From a 4 month old thread titled “Life expectancy and infant mortality: the problem with international comparisons”:
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Life Expectancy
Life expectancy is a poor statistic for determining the efficacy of a health care system because it fails the first criterion of assuming interaction with the health care system. For example, open any newspaper and, chances are, there are stories about people who die “in their sleep,” in a car accident or of some medical ailment before an ambulance ever arrives. If an individual dies with no interaction with the health care system, then his death tells us little about the quality of a health care system. Yet all such deaths are computed into the life expectancy statistic.
Life expectancy also largely violates the second criterion - a health care system has, at most, minimal impact on longevity. One way to see this is to reexamine the table constructed by the Center for Economic and Policy Research. The interpretation that the Center for Economic and Policy Research wants readers to derive from Table 1 is that the United States would be better off with a system of universal health care. However, a careful examination of that table yields a more accurate interpretation: There is no relationship between life expectancy and spending on health care. Greece, the country that spends the least per capita on health care, has higher life expectancy than seven other countries, including Belgium, Denmark, Finland, Germany, Netherlands, the United Kingdom and the United States. Spain, which spends the second least per capita on health care, has higher life expectancy than ten other countries that spend more.
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GDP per capita is one of the more consistent predictors of life expectancy.
Yet the United States has the highest GDP per capita in the world, so why does it have a life expectancy lower than most of the industrialized world? The primary reason is that the U.S. is ethnically a far more diverse nation than most other industrialized nations. Factors associated with different ethnic backgrounds - culture, diet, etc. - can have a substantial impact on life expectancy. Comparisons of distinct ethnic populations in the U.S. with their country of origin find similar rates of life expectancy. For example, Japanese-Americans have an average life expectancy similar to that of Japanese.
A good deal of the lower life expectancy rate in the U.S. is accounted for by the difference in life expectancy of African-Americans versus other populations in the United States. Life expectancy for African-Americans is about 72.3 years, while for whites it is about 77.7 years.11 What accounts for the difference? Numerous scholars have investigated this question.12 The most prevalent explanations are differences in income and personal risk factors. One study found that about one-third of the difference between white and African-American life expectancies in the United States was accounted for by income; another third was accounted for by personal risk factors such as obesity, blood pressure, alcohol intake, diabetes, cholesterol concentration, and smoking and the final third was due to unexplained factors.13 Another study found that much of the disparity was due to higher rates of HIV, diabetes and hypertension among African Americans.14 Even studies that suggest the health care system may have some effect on the disparity still emphasize the importance of factors such as income, education, and social environment.15
A plethora of factors influence life expectancy, including genetics, lifestyle, diet, income and educational levels. A health care system has, at best, minimal impact. Thus, life expectancy is not a statistic that should be used to inform the public policy debate on health care.
At first glance, infant mortality appears to be a good measure of a health care system. First, it assumes interaction with a health care system since most babies born in the industrialized world are born in a hospital or other health care facility. It also satisfies the second criterion of assuming that health care professionals can affect the outcome, since doctors and nurses have a direct impact on the survival chances of a newborn. If infant mortality were accepted as an adequate measure based on those two criteria alone, then the U.S. health care system is one of the least effective in the industrialized world.
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But infant mortality tells us a lot less about a health care system than one might think. The main problem is inconsistent measurement across nations. The United Nations Statistics Division, which collects data on infant mortality, stipulates that an infant, once it is removed from its mother and then “breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles… is considered live-born regardless of gestational age."16 While the U.S. follows that definition, many other nations do not. Demographer Nicholas Eberstadt notes that in Switzerland “an infant must be at least 30 centimeters long at birth to be counted as living."17 This excludes many of the most vulnerable infants from Switzerland’s infant mortality measure.
Switzerland is far from the only nation to have peculiarities in its measure. Italy has at least three different definitions for infant deaths in different regions of the nation.18 The United Nations Statistics Division notes many other differences.19 Japan counts only births to Japanese nationals living in Japan, not abroad. Finland, France and Norway, by contrast, do count births to nationals living outside of the country. Belgium includes births to its armed forces living outside Belgium but not births to foreign armed forces living in Belgium. Finally, Canada counts births to Canadians living in the U.S., but not Americans living in Canada. In short, many nations count births that are in no way an indication of the efficacy of their own health care systems.
The United Nations Statistics Division explains another factor hampering consistent measurement across nations:
...some infant deaths are tabulated by date of registration and not by date of occurrence… Whenever the lag between the date of occurrence and date of registration is prolonged and therefore, a large proportion of the infant-death registrations are delayed, infant-death statistics for any given year may be seriously affected.20
The nations of Australia, Ireland and New Zealand fall into this category.
Registration problems hamper accurate collection of data on infant mortality in another way. Looking at data from 1984-1985, Eberstadt argued that, “Underregistration of infant deaths may also be indicated by the proportion of infant deaths reported for the first twenty-four hours after birth."21 Eberstadt found that in the U.S. and Canada more than a third of all infant death occurred during the first day, but in Sweden and France they accounted for less than one-fifth.
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Inconsistent measurement explains only part of the difference between the U.S. and the rest of the world. Were measurements to be standardized, according to Eberstadt, “America might move from the bottom third toward the middle, but it would be unlikely to advance into the top half."22 Another factor affecting infant mortality Eberstadt identifies is parental behavior.23 Pregnant women in other countries are more likely to either be married or living with a partner. Pregnant women in such households are more likely to receive prenatal care than pregnant women living on their own. In the U.S., pregnant women are far more likely to be living alone. Although the nature of the relationship is still unclear (it is possible that mothers living on their own are less likely to want to be pregnant), it likely leads to a higher rate of infant mortality in the U.S.
In summary, infant mortality is measured far too inconsistently to make cross-national comparisons useful. Thus, just like life expectancy, infant mortality is not a reliable measure of the relative merits of health care systems.
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Anyone who thinks that the Canadian system is better than America’s is woefully ill-informed.[/size]
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No health-care system is without its flaws. For procedures which requires specialized equipment or technicians, there is indeed a long wait so many Canadians come here. However, for routine care as well as preventative care, the Canadian system is cheaper and you are guaranteed care.
Fun fact: The U.S. and Canada used to have roughly the same statistics in terms of average life span and infant mortality rates. Canadians started becoming healthier and longer-lived in the seventies—round about the same time they implemented universal single-payer healthcare.
Canadian healthcare taken as a whole is, by empirical measurement, objectively superior to U.S. healthcare. This is almost certainly due to the implementation of a nationalized, single-payer healthcare system.
Okay, lets be objective. There is such a thing as “ideal care”. For example, “ideal care” for cholelithiasis (gallstones) is to get them to surgery soon, before simple stones becomes inflammation (cholecystitis). There is a measurable increase in mortality and morbidity in cholecystitis versus cholelithiasis. The wait for surgery in Canada for cholelithiasis is literally months, compared to much less for the US. This translates into more cases of cholecystitis, which is inherently more serious than gallstones. Their statistics on cholecystitis outcomes are similar in every respect to the US outcomes - what they don’t tell you is how many cases of simple gallstones BECAME cholecystitis because they waited so long. No one can tell you that. But we know that it increases with time, and we know that they wait much longer than us.
To wait up to 9 months for knee replacement or to wait up to 6 months for hip replacement would just not be tolerated here. And the cost of that is for the patient to live in pain longer. This doesn’t show up in mortality statistics, but it exists nonetheless.
I contest your statement above that Canadian is, by empirical measurement, superior to US medicine. There is a lot more involved than simplistic comparison of longevity studies. Yet this is what you seem to be basing your opinion on. Even Canadian physicians don’t think that. And to say that a “single-payor” system is RESPONSIBLE for improvements in people’s health - you’ll have to demonstrate how that could be. A temporal association is not strong enough evidence.
Okay, lets be objective. There is such a thing as “ideal care”. For example, “ideal care” for cholelithiasis (gallstones) is to get them to surgery soon, before simple stones becomes inflammation (cholecystitis). There is a measurable increase in mortality and morbidity in cholecystitis versus cholelithiasis. The wait for surgery in Canada for cholelithiasis is literally months, compared to much less for the US. This translates into more cases of cholecystitis, which is inherently more serious than gallstones. Their statistics on cholecystitis outcomes are similar in every respect to the US outcomes - what they don’t tell you is how many cases of simple gallstones BECAME cholecystitis because they waited so long. No one can tell you that. But we know that it increases with time, and we know that they wait much longer than us.
To wait up to 9 months for knee replacement or to wait up to 6 months for hip replacement would just not be tolerated here. And the cost of that is for the patient to live in pain longer. This doesn’t show up in mortality statistics, but it exists nonetheless.
I contest your statement above that Canadian is, by empirical measurement, superior to US medicine. There is a lot more involved than simplistic comparison of longevity studies. Yet this is what you seem to be basing your opinion on. Even Canadian physicians don’t think that. And to say that a “single-payor” system is RESPONSIBLE for improvements in people’s health - you’ll have to demonstrate how that could be. A temporal association is not strong enough evidence.
And what else doesn’t show up is the impact and cost of a decline of worker productivity related to long waits for treatments. Take the example I gave previously on the Canadian having to wait 9 months of a hernia repair. Suppose he worked in a job that required physical stamina to perform or someone who misses work because of nausea & vomiting from cholelithiasis while waiting for surgery? None of these costs are captured as “costs” to the Canadian health care system that I can see. The pain and suffering these poor chaps endure while waiting for surgery would probably get them a cool million here in the U.S.
The health care system dispute in the US is basically a story of class warfare. Affluent people with good health care do not wish to pay more in taxes so that the poor can get better health care. Because it is unappealing to make a selfish argument, they pull together all kinds of anecdotes and statistics to demonstrate that the US system is better for everyone. But it sure as hell isn’t better for the uninsured, and as the number of uninsured grows, the passage of universal health care legislation in the US becomes more likely.
The health care system dispute in the US is basically a story of class warfare. Affluent people with good health care do not wish to pay more in taxes so that the poor can get better health care. Because it is unappealing to make a selfish argument, they pull together all kinds of anecdotes and statistics to demonstrate that the US system is better for everyone. But it sure as hell isn’t better for the uninsured, and as the number of uninsured grows, the passage of universal health care legislation in the US becomes more likely.
The health care system dispute in the US is basically a story of class warfare. Less affluent people who rely on free basic health care wish for others to pay more in taxes so that they can get premium health care at the expense of others. Because it is unappealing to make a selfish argument, they pull together all kinds of anecdotes and statistics to demonstrate that the Canadian system is better for everyone. But it sure as hell wouldn’t be better for the vast majority of responsible Americans who maintain their own health care insurance. And as the number of uninsured grows, the demagoguery of those who wish to worsen health care for all so that some can have it for free grows in direct proportion.
There is no question that the Canadian and European health services are well set-up for “catastrophic” care. But this is not what is being sold by the political hacks. The reality is that in anything but the most serious cases the client of a state-run system has two challenges:
1. they wait in line for an appointment/ procedure (even for dire cases - remember “dire” is not the same as “dying").
2. they cannot choose their physician or treatment
The only positive thing you can say about this is that nobody has to think about paying insurance fees (the government already took care of that for you by lifting it from your paycheck).
Only an ignoramus would claim a state-run health-care system is appreciably better than the US system. I say that as a person with direct experience of both (flawed) systems.
Well, maybe “ignoramus” is a strong word. It’s certainly true that citizens of these socialist paradises do have a touching faith in the excellence of their doctors and their care (as they mark off the days on their calendar to the appointment with the imperious specialist who will decide, 2 hours late for the consultation, in under 10 minutes what list they will enter next).
I wish those who really loved the Soviet Union had just had the courage to pick up and go there (before it collapsed) rather than inflicting their nightmare utopias on the rest of us.
The health care system dispute in the US is basically a story of class warfare.
A poll a couple of years ago showed that the groups most happy with their health care were poor people and old people: two groups who rely more than others on government programs.
I wish those who really loved the Soviet Union had just had the courage to pick up and go there (before it collapsed) rather than inflicting their nightmare utopias on the rest of us.
How is it that the United States is the only country among advanced nations to have the brilliance and insight to make sure that 15% of the population is uninsured so as to assure superb health care for the rest of us? Why did the rich nations of Europe and Asia not think of this brilliant public policy? What are they missing?
The health care system dispute in the US is basically a story of class warfare.
A poll a couple of years ago showed that the groups most happy with their health care were poor people and old people: two groups who rely more than others on government programs.
It’s only one data point, but there it is.
Sounds like a pseudo-datapoint to me, but lets accept that it is true, just for argument.
a) If the poor are so ecstatic about their healthcare, why do we need to change it?
b) If the old are so ecstatic about their healthcare, why do we need to change it?
If we needed to change it, in view of this “datapoint”, one would have to postulate that the poor and the old are STUPID, and simply don’t understand how poorly they are treated.
And who are the people who seem to be making that supposition? Who are the ones FOR changing their healthcare, even though they are the “most happy” of ALL THE PEOPLE IN THE UNITED STATES about their healthcare? The left.
So here, we have independent confirmation, supplied by vlad, that the left thinks that the poor and the elderly are stupid.
I wish those who really loved the Soviet Union had just had the courage to pick up and go there (before it collapsed) rather than inflicting their nightmare utopias on the rest of us.
How is it that the United States is the only country among advanced nations to have the brilliance and insight to make sure that 15% of the population is uninsured so as to assure superb health care for the rest of us? Why did the rich nations of Europe and Asia not think of this brilliant public policy? What are they missing?
Because the United States has the greatest tradition of ensuring individual freedom. Much more than the “rich nations of Europe and Asia”, who come from an authoritarian, or oppressive, or oligarchic, or monarchic backgrounds. We didn’t. We broke free of that yoke. It is guys like you that wish us to go back, and who seem to yearn for such a background. The freedom to succeed includes the freedom to fail. And you seem to be quite happy to damage the freedom to succeed in order that the freedom to fail doesn’t happen.
Thanks for including the United States under the classification of “advanced nations”. It goes against what you usually say. The fact is that EVERYONE in this country has the ability to get insured. Those who do not choose to pay the price to get insured, don’t. And of course, when the consequences of this decision becomes clear, they are quite ready to blame it on everyone else. And you are quite ready to buy that excuse.
Every person in America can raise their education, their productivity, their skill level, their knowledge base, and their compensation. Every one. What you seem to be trying to do is to ensure that failure never carries consequences. And this, of course, will ensure that there are decreased incentives to succeed. This will INCREASE failure in the US, not decrease it. I would have thought that you cared more for the poor than that.
How is it that the United States is the only country among advanced nations to have the brilliance and insight to make sure that 15% of the population is uninsured so as to assure superb health care for the rest of us? Why did the rich nations of Europe and Asia not think of this brilliant public policy? What are they missing?
I have this meliorist guy on ignore but I enjoy Oscar’s comments about healthcare so I read the quote he used.
Every now and then the underlying marxist shows itself. It can be quite subtle but it is there nonetheless. In this case I point out the words “...so as to assure superb healthcare for the rest of us.”
This is the old Karl Marx zero sum game. Meliorist wishes us to believe that our superb healthcare is somehow made possible ONLY through keeping others uninsured. It is the old “the wealthy achieved their positions on the backs of the workers” nonsense. And it is nonsense.
but wait, there’s more. Meliorist also contends that this oppression of the great mass of uninsured is the direct result of policy choices made by those who have insurance. It just doesn’t get any more nonsensical than that. Let me be sure I’m getting this right: I chose to pay for medical insurance via my employer, therefore some other employee somewhere else must do without medical insurance? Is that really what this jerk wants us to believe?
Of course the biggest hurdle that the socialists and communists must overcome is the simple fact that the national healthcare systems in other countries are inadequate to the task. Oscar has shredded their arguments repeatedly.
Frankly I’d love it if more people chose to act responsibly and obtained insurance. Unpaid medical bills are an expense that providers must face and they do so by rasing thier rates. There is a cost to charity care and bad debt. While charity care is central to the mission of most hospital providers, bad debt is not. What’s the difference? Charity care is given to people who cannot pay for care. Bad debt is people chosing NOT to pay, even though they have the means to do so.
Further if more people were insured the risk pool would be larger, thus there would be more individuals to share the cost of expensive care for those who need it. Therefore our premiums would DECLINE. It makes no economic sense to purposely exclude people from insurance risk pools. Once again meliorist just demonstrates abyssal ignorance. You’d think the boy would learn, but I guess Howard Zinn and noam chomsky’s mental programming is simply to effective for him to overcome.
The fact is that EVERYONE in this country has the ability to get insured.
This is demonstrably false. If you have a serious pre-existing condition, you will never find affordable insurance. Most of you fools are just one bad diagnosis away from bankruptcy. Of course, you would enjoy becoming destitute because, as a loser, you would be upholding the right of the winners to profit from their hard work.
The fact is that EVERYONE in this country has the ability to get insured.
This is demonstrably false. If you have a serious pre-existing condition, you will never find affordable insurance. Most of you fools are just one bad diagnosis away from bankruptcy. Of course, you would enjoy becoming destitute because, as a loser, you would be upholding the right of the winners to profit from their hard work.
Define “affordable” in a manner that doesn’t include “what I feel like paying”.
Every insurance company has an open enrollment period whereby those with pre-existing conditions may buy their product.
