« Assorted links | Main | Via you-know-who »
A new paper on life expectancy
This isn't quite news, but here's the latest word, from Samuel Preston and Jessica Ho:
Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the health care system rather than on behavioral or social factors. This paper presents evidence on the relative performance of the US health care system using death avoidance as the sole criterion. We find that, by standards of OECD countries, the US does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and where behavioral factors do not play a dominant role. We show that the US has had significantly faster declines in mortality from these two diseases than comparison countries. We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system.
Posted by Tyler Cowen on August 10, 2009 at 02:28 PM in Medicine | Permalink
Comments
The paper lists some diseases, shows rapid improvement of US outcomes for those diseases and concludes that low longevity ranking is not the result of the US healthcare system. This argument fails basic logic. That we've improved in some diseases shows nothing about the healthcare system in general.
They then try to blame US longevity on obesity and smoking. In one sentence they say the US is more obese than the rest of the world. On smoking, the best they can do is suggest smoking issues are to blame for a few positions in longevity rankings. If such factors are a significant part of their argument, they should spend some more time developing the argument.
Perhaps interestingly, they include data on breast cancer. Their charts show that the US has improved greatly, to the point that we now match the rest of the world.
Posted by: fusion at Aug 10, 2009 2:47:17 PM
I'd add that the summary at the end of the paper is much more hedged than the abstract Tyler quotes.
Posted by: fusion at Aug 10, 2009 2:49:10 PM
fusion: "I'd add that the summary at the end of the paper is much more hedged than the abstract Tyler quotes."
It is? Here's the last two sentences from the end of the paper:
does a poor performance by the US health care system account for the low international ranking of longevity in the US? Our answer
is, “no”.
What is hedged about that answer to that question? That's the question they were attempting to answer. The title of their paper is:
Low Life Expectancy in the United States: Is the Health Care System at Fault?
Is your argument that they asked the wrong question?
Posted by: John Dewey at Aug 10, 2009 3:08:08 PM
Does the paper ever mention as an advanced technology available only in the U.S. the exclusion of a fraction of the population from health care provision either due to non-provision of insurance, exclusion of pre-existing conditions, or termination of insurance due to unemployment or overuse during major illness? Since no other developed country has access to such sophisticated technologies, they might be useful places to dig.
Posted by: DCBob at Aug 10, 2009 3:08:32 PM
Does the paper mention who finances the health care of elderly people in the United States?
Posted by: Stan at Aug 10, 2009 3:48:50 PM
The argument fails basic deductive logic. But most real world inferences fail deductive logic. That is, precious few inferences, including scientific ones, are actually deductions. Science is not mathematics.
Posted by: Constant at Aug 10, 2009 4:09:31 PM
I'd be more interested in a study of Obstetrics. This seems to be an area that well reflects US doctors focus on providing medical services, rather than focusing on good outcomes to pregnancy and birth. (Limiting interventions has shown better outcomes in Europe).
Posted by: Steven Wicklund at Aug 10, 2009 4:34:51 PM
Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50.
Hmmm I was under the impression that the USA lagged due to deaths before age 50 and that we did OK after age 50.
Posted by: Floccina at Aug 10, 2009 4:37:00 PM
"Perhaps interestingly, they include data on breast cancer. Their charts show that the US has improved greatly, to the point that we now match the rest of the world."
Maybe I'm extremely confused, but what is "the rest of the world," and since when have we managed to finally catch and match them? The 1940s?
Posted by: MPO at Aug 10, 2009 4:57:24 PM
While I haven't read the entire research paper, I sincerely do hope the authors are comparing "apples to apples." And I'd certainly like the see the list of countries' life spans and see the DEGREE to which the U.S. is "behind" Japan, etc. Having lived there I agree that lifestyle and diet can make one live longer, healthier than any expensive nanny-state federal health care program (which, if you wait in line long enough, you will get over-medicated).
And BTW, how is there a "Mortality Rate," and then a second category called "Mortality Rate after Age 50?" Are we in equal ranking in both categories?
Posted by: S Ronell at Aug 10, 2009 5:32:22 PM
Riffing on "fusion"'s first comment about faulty logic, I would have to agree. How can someone suggest that our health care system is not at fault when its entire modus operandi is based on finding ever more lucrative treatments to give people after they are already sick? Rather than, say, honoring the hard science which says that not only is it possible to prevent these diseases but that it's way more cost effective to the patient (and also just plane more effective). And how is it not a failing of our health care system that a third or more of our population is so obese, diabetic, sedentary, etc in the first place?
Posted by: Rafe Furst at Aug 10, 2009 7:32:49 PM
If it's the fault of our healthcare system that people are obese, diabetic and sedentary, why are people who make these criticisms (especially those who insist we can "prevent" so many diseases, and that prevention is a near-panacea) pointing us toward a European-style system whose population is not _as_ badly off on these marks, but is getting there? The "hard science" has increasingly and for some time now described obesity and diabetes in Europe as increasing at an "epidemic" rate.
Posted by: MPO at Aug 10, 2009 7:55:16 PM
They don't really have anything to say about the uncovered. A comparison of 50-64 and 65+ would have helped, but the lack of much of a safety net may have more effect than medicine. It does seem the much greater spending here produces very meager results at best. If anything, the US may look overly good here if its betterment is simply due to standards and techniques that have not permeated as fast elsewhere. Their prostate cancer example seems to be a case of this.
Posted by: Lord at Aug 10, 2009 8:42:19 PM
Obesity and sedentary people are lifestyle issues, not health care issues. If you want socialized health care so that we can get rid of obesity and sedentary people, what exactly are you hoping for? That people will be arrested and forced to diet and exercise? Otherwise, how can you hope that any change in the health care "system" will change anything? Clearly there is nothing we can do short of force to make somebody not be obese.
Posted by: Cliff at Aug 10, 2009 8:49:17 PM
Interesting but something doesn't quite add up here:
1. This seems inconsistent with the analysis Ohsfeldt and Schneider have done that shows when controlling for fatal accidents and injuries, the U.S. looks much better in terms of life expectancy.
2. The statistic posted here a few days ago that the U.S. has a lower life expectancy at birth than the Netherlands but a higher life expectancy at age 65. Maybe this isn't inconsistent if mortality in the U.S. is concentrated between 50 and 65 but it seems odd.
Posted by: Ricardo at Aug 10, 2009 9:59:09 PM
The US health care system is better at treating serious maladies than other systems. Are people shocked by this? The US has generally outperformed all other nations in terms of cancer survival rates and cardiac care. Lets not forget that the US is home to MD Anderson and the Cleveland Clinic.
Posted by: john pertz at Aug 10, 2009 10:02:13 PM
"The paper lists some diseases, shows rapid improvement of US outcomes for those diseases and concludes that low longevity ranking is not the result of the US healthcare system. This argument fails basic logic. That we've improved in some diseases shows nothing about the healthcare system in general."
The argument of the paper is obvious. They are saying that if one want to compare outcomes of health systems which should look at the areas where health care has greatest impact. Those areas are areas like heart disease mortality reduction, cancer treatments blah. There are many things were health care systems have little impact (e.g. diabetes, incidence of heart disease, cancer etc) because they are chronic lifestyle type diseases. It makes absolutely no sense to blame a health care system for the incidence of diabetes, cancer or heart disease because these are lifestyle choices. It does make sense to examine the ability of the health care system to reduce mortality given that one has a disease.
The left never really separates these factors. There arguments make a lot of sense. You need to dis-aggregate factors outside the control of the health care system which cause increased mortality: obesity, no exercise, late pregnancies, high murder rate, irresponsibility, drug use, poverty etc. Whether they successfully do this or not that is another question.
Posted by: assman at Aug 11, 2009 12:18:05 AM
It makes absolutely no sense to blame a health care system for the incidence of diabetes, cancer or heart disease because these are lifestyle choices
This incidence of these diseases are certainly the responsibility of health care...it's called preventive medicine for a reason and there is a whole field of medicine devoted to it. but more importantly, the progression of the disease and it's sequalae are most definitely the responsibility of health care.
the right readily ignores this.
Posted by: BK, MD at Aug 11, 2009 1:12:42 AM
The left never really separates these factors.
Heck, the left doesn't even separate shootings and auto accidents as a factor. It's just "life expectancy". The real point is that actuarial "life expectancy" is a poor measure for anything outside of the life-insurance business, and (at least if not actually controlled for actual cause of death, etc) is not a good metric for health care.
Posted by: Sonic Charmer at Aug 11, 2009 1:16:06 AM
BK, MD
[It makes absolutely no sense to blame a health care system for the incidence of diabetes, cancer or heart disease because these are lifestyle choices]
This incidence of these diseases are certainly the responsibility of health care...it's called preventive medicine for a reason
Please tell me how various cancers - for example, pancreatic, or, say, leukemia - are "prevented" by health care doing Preventative Medicine in All The Other Good, Socialist Countries.
but more importantly, the progression of the disease and it's sequalae are most definitely the responsibility of health care. the progression of the disease and it's sequalae are most definitely the responsibility of health care.
I don't know what you mean by "the right", but the paper described above sounds like it's specifically about this (how US health care re: progression of disease). Cancer is specifically mentioned in the excerpt.
Posted by: Sonic Charmer at Aug 11, 2009 1:20:46 AM
Probably the largest causes of these so-called 'lifestyle' diseases is stress, stress due to employment problems, stress due to poor safety nets, stress due to how we treat each other. Those may not be healthcare related, but they are societal. Those are the areas that need attention more than any.
Posted by: Lord at Aug 11, 2009 2:05:16 AM
My dad died of prostate cancer in his 70s; he had a reason to live: putting his wife with dementia "in the ground". So, I'm aware of his treatment which was quickly merely life extension, and the last time I checked, that's pretty much the state of the art if your prostate cancer matters. Which is why watchful waiting is now the most common "treatment".
If life extension is merely improved, and at high cost in money and lifestyle, is the treatment really better? And if life extension merely moved from four years to five years, is it really better?
The real problem is the fragmentation of the diagnosis and treatment data; until it is centrally collected for statistic analysis, so many questions will remain. If Wal-Mart informatics were used, doctors treating prostate cancer would have access to near real-time data analysis of all treatment option's effectiveness.
Posted by: mulp at Aug 11, 2009 2:14:54 AM
If life extension is merely improved, and at high cost in money and lifestyle, is the treatment really better?
Maybe.
And if life extension merely moved from four years to five years, is it really better?
Yes.
Posted by: Tracy W at Aug 11, 2009 5:43:39 AM
If you want to compare different medical processes to life expectancy you have to answer a few questions. Among these questions, are the medical inputs to the process identical, or if different does it matter? Of course inputs matter. So, are there particular sub-processes that have to do only (mainly) with medical process and are not affected by inputs? The paper makes an effort. As a libertarian, I want these questions answered before we dismantle our current medical system and they call this ideology. Progressives don't think we need answers and they call that pragmatism.
Posted by: Andrew at Aug 11, 2009 6:09:43 AM
More definitions for progressives: When gov't redistribution programs that run deficits (SS or Medicare) are popular that is democracy. When these programs go bankrupt that is market failure. When proposals for expanding these programs is found to be extremely unpopular, that is racism. When you identify and eliminate racism, that is progress.
Posted by: Andrew at Aug 11, 2009 8:45:33 AM
