lower quality of life.
You did read my comment mentioning the two Commonwealth Fund surveys? Both surveys mentioned that - while each health care system might have problems - the American one doesn´t come out as the winner.
You might think about it.
Posted by: Detlef at Mar 6, 2007 6:51:04 PM
You did read my comment mentioning the two Commonwealth Fund surveys? Both surveys mentioned that - while each health care system might have problems - the American one doesn´t come out as the winner.
You might think about it.
I read it, and I don't claim that the American system is perfect. In particular, the fact that insurance is tied to employment is something I really hate about it. However, IF you have insurance in the US, the amount of healthcare that is available to you is far higher. It's a big if, though, sometimes.
The point remains, though, that the people in the US who have insurance get a lavish amount of healthcare for the lavish amount we spend. That can be pretty significant for quality of life.
Posted by: JFP at Mar 6, 2007 7:38:39 PM
"two Commonwealth Fund surveys"
Two narrow surveys of subjective variables by a left leaning fund? Not one, but TWO! End of debate.
Posted by: Tino at Mar 6, 2007 7:54:58 PM
Hispanic-American infant mortality is also quite low, about the same as white and Asian infant mortality in America, while African-American infant mortality is much higher. Short pregnancies and low birth weights appear to be more common among African-American women even at the high end of the social scale, perhaps related in some fashion to the relatively narrower pelvis bones of women of African descent (which is related to the more efficient running stride of blacks), which make larger babies more dangerous to deliver.
On the other hand there is evidence that past a certain high age, such as 75, that African-Americans then have the longest life expectancies. There do seem to be a lot of black female centenarians.
Posted by: Steve Sailer at Mar 6, 2007 9:13:00 PM
Either the Commonwealth Fund studies are valid or they are not. I don't automatically reject Dr. Cowen's arguments because he is the director of the corporate financed Mercatus Center.
Posted by: yes or no at Mar 6, 2007 9:24:44 PM
Being Canadian, I've always looked at our healthcare system as the best way of rationing healthcare possible. We get, in my opinion, about 90% of the American healthcare levels for about 1/2 the cost.
Of course anyone who believes that America can improve their current healthcare levels *and* save money with a one-payer system is dreaming in technicolor. But if you want to restrain healthcare spending (and American levels of healthcare spending would bankrupt any other nation on the planet and may, in fact, be bankrupting the US), a one-payer system is the most humane method of doing so.
It's a heck of a lot easier to be told "Nothing can be done" to save Grandma than to be told "For only an extra $250,000, you could give Grandma a shot at life. Is it worth it?"
Posted by: Tom West at Mar 7, 2007 6:29:55 AM
footloose wrote: A big analytic distortion here is end of life health care. You can extend life at the front end by care that makes sounder organisms for one price. Or you can extend life (a little) by spending (asymptotically) at the end. The second mode is largely cultural and skews the whole cost/benefit who pays analysis.
I'm surprised that nobody has commented on footloose's very sensible observation about end-of-life health care expenditures in the U.S. There has been a dramatic change in the way Americans die over the past century. According to this Rand white paper, the typical American dying in 1900 experienced very little or no "disability" prior to death, whereas the typical American dying in 2000 was disabled for 2+ years prior to death.
"So, although the overall health picture for Americans has improved dramatically, health problems have become clustered in the last years of life. In effect, the average American now lives a long, healthy life, with only intermittent health problems or chronic conditions that are compatible with normal life. However, increasingly fragile health and complicated care needs ordinarily mark the years just before death."
The various economic and technological developments of the past century that enabled industrialized, Western societies to almost double average life expectancies have in turn created considerable demand for medical services directed toward the very sick, the very infirm, and the senescent. A cultural change toward end-of-life issues certainly could help contain health care cost growth -- perhaps even in a manner that is plausibly pareto-improving. But end-of-life costs will continue to produce a disproportionate share of health care costs (unless we move to a Soylent Green or Logan's Run-style solution).
Posted by: brianS at Mar 8, 2007 7:29:35 PM
Regarding Mormons, they also eschew consuming caffeine.
No coffee, tea, or cola.
This business of "more" versus "less" health care is really
not very to the point. Details matter. Thus, the point about
care out of hours is probably non-trivially important. I remember
when doctors in the US made house calls. They simply do not
any more, and if you raise this issue with a US doctor you are
treated like you are out of your mind. But doctors in most other
countries do still make house calls. Is this a backward bending
supply curve of labor phenomenon? Our highly paid doctors cannot
waste their time making house calls?
So, sure, they are more likely to recommend specialist care to someone,
but you can die before you ever get it because they are not available.
I have long said that the US system is best for someone who is rich and
has a non-life threatening ailment requiring surgery.
Posted by: Barkley Rosser at Mar 10, 2007 8:15:30 PM
Nobody's healthy enough, just link nobody's ever rich enough. And in the end, Queen said it best: "Nothing really matters, anyone can see, nothing really matters to me... Any way the wind blows.."
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