via Columbia / Sam Cook

Category: Weekend

Please use the comments to demonstrate your own ignorance, unfamiliarity with empirical data and lack of respect for scientific knowledge. Be sure to create straw men and argue against things I have neither said nor implied. If you could repeat previously discredited memes or steer the conversation into irrelevant, off topic discussions, it would be appreciated. Lastly, kindly forgo all civility in your discourse . . . you are, after all, anonymous.

26 Responses to “Health Care Expenses vs. Life Expectancy”

  1. sainttjames says:

    Hey! I know…want to move the USA to the left and up?

    Get all the crap vending machines selling honeybuns/soda/chips out of the schools for a starter and have the school districts cancel the contracts that THEY SIGNED placing them there…

  2. zambrus says:

    Anyone care to let us know what the bubble size reporesents? It’s obviously not population or GDP or GDP per capita or health care spending as a percent GDP, which were the options that came to mind.

  3. scorponic says:

    Scrolling through the comments to the blog on which this originally appeared, I found a reference to what the size of the circles represents: doctor visits per capita.

  4. wink51 says:

    How about percentage of citizens covered with health care??

  5. VangelV says:

    The numbers are misleading because they leave out accidents and homicides. If we adjust for those, which we should because they have nothing to do with health care, the US life expectancy increases substantially.

    ~~~

    BR: Do you have any data to show that the accidents and homicides are a statistically different in the US than elsewhere?

  6. ironman says:

    BR: Wrong measure. For one, the life expectancy data isn’t corrected for cause of death (to account for the U.S.’ disproportionately high levels of mortality involving vehicle accidents or homicides, to name just two such factors, which are independent of the health of individuals who die from these events, not to mention the quality of the health care system.)

    For another, they’re also not adjusted to account for differences in the demographics of each nation. The other nations listed are very homogeneous, especially as compared to the United States.

    Finally, what nations spend on health care is tied to their GDP. Since the U.S. GDP per capita is so much higher than other nations, you should expect that it also has much higher levels of health care spending. What you don’t know is that there are diminishing returns to that kind of spending, which is evident in the data once you break it out into sub-national units.

  7. Uchicagoman says:

    @VangelV: That isn’t the point. It is the cost. So, dead people must cost a lot to take care in our heath care system then?! WTF, mate?

  8. Uchicagoman says:

    @ ironman So, we should adjust to reflect the demographics of rich-white people only?

    Also, yes, I think we should include the whole picture, full-life expectancy of anyone. To me, that is what I would want to know, regardless of the “cause”. Especially, since, those one would think the homicides and accidents should be overwhelmed by a supposedly healthier,longer living populace.

  9. drocto says:

    ironman,

    Great post. [I would not say that accident and homicide death rates are completely independent of the health care system though. They are related to the quality of health care available - if you get in a major car accident in the U.S. you're more likely to survive than if you were in a undeveloped country. That said, I'd agree that death from accident and homicide are quite independent of the health care *coverage* regime. In other words, since everyone gets emergency and life saving care regardless of coverage, your point stands.]

    scorponic,

    Thanks for doing the legwork and finding out the meaning of the bubble size. Ritholtz is getting lazier and just tossing stuff up.

  10. You are now in the “Weekend” tab of the blog — its random stuff.

    Not a lot of commentary — graphs, pictures, video. Literally tossed here. (This chart was pointed to by a commenter in the Health Care discussion).

    But Lazy? Talk to me after you’ve written your 12,000th post. Until then, GYOFB.

  11. ironman says:

    @uchicagoman: One should always compare apples to apples or the statistical comparison fails. Entirely. Doing otherwise is inherently dishonest and potentially racist.

  12. kstills says:

    Uchicagoman,

    Um, death by accidents lowers life expectancy. One would also imagine the costs involved in trying to save those folks would also be substantial.

    Another factor in life expectancy to consider is infant mortality. All depends on when you decide a life has ended. I don’t have hard data on that, but the US tends to try to salvage more premature births, which then go onto the debit side of this equation, then some other countries.

  13. kstills says:

    Drocto,

    Independant of life expectancy, maybe, but the trauma care counts towards costs.

  14. Uchicagoman says:

    @ironman: I’ll take the bait. Please, elaborate.

    I see you are an associate of Pajamas Media.

    http://en.wikipedia.org/wiki/Pajamas_Media

    Did “Joe the plumber” help with your analysis?

  15. Uchicagoman says:

    @kstill, others: But my point is, so what? “Life expectancy isn’t corrected for homicide or accident” What the hell does this mean?

    Health costs are health costs, a life lost is a life lost…. Not rocket science. Nothing ambiguous here.

    I am not trying to be a smuck, just giving my honest opinion, but it just sounds like Enron accounting… Doesn’t matter how one wants re-distribute and re-organize the variables. If it makes you feel better, that’s wonderful for you.

    To me, the data and chart above speaks for itself.

  16. uclalien says:

    I think we can all agree that people in here are looking at the data from two very different perspectives. People like Uchicangoman are simply interested in the cost of health care in a given nation, regardless of any events that may skew the data. On the other hand, people like kstills and ironman appear to be more interested in stripping out any variations in order to provide an apples to apples comparison.

    In isolation, the Uchicangoman’s approach does provide us with useful information about a country’s health care costs, but it doesn’t provide us with the a useful tool for comparison across countries where outcomes may be affected by non-health care related events. In other words, the graph above is virtually useless when making comparisons across countries.

  17. Uchicagoman says:

    @uclalien Fair enough. I am just saying, we should call a spade and spade. As BR said, people in rest of the developed world think we are bit insane in regards to health-care. I think this chart speaks to that a bit.

    We all know the wealthy do very well for themselves here in this great nation, and spend like crazy. But we shouldn’t fool ourselves into believe there are not many who are disenfranchised, close to helpless, and bearing the weight of others opulence.

    And, yes ironman has a point with the homogeneity of smaller nations. But, that is no excuse to not look at the reality of America in all of its imperfect, homicidal, heterogeneous, mixed-income, mixed-race glory.

    Either way, we see that on average people die earlier, despite the enormous economic output.

    Perhaps add EU as a whole on that graph?

  18. Is the USA a nation where accidental deaths are much greater than elsewhere?

    That’s news to me.

  19. So why do Americans die younger than people living in most other developed democracies? Well, there is the Michael Moore answer delivered in his “documentary” Sicko—it’s because we lack a benevolent government funded health care system. But life expectancy is not dependent on just medical care. For example, Texas A&M health economist Robert Ohsfeldt and health economics consultant John Schneider point out that deaths from accidents and homicides in America are much higher than in any other of the developed countries. Taking accidental deaths and homicides between 1980 and 1999 into account, they calculate that instead of being at near the bottom of the list of developed countries, U.S. life expectancy would actually rank at the top.

    However as Carl Bialik, the invaluable Wall Street Journal “Numbers Guy” columnist, notes Ohsfeldt and Schneider’s analysis does not account for the fact a better health care system would have saved more accident victims and thus would have boosted life expectancy. In fact, in 2002, Harvard researchers argued that the U.S. murder rate is much lower than it would otherwise have been because so many assault victims are being saved by improved medical care. Nevertheless, Ohsfeldt and Schneider are likely right that U.S. life expectancy is being depressed by our higher accident and homicide rates.

    http://reason.com/archives/2008/06/17/accidents-murders-preemies-fat

  20. Ben Best says:

    US Causes of Death

    (1) Diseases of the heart heart attack (mainly) 28.5%
    (2) Malignant neoplasms cancer 22.8%
    (3) Cerebrovascular disease stroke 6.7%
    (4) Chronic lower respiratory disease emphysema, chronic bronchitis 5.1%
    (5) Unintentional injuries accidents 4.4%
    (6) Diabetes mellitus diabetes 3.0%
    (7) Influenza and pneumonia flu & pneumonia 2.7%
    (8) Alzheimer’s Disease Alzheimer’s senility 2.4%
    (9) Nephritis and Nephrosis kidney disease 1.7%
    (10) Septicemia systemic infection 1.4%
    (11) Intentional self-harm suicide 1.3%
    (12) Chronic Liver/Cirrhosis liver disease 1.1%
    (13) Essential Hypertension high blood pressure 0.8%
    (14) Assault homicide 0.7%
    (15) All other causes other 17.4%

    Source: National Vital Statistics Report, Volume 53, Number 5

  21. Carl Bialik says:

    Does the U.S. Lead in Life Expectancy?

    Life expectancy has become a popular measure for comparing different countries’ health-care systems. Keeping people alive is, of course, an important goal of medicine — and the fact that the U.S. ranks below dozens of countries has served as fodder for politicians angling to revamp the U.S. system.

    health care

    However, two economists have argued in a recent book that life expectancy is a lousy way to compare two countries. Murders, suicides and accidents can have a big effect on life-expectancy stats because their victims die younger, on average, than victims of disease. And, they argue, the health-care system can’t do much to prevent those kinds of deaths. After adjusting for those kinds of deaths, the U.S. ranks at or near the top of developed nations in life expectancy, health economists Robert Ohsfeldt (of the Texas A&M Health Science Center) and John Schneider (of Health Economics Consulting Group LLC) write in “The Business of Health,” a 2006 book published by the conservative American Enterprise Institute think tank.

    The notion is politically significant. The U.S.’s poor ranking in life expectancy is a key tenet in filmmaker Michael Moore’s excoriation of American health care in “Sicko,” and in calls by reformers for broader access to medical care — calls being heeded by the leading Democratic presidential candidates. Yet the U.S. has an unusually high rate of deaths from accidents and homicides, compared with other developed countries. (For instance, transport-accident deaths are three times higher in the U.S. than in the U.K., according to the World Health Organization, while the murder rate is 10 to 12 times greater.) Subtract out these deaths and suicide — where the U.S. is at or below average — and the American health-care system doesn’t look so bad. Hence, the adjusted life-expectancy rankings have been mentioned in several conservative publications critical of health-care reform, including National Review and City Journal.

    But there are several shortcomings to this analysis. First, death rates from accidents, homicides and suicide are dependent not only on how many people suffer injuries from such events but also on how effective the health-care system is at averting death in borderline cases (a point I made in a column earlier this year). Various factors influence that success rate; one of them is the distance emergency services must travel to reach victims, in which population density comes into play and the relatively spread-out U.S. is at a disadvantage.

    Also, the authors didn’t directly adjust for these deaths. Instead, Dr. Ohsfeldt and Dr. Schneider performed a statistical calculation, called a regression, to estimate how much mortality rates from homicide, suicide and accident influenced mortality, on average, from 1980-1999 in 29 of the 30 developed countries in the Organisation for Economic Co-operation and Development (they skipped tiny Luxembourg). Then they adjusted life-expectancy stats to get a rough handle on what life expectancy would have been like had the rates of these deaths been the same in all 29 countries. Their result: The U.S. would have ranked first, at 76.9 years of life expectancy — an increase of 1.6 years. Meanwhile, Japan fell from 78.7 years to 76 years, indicating it had been benefiting inordinately from low rates of accidental deaths and homicides. (You can see a partial list at this blog.)

    Carl Haub, a demographer at the Population Reference Bureau in Washington, D.C., said the method was incomplete. A more-precise analysis would have removed those who died from these causes from overall mortality stats, and then recalculated life expectancy. (For more on how life expectancy is calculated, see this earlier blog post.) “Just because another method is a lot of work, does not mean regression will yield a correct result,” Mr. Haub told me.

    Prof. Ohsfeldt acknowledges that regression was chosen for its relative simplicity for what he called his “little book project.” And he agrees that some deaths that his book attempted to remove from the life-expectancy tables might be dependent on health-care systems. “We’re not trying to say that these are the precisely correct life-expectancy estimates,” he told me. “We’re just trying to show that there are other factors that affect life-expectancy-at-birth estimates that people quote all the time.” These factors (which could also include rates obesity and smoking, also arguably the result of lifestyle choices rather than health care) call into question the value of country rankings, especially where the difference between the leading countries is often less than a year. Prof. Ohsfeldt compared the situation to college rankings where two schools with minute differences are ranked, somewhat arbitrarily.

  22. ironman says:

    BR: The U.S. does indeed rank high in the number of deaths due to motor vehicle accidents. Here’s an article in the JAMA from 2004, reporting data as of 2000, which confirms motor vehicle accidents as the sixth leading cause of death in the U.S.

    While not accidental, homicides rank as the seventh.

    By comparison, neither category makes the top 11 for leading causes of death worldwide, at least as reported by the Lancet.

  23. pjschgo says:

    Isn’t Japan’s suicide rate per capita more than twice that of the USA? I think you’re all greatly exhaggerating the effects of “unnatural” deaths.

  24. sarkozozo says:

    Hi folks !

    The circles are proportional to the square root of average number of doctors visits per year for each country.

    details from the R code here:

    http://www.stat.columbia.edu/~cook/movabletype/archives/2009/12/healthcare_spen.html#more

    In fact it is a three series graphs as you will find on the same page another graph in parallel coordinates depicting the same data.

    The message is that, universal cover in health care is strongly associated with a higher life expectancy.

    Note also that the perverse incentives of the US system put it as an extreme outlier: most of the cost goes into the pockets of insurance companies and medics. While the poors finish with heavy pathology whose cost are very high. Results: the system is very socially very costly and deliver very few. I remember a source stating that the first cause of mortality in the USA is… the health care system !

    cheers.

  25. carrottop says:

    for those who want to subtract the cherry picked accidents,
    let’s then,
    following the same logic,
    subtract cancer deaths in japan where 1/3 of the pop smokes,
    and in europe where 1/4 of the pop smokes.

    america spends too much and covers far fewer people.