
U.S. health is lousy compared with peer nations, report says - kafkaesque
http://www.latimes.com/health/boostershots/la-heb-us-health-lags-peers-20130109,0,357668.story
======
RyanMcGreal
The US is at or very near the worst among OECD countries in: infant mortality,
child poverty, child health and safety, life expectancy at birth, healthy life
expectancy, rate of obesity, disability-adjusted life years, doctors per 1000
people, deaths from treatable conditions, rate of mental health disorders,
rate of drug abuse, rate of prescription drug use, incarceration rate, rate of
assaults, rate of homicides, income inequality, wealth inequality, and
economic mobility.

~~~
refurb
Dig a bit deeper and you'll see that those statistics don't tell you the whole
story.

In the US, premature births occur at a much higher rate than other country and
account for a large portion of the higher infant mortality rate. Those stats
also don't tell you that if you have a premature baby, it's most likely to
survive if treated in the US.

~~~
slurry
> In the US, premature births occur at a much higher rate than other country

Pretty much what you'd expect for a system that doesn't emphasize accessible
prenatal care.

~~~
refurb
Ummm.... no.

Prenatal care has a minimal impact on premature births.

~~~
slurry
True, some other things have a greater impact on premature births than
prenatal care, and the US system is shitty at those things as well.

I picked access to prenatal care because it's one of the easiest ones to
improve, it has a positive impact on a variety of metrics, and it should be
desirable in itself to anyone who isn't a sociopath.

------
jere
My first thought was "what the hell does health have to do with accidents?",
which I learned was justified by the first article I found after googling for
"life expectancy without accidents":
[http://www.forbes.com/sites/aroy/2011/11/23/the-myth-of-
amer...](http://www.forbes.com/sites/aroy/2011/11/23/the-myth-of-americans-
poor-life-expectancy/)

>A few years back, Robert Ohsfeldt of Texas A&M and John Schneider of the
University of Iowa asked the obvious question: what happens if you remove
deaths from fatal injuries from the life expectancy tables? Among the 29
members of the OECD, _the U.S. vaults from 19th place to…you guessed
it…first_. Japan, on the same adjustment, drops from first to ninth.

~~~
digeridoo
Perhaps I'm tired, but how can the Japanese life expectancy figure be higher
when considering fatal injuries?

~~~
jere
The article has an updated section on that question.

>I asked Robert Ohsfeldt about this, who responded that the adjustment factor
was based on fatal injury rates relative to the average. Hence, the adjusted
numbers shouldn’t be seen as hard numerical estimates of life expectancy, but
rather as a way of understanding the true relative ranking of the various
countries on life expectancy excluding fatal injuries.

------
tptacek
Worth remembering some things here:

* The US is thought by some economists to have an artificially high infant mortality because the US is more rigorous about reporting live births than other countries which might write up the same events as stillbirths.

* Outcomes in the US for chronic serious illnesses are at or near the top of the rankings.

* Life expectancy figures in the US are anchored down by suicides and, more importantly, traffic fatalities, which the US leads the world in. While that's not something we should be OK with, it's also a direct consequence of the vast land mass and wide population dispersal in the US.

~~~
avalind
This report[1] claims that the difference in reporting child mortality isn't
the chief cause of the difference in infant mortality between the U.S and
similarly developed countries. Instead the claim that most of this difference
is due to the high percentage of pre-term births in the US compared to other
developed countries.

[1] <http://www.cdc.gov/nchs/data/databriefs/db23.pdf>

~~~
tptacek
Isn't a preterm baby which fails to survive exactly the kind of event that
wouldn't be documented as an infant mortality at all in a less rigorous
country?

~~~
avalind
Yes. But I'm not sure I follow here, both Sweden and the US use the same
criteria to report a live birth (All live births are reported) and seem to use
the same definition of Infant mortality rate, (Death before first birthday). I
fail to see how reporting differences explain the difference in infant
mortality between the two countries. Of course, compared to countries that use
extra conditions for live births (weight limits etc.) the US would get a
higher rate of infant mortality due to having more laxed conditions for what
constitutes a live birth.

~~~
tptacek
It would be shocking if the US had infant mortality rates that were apples-
apples close to Sweden. Sweden has just 9 million people, and they're very
homogenous.

The lede on stories about US infant mortality isn't that Sweden outdoes us.
It's things like "the US ranks alongside Qatar and Croatia". Those are the
assertions I think we need to be more careful about.

~~~
grecy
> Sweden has just 9 million people, and they're very homogenous.

The population has no impact when we're looking at per-capita statistics.

Canada and Australia have the highest immigration rates in the world, so their
homogeneity is going down, yet statistics like these are not going up.

~~~
tptacek
That's silly. Compare Sweden to Washington State, which is similarly sized,
more diverse, and has the second best infant mortality stats in the US.

The point is that Sweden is a cherry-picked comparison.

~~~
grecy
> The point is that Sweden is a cherry-picked comparison.

Choose any other OECD country then. The results are the same.

------
kafkaesque
Darn. I should've posted this NY Times article instead:

[http://www.nytimes.com/2013/01/10/health/americans-
under-50-...](http://www.nytimes.com/2013/01/10/health/americans-
under-50-fare-poorly-on-health-measures-new-report-says.html)

It provides a little more detail.

------
aresant
This is a great example of how macro-statistics are inherently useless to
predict individual outcomes (or even individual group outcome).

I'd go so far to say irresponsible to publish without disclaimers since these
kinds of studies are so easy to regurgitate and buy into about the "state of
the USA".

A glaring example - how can you even consider Japan a "peer" nation to the USA
when comparing health?

Ethnicity has been shown, again and again, to have a gigantic impact on life
expectancy - so a more compelling study may be USA Japanese with Japanese
parents vs. Japanese in Japan.

But then again what about RICH Japanese in USA vs. RICH Japanese in Japan?

Or broken out by Japenese that follow different diets?

Or Japanese that smoke?

Or any of the other "studies" that try to identify individualized trends.

If we're trying to glean anything from this data beyond pageviews for
newspapers then segment & compare the data along actually comparable lines -
class, ethnicity, and regional lines.

~~~
graeme
When Japanese immigrate to America, their health outcomes quickly converge
with those of other Americans. 'Ethnicity' isn't the culprit, usually - more
likely culture and national policies.

------
mattmiller
I think an easy way to improve the health care industry would be to quadruple
the number of urgent cares and keep them all open 24 hours a day. Financially
the system encourages urgent care use, but they are often tough to access.
Many times in the middle of the night we have to consider taking a child to
the ER or just waiting until morning.

I don't know if this would improve general health, but it sure would make me
feel like I am getting more for what I pay.

------
tsotha
>The study listed nine health areas in which Americans came in below average:
infant mortality and low birth weight, injuries and homicides, adolescent
pregnancy and sexually transmitted infections, HIV and AIDS, drug-related
deaths, obesity and diabetes, heart disease, chronic lung disease and
disability.

I hope people don't think this is some condemnation of the US health care
system. No matter how good your health care system is you're not going to be
able to correct for serious lifestyle problems.

------
127001brewer
I found the following blurb from the article interesting as it tries to make
the information relevant the gun control debate:

 _Gun use emerged as a factor: Americans were seven times more likely to die
in a homicide and 20 times more likely to die in a shooting than their peers.
In all, two-thirds of the mortality disadvantage for American men was
attributable to people under the age of 50 -- and slightly over half of that
resulted from injuries..._

However, why is this article interesting to the Hacker News crowd?

~~~
npsimons
Why is health interesting to anyone? Viewed in a more hackish light: here's a
problem; how can we fix it?

~~~
roc
It's not a problem that can be 'hacked'.

Much like hunger in the third world: it's a political problem.

Practical solutions have long since been developed and proved in other places.
The problems persist where they do, because there's no political will to
actually implement the solutions in those places.

~~~
viraptor
> It's not a problem that can be 'hacked'.

While I agree it's a political problem in general, there's apparently a lot
that can be hacked. Starting with lowering the cost of diagnostics and
improving the information flow... There were a couple of interesting companies
interviewed on Mendelspod (<http://mendelspod.com/>) - if you're interested in
what can be hacked, give it a go.

There are also projects like <http://nhshackday.com/>

~~~
dtkuhn
Agree. Patients need better information if we are ever going to be serious
health care consumers. Doctors have very little incentive to help us shop for
services. Co-payments, lack of reimbursement, etc are all tools used by
insurers to reduce cost (combat moral hazard, etc), but very little has been
done by patients historically to systematically lower costs.

------
Irregardless
And yet people from around the world fly here every day to have critical
surgeries performed by the world's top doctors in state of the art facilities.

News Flash: The U.S. isn't a welfare state. To benefit from everything this
country has to offer, you need to pay for it. Yes, it would be better if that
didn't apply to healthcare, but there needs to be some method of exclusion
when demand is high and supply is low. Would you rather wait 2 months just to
see a specialist and another 2 months for treatment like patients in
nationalized healthcare systems frequently do? (I'm looking at you, Canada and
Europe)

~~~
potatolicious
> _"And yet people from around the world fly here every day to have critical
> surgeries performed by the world's top doctors in state of the art
> facilities."_

Citation sorely needed. This claim is regularly trot around, but nobody has
been able to point to data that would suggest that this is anything but
extreme outlier behavior.

As a Canadian who lives in the US it's often shocking how different the
perception of the Canadian health care system is between the US and Canada.
Canadians by and large are quite satisfied with the system, while even
reasonably liberal Americans I've met seem to believe it's some kind of
waitlist-filled hellhole.

I've had more than one American express incredulity when I pointed out going
to the US for major medical procedures isn't really a _thing_ in Canada, where
they thought it was widespread and relatively common.

By my own observation, there are a few isolated cases of this happening
(mostly among the extremely wealthy), and is not at all widespread.

> _"but there needs to be some method of exclusion when demand is high and
> supply is low."_

The supply of medical capacity is not fixed or subject to a real physical
limitation (like, say, rare earth metals). In Canada the response to
constricted supply has been _expanding_ the supply, as well as reducing per-
use costs to make this possible. The supply is not infinite, but is high
enough that people who need it, get it, and at a cost affordable to them
(amortized across the entire population).

[edit] It's worth mentioning that, due to the economic incentive of single-
payer health care, Canada invests a tremendous amount of money in preventative
care and screening, which serves to _dramatically_ reduce demand for the most
expensive, most supply-constrained treatments. In fact I have a friend who
works for the Canadian government right now doing computational screening for
early cancer detection. It's interesting stuff, saves lives, _and_ saves
money, but requires a dramatic economic incentive to build out that simply
doesn't exist in privatized care.

> _"Would you rather wait 2 months just to see a specialist and another 2
> months for treatment like patients in nationalized healthcare systems
> frequently do? (I'm looking at you, Canada and Europe)"_

Citation, again, sorely needed. I grew up in Canada and have _never_ waited 2
months to see a specialist, nor 2 months for treatment. The longest I've
waited for a specialist was _a few days_. I've also (unfortunately) been to
both Canadian ERs and American ERs, and the wait times are not substantially
different (immediate (Can), 4 hours (Can), 7 hours (Can), and 6 hours (US)).

~~~
jgon
As a Canadian I'll chime in and say that I waited 6 months for knee surgery.
In a way it sucked, but on the other hand it made sense. I waited 6 months
because all I had was a meniscus tear, so I could still do many forms of
exercise, drive, walk, run, and work. My chief limitation was my inability to
do Judo and soccer.

So I waited for 6 months behind a number of people including those who had
similar non-critical injuries but were diagnosed earlier and those who had
severe knee injuries requiring reconstruction or replacement. Rationing was
done on a need basis rather than my ability to pay. Some people may talk about
how terrible this is, and to be honest I probably could have afforded the
surgery in a "private" system. Then again, when I was much younger and needed
my first knee surgery I would have been hosed in a private system. And no, I
wouldn't have been covered under my parent's policy in a private system.

Furthermore, when I have required urgent care, I have received it immediately.
The longest I have waited is a few hours in the emergency room. Close friends
who have dealt with much more serious life-threatening diseases have started
receiving treatment/surgery within a few days or even the same day.

So yes, I experienced the terrible gulag that are Canadian medical wait lists
and it really wasn't that bad. The wait lists are based on triaging, rather
than wealth, and having wait times based on medical decisions made by
professionals rather than economic incentives seems a much more humane system
to me. I understand that some will call this "unfair" but that just means our
definition of fair is different.

------
jchrisa
No mention of corn and petroleum subsidies.

~~~
lostlogin
Please could you expand on that. I'm mystified.

~~~
wtn
Grain subsidies indirectly subsidize high–calorie, low–nutrition foods like
bread, cookies, crackers, soda drinks (corn syrup), and other stuff that is
terrible for you. Fuel policy promotes more driving, less walking.

It is an interesting question as to where to draw the line between personal
responsibility and governmental responsibility. Of course most people in the
US can afford to buy quality food, if they really wanted to, and some
Americans are doing well. But Americans clearly aren't doing well at keeping
up their health, and gov policy is making obesity worse. I saw some data point
recently that suggested we may have passed an inflection point (for the
better), hopefully it turns out to be true in the long run.

------
elchief
US health care is amazing for rich people, and terrible for the rest. On
average, it is lousy.

------
tokenadult
In a top-level comment, the HN participant who kindly submitted the L.A. Times
article that opens the thread here notes with regret that the New York Times
report

[http://www.nytimes.com/2013/01/10/health/americans-
under-50-...](http://www.nytimes.com/2013/01/10/health/americans-
under-50-fare-poorly-on-health-measures-new-report-says.html)

on the same report provides more detail. The lede paragraph shows the
importance of cultural and lifestyle factors rather than health-care-as-such
in the mortality and morbidity outcomes:

"Younger Americans die earlier and live in poorer health than their
counterparts in other developed countries, with far higher rates of death from
guns, car accidents and drug addiction, according to a new analysis of health
and longevity in the United States."

Drug addiction in particular is a severe problem in the United States to a
degree not seen in (for example) east Asia. The stark historical memory of the
Opium Wars imposing Western drug-pushing on east Asian populations makes many
countries on the other side of the Pacific Rim very wary of letting young
people start drug use. Illicit drugs were all but unknown in the childhood
experience of my wife under Taiwan's former military dictatorship. Growing up
free of harmful psychoactive substances allows young people clear heads to
learn a lot (including learning other languages for international
understanding) and to grow up to promote social improvements, such as the
steady democratization and upgrades in provision of health care in Taiwan
during my adult life.

So let's be clear what the report tells us: health outcomes in the United
States often fare poorly compared to the health outcomes in other countries
approximately as rich. But the challenges to health in the United States
sometimes differ in ways that reflect long-standing differences in United
States culture that still need to be nudged in healthier directions.

AFTER EDIT: There has been some hand-waving (without specific deep links)
about OECD health statistics in this thread. In fact, the United States does
not fare as badly in comparison to other OECD countries

[http://www.oecd-
ilibrary.org/sites/factbook-2011-en/12/01/01...](http://www.oecd-
ilibrary.org/sites/factbook-2011-en/12/01/01/12-01-01-g1.html?contentType=&itemId=/content/chapter/factbook-2011-104-en&containerItemId=/content/serial/18147364&accessItemIds=&mimeType=text/html)

as some of the statements in this thread have suggested. The decline in all-
cause mortality at all age ranges during my lifetime in the United States

[http://www.scientificamerican.com/article.cfm?id=longevity-w...](http://www.scientificamerican.com/article.cfm?id=longevity-
why-we-die-global-life-expectancy)

has been steady, so people in general in the United States are living longer,
healthier lives than ever before in history.

------
CletusTSJY
Look, you can't convince me life is worse in America than other countries. I
watch House Hunters International, I see the size of those kitchens.

------
seivan
I suspect mostly it's your high medication and food.

Too much "low fat" stuff being shipped around as "healthy" alternatives, when
they are filled with sugar, instead of healthy fat.

