Paying through the (surgically altered) nose

... and that would be a complete non-sequitur.

But god forbid we look outside our borders for ideas about healthcare.

Good luck with that. We're seeing a redefinition of America going on with the leading candidate now being a quasi-religious formulation of "exceptionalism," meaning America is "exceptional" because God gave us a unique set of principles through the Founders and as embodied in the sacred document of the Constitution. This means we are, by Grace, the best nation on earth.

So, we can't destroy the environment because it renews itself and is for our use as long as we adhere to our God-given principles. So, our way of life is innately superior and our economic system needs to manifest our God-given principles. So, any failure is due to our not believing and not putting our beliefs in action because that is not being true to our God-given principles and that is a denial of God.

So, our healthcare system is the best and any ways that it isn't the best are due to government interference, whatever statistics say. Our way of life is best, no matter how much vacation and pension Europeans get. Our economic system is best, no matter how much inequality it creates, no matter how other systems work.

Can't confront belief with fact. Just doesn't work.

Dear Buttonwood,

Not having the chart available, I can't say for sure, but I suspect that the difference between the US and the most other countries is a matter of months rather than years. Certainly that has been the pattern in similar studies I've seen in the past.

With that in mind, have Mr Grice's figures been normalised for factors such as road fatality rates (given the higher number of road miles clocked up by Americans compared to most other parts of the world) and gun crime, neither of which are functions of health care quality? If not, then the chart will be misleading, underestimating the quality of US private health-care in terms of US life expectancy outcomes.

I'm sure many other countries can advance their own claims to extraneous factors (butterfat poisoning from the sachertorte at Demel's for the Viennese, for a start). You yourself mention crime as a complicating factor. But if you recognize the shortcomings of the study, why would you propose to use it to bait those family members who disagree with you? Doesn't sound very civil to me...

OK, so now that we've substantially mitigated some of the most common detractors to life--infectious diseases and infant mortality--what's left to play with?

Well, health care quantity/quality is pretty far down on that list--by a margin behind 1) genetic predisposition for health/longevity; and 2) lifestyle. Could the Japanese phenotype just be inherently healthier and longer-lived than the average mix of American genetic heritage? Could our diet, stress, physical activity and environment have something to do with our results that is not really related to the health care system? Health care is a pretty weak mitigant if those two are not working for us.

Freedom Fields wrote: Mar 3rd 2011 8:06 GMT
"Not having the chart available, I can't say for sure, but I suspect that the difference between the US and the most other countries is a matter of months rather than years. Certainly that has been the pattern in similar studies I've seen in the past."

Yes, most of the data I have seen from the WHO shows that Japan has a nice high life expectancy at around 82. England and Canada are around 79. The U.S. is around 78. All things considered, I think it is far more likely that we are seeing the concept of diminishing returns: it looks like our human life expectancy is capping out in the 78 to 79 year range, and adding more and more health expenditures does not seem to push that limit significantly higher.

Instead of a single insurer, there are hundreds. Administrative costs for so many different plans are much higher than in other countries. Each state has its own rules and gold plated unfunded mandates tacked onto insurance. Legal concerns cause a lot of additional tests. Lobbies are more powerful in the states, so they can demand more rent. One example: Pfizer recently made an agreement with the generic supplier to allow generics 6 months earlier in the entire world, but the cost is 6 months later for the US. An additional year longer in the US than in other countries, and no one to stick up for the US consumer.

There was a report out recently which persuasively argued that lower US life expectancy is to do with the earlier adoption of widespread smoking by US men and (especially) women in the 30s-50s, who are now dying out.

The difference in longevity was discussed recently in the US because of the GOP's proposal to push out the age for Social Security. After all, people live longer, right? Turns out in the US, the rich live longer but the poor don't, so the proposal would deny funds to those who most need them.

CBPP did an analysis of this topic. Others did too but theirs is quite readable. The net effect would be to impoverish some millions of elderly and a number of children as well because many children live with grandparents.

The axis for cost is mislabelled. It indicates $70,000/person for the US not $7,000.

@ Buttonwood,

I noted your update commenting on longevity, and observing that life expectancies are slowly increasing, and are not capped out. However, I don't think this directly addresses the point of diminishing returns. Life expectancies may be slowly creeping upwards, but to determine whether this increase over time has any correlation with health care spending is a different chart than what you originally posted.

The chart simply shows current life expectancies versus health care spending. On that basis, I would say that if Britain doubled its health care spending tomorrow, life expectancies would not magically double overnight. Health care dollars can be spent much faster than years can be added on to life expectancy, which is why I am guessing that we are at a point of diminishing returns in the U.S. regarding dollars spent versus years-of-life gained. You would need to wait 10 years and see what life-expectancies were in order to accurately gauge whether health care dollars spent today have any meaningful effect on life-expectancies downstream.

@ Buttonwood,

Incidentally, it might be a good exercise to see what health care expenditures were in Britain, France, and the U.S. back in 1940, and in the years that follow, to see if the marginally greater increases in life expectancy in Britain and France versus the U.S. are correlated with spending increases.

Can we normalize this for gun ownership and HIV prevalence?

Wilkinson and Pickett in "the Spirit Level" establish very clearly that in countries with great inequality, it is not just the poor who bring down the average, the rich also have shorter life expectancy. This is a statistical conclusion, and the detailed rationale is not clear, but the concluson is clear.

Longevity is but one factor in any debate over socialized health care. Quality of life is another, as is cost. Not just financial cost, but cost to the social fabric, that is, what values are you undermining or promoting by such policies?

Further, spending on administering to those who are already ill is grossly inefficient. *Prevention* should be the primary focus of any social health care system, and the *first* step in prevention is being responsible for one's own lifestyle. Yet a general, socialized health care system directly undermines being responsible for one's life choices because the financial cost of the system is incurred regardless of use. You therefore diminish the cost of their actions to the individual, and encourage them to make use of a system that they have already paid for. Socialized health is, therefore, a policy that undermines what it is trying to do, that is, promote public health. It is, therefore, mad to promote such a system.

The counter-argument to that is that people do not take responsbility for their lifestyle regardless of the cost, i.e. the will live on cheese burgers regardless of whether they have free medical services or not. In addition, the cost of any hospitalization will be borne directly by their family, and so it may have severe social consequences (impoverishment, crime, etc.). There is also (some degree of) a social responsibilty to assist those who cannot help themselves.

All such factors need to be part of the equation, but the answer that you ultimately get depends upon your weighting of the various factors. A weighting that depends upon ideology, time-frame and values. And, of course, there is no hard data on any of these things.

What you need to do then is to promote a system that *gives* you hard data, so that the debate can at least be grounded in something concrete. That is, you must treat your system as an *experiment* with the objective of determining what works and what it costs over all significant aspects. Indeed, you'd need *several* such systems run independently.

For such a program to work, however, everyone must buy into the fact that currently no definitive answer to the problem of socialized heatlth care can be given, and that it is exactly society's responsibilty to *find* one rather than impose one.

In addition to mccuerc's 10X error finding, please note:
The units are in PPP, which I assume is purchasing power parity. This alters the results in ways that I cannot determine. When PPP is used, I suggest that the writer explain how or whether the calculation has skewed the data.

I do not disagree with the overall conclusions, just the data presentation.

I don't know what to trust more, PPP or the Big Mac Index.

I'm not quite clear why the chart includes a straight line, rather than a curve. It is pretty clear that the relation is not linear. If we ignore the anomaly that is the United States, what we actually have is a strong increase in longevity for initial increases in health care spending, followed by slower increases in longevity for further increases in spending.

I like correlation graphs because they always imply the chance of a two-way causality. Are we living longer because we are spending more on health care or are we spending more on health care because we are living longer?

Answers to everybody because I Know It All.
@Jouris: good call there, straight line vs curved line. The straight line is just because they're trying to make a point, and it makes the US data point look lower than it would if the line flattened out, which would better fit both the points and the underlying concept (that the big/cheap improvements come from eliminating things that shorten "normal" life span like starvation and infection, with diminishing returns coming from efforts to lengthen it over "normal").
@freedom files: the difference between countries is a few years, about 10 from top to bottom, which is consistent over all the studies that have been done on this topic for the past 15 years or so that i have been following it. Similarly, most of these studies eliminate deaths by accident/violence etc. because they come to the mind of the researchers the same way they come to your mind, and the results are pretty much always the same.
@blogeconomist: Similarly, accounting for healthy habits, we find that the US is pretty good for things like smoking, exercise, or alcoholism, and only gets a demerit point for obesity; however the rankings of the countries haven't changed much over time since when our obesity wasn't so unique. Others have stated as fact the hypothesis that it's because we save so many babies who die after a few days but wouldn't have been counted as live births in other countries; that also doesn't work because plenty of studies have been done using not live births but just late term pregnancies, and the US does only a tiny bit better in survival then if you count our heroically saved babies who die soon.
Which brings us around to the main point, which is pretty much consonant with what we all know; that the bulk of US healthcare is focused on heroic/expensive/low bang for the buck medicine, spending thousands of dollars to get a terminal patient a month or two of life, while other countries put more money and effort into things like simple vitamins for impoverished pregnancies, which cost almost nothing and show an improvement throughout the baby's entire left. Huge bang for the buck, in comparison.
This is due to a couple of related factors; the greater prestige and therefore payment given to such superduper hightech medicine in the US compared to simple care.
The clincher for this is in the related studies that compare life expectancy in different countries by age group. Although the US is worst in life expectancy at birth, it gets relatively better with increasing age groups until life expectancy in the US become highest in the world in geriatric medicine, like over age 70. This is where all that money spent on hightech fancy interventions kicks in. Of course, it's also all done under the aegis of Medicare, what you might call socialized medicine. So I guess you could say the US can do world class socialized medicine just fine.

Considering that most health spending is in those last few years, sometimes months/weeks of life, in what way does health spending relate to longevity? It is surely more a function of lifelong habits both nutritional and physical hewn over decades. Health and eating habits atrocious in the U.S., this graph illustrates nothing more than that the U.S. will pour a fortune into a dying man.