

Is life expectancy a flawed measure of health care quality? - gronkie
http://theincidentaleconomist.com/wordpress/how-flawed-is-life-expectancy/

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yummyfajitas
Poor scientists. Their conclusions are correct, but a significant portion of
the reasoning which would allow them to get there is politically off limits.

That's ok, I'm politically incorrect. I'll stick to the comparison between the
US and Japan, since numbers are easy to come by[1]. On the face of it, it
looks as if Japan has us beat: 82.6 years to 78.4 years.

Now lets break things down by subgroup:

People of Japanese descent: 84.5 years in the US, 82.6 years in Japan. This
long lived group makes up <5% of the US (too lazy to look up exact #, but east
Asians in total are about 5% of the US), and about 99.4% of Japan.

[http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2...](http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=53)

People of European descent: 78 in the US, unknown (but irrelevant) in Japan.
This group makes up about 80% of the US, and < 0.6% of Japan.

People of African descent: 72 in the US, unknown/irrelevant in Japan. This
short lived group makes up about 12% of the US, and as far as I'm aware Japan
only knows about this group via video games.

<http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_15.pdf>

So if the US had the same demographics as Japan, our life expectancy would be
2 years longer.

[1] Japan is the only industrialized nation with the property that the
(possibly great great) grandchildren of Japanese immigrants is classified by
the census a "Japanese American".

~~~
borisk
>>People of Japanese descent: 84.5 years in the US, 82.6 years in Japan.

What if someone was to add something like "People of Japanese descent: $85 000
average family income in the US, $50 000 in Japan." (I've made up the numbers
from personal experience) Obviously richer ppl live longer.

~~~
yummyfajitas
If you assume Japanese Americans are average for Asian Americans, the actual
number is $65,000 (see my link).

In any case, I agree with you. Income is a major effect, although it's far
from clear that this is due to income buying health care. In fact, most of the
evidence suggests health care has nothing to do with it. For instance, during
the RAND experiment, richer people were healthier than the poor regardless of
which category they were randomly dropped into. (Observational studies since
then draw less clear conclusions, since observational studies are crappy in
comparison to randomized experiments.)

Another fun fact. The shortest lived people in the US are the Lakota, who live
_35 years less_ than Japanese Americans (not a typo, life expectancy = 50).
This group gets free health care via IHS (I believe it is structured similarly
to Britains NHS), so it seems that there are other factors at work.

Huh, imagine that. Life expectancy is, in fact, not a great measure of health
care, since it is affected by so many other factors.

~~~
anamax
> This group gets free health care via IHS (I believe it is structured
> similarly to Britains NHS)

IHS is pretty much a horrorshow. It's one of the best arguments against govt-
run healthcare.

It doesn't much matter if some govt somewhere can run healthcare well. The US
govt runs healthcare badly. Fix that first.

------
carbocation
Yummyfajitas' argument regarding life expectancy of different ethnic groups
that have come to the US is thoughtful.

I've always felt that the life expectancy stat only works in a statist, hyper-
controlled system. Once you let people make personal decisions about their
health, the utility of the stat declines.

The scientists in this article try to distinguish health-related from non-
health-related causes of death. But even our health-related causes of death
are not exactly under the control of the medical establishment. People eat
food as if they had an active death wish.

------
matwood
I've always thought that life expectancy was a poor measure of health care
quality. My reasoning is simple, the US is the most obese country in the
world, and obesity is known to cause numerous health problems and shortens
life expectancy. The health problems and shortening of life expectancy ends up
having very little to do with poor health care quality (poor health education
maybe).

I wonder if an argument could be made that given the USs propensity towards
unhealthy lifestyles that the US is in fact great at healthcare because the
life expectancy is as high as it is?

Finally, the best measures I've seen to date on healthcare quality are looking
at individual outcomes. For example, if you get prostate cancer what are the
odds of living in the US versus other countries. I can't find the exact
article now, but various countries do better at various health issues with the
US leading many of them.

[http://www.webmd.com/cancer/news/20080716/cancer-survival-
ra...](http://www.webmd.com/cancer/news/20080716/cancer-survival-rates-vary-
by-country)

 _The highest survival rates were found in the U.S. for breast and prostate
cancer, in Japan for colon and rectal cancers in men, and in France for colon
and rectal cancers in women, Coleman's team reports._

~~~
loewenskind
>I wonder if an argument could be made that given the USs propensity towards
unhealthy lifestyles that the US is in fact great at healthcare because the
life expectancy is as high as it is?

This is no argument to be made about the US having great health care. I don't
know how a place where a random illness can wipe out your _and your family's_
finances can even be considered first world.

To address your specific claim "we must be good because we make horrible life
choices and don't die!" I would point at the UK and alcohol consumption. Their
bad life choices are driving costs up to the point that they'll probably have
to make some big changes to deal with them but so far the system is doing a
reasonable job of keeping them from dying from it.

~~~
matwood
_This is no argument to be made about the US having great health care. I don't
know how a place where a random illness can wipe out your and your family's
finances can even be considered first world._

I didn't claim anything and simply wondered aloud. Also, the article was about
life expectancy and quality of healthcare and spoke nothing about costs.

Your statement does bring up another question. Would that same hypothetical
family prefer to have their finances ruined or have their loved saved from
some random illness? Of course the best solution is perfect care at zero cost,
but I think we can agree that it is impossible. If the US is actually getting
better health outcomes than other systems perhaps the cost is worth it?

And to address your specific claim, I've always thought that the government
should provide health related catastrophic fallback insurance similar to the
way they do for floods. I don't think the government needs to be involved in
the day to day healthcare or insurance matters, but I agree that getting
cancer for example should not ruin your families finances.

~~~
loewenskind
> Would that same hypothetical family prefer to have their finances ruined or
> have their loved saved from some random illness?

False dichotomy. The US isn't so much vastly better that the choice is go
there and be saved or stay in e.g. France and die. In fact all the sources
I've shown seem to indicate the US isn't the best even if you can afford it.
Keep in mind that doctors tend to make 3 times more than the average salary in
their European "socialist" countries, just not 5 times like their US
counterparts.

>but I think we can agree that it is impossible

Of course, it always costs, the question is just how much waste is going into
giving huge bonuses, etc., to CEOs of insurance companies who make even more
money by cutting people's coverage (insurance is a profitable business in its
own right, these guys just want even more).

>If the US is actually getting better health outcomes than other systems
perhaps the cost is worth it?

It it were we could discuss it. The reports from both the WHO and Berkely
indicate pretty clearly that this isn't the case.

>And to address your specific claim, I've always thought that the government
should provide health related catastrophic fallback insurance similar to the
way they do for floods. I don't think the government needs to be involved in
the day to day healthcare or insurance matters, but I agree that getting
cancer for example should not ruin your families finances.

This sounds like something reasonable to look at. Just keep in mind that so
many people are living paycheck to paycheck that even a surprise bill of $5k
can be enough that they never recover from it.

------
matrix
I take what this guy writes on statistics with a large grain of salt; despite
the domain name the author is not an economist. He is an MD and it goes
without saying that he's very smart and accomplished -- but not in the field
of statistics.

This is relevant to this particular article, because he may be missing subtle,
but important factors that a lay-person would miss. For example, see
yummyfajita's post in this discussion.

------
DanielBMarkham
I'm sure I'll get clobbered for this, but I am wary of economists using
statistics to make political arguments. Between "economist","statistics", and
"politics", that's three yellow flags right at the outset.

Unless, of course, they agree with me, in which case they are simply wise
academics trying to share their wisdom with the unwashed masses. :)

There is a logical problem here, and it's much deeper than life expectancy.
It's a problem with this form of argument. The problem is that, if you use
statistics to make political arguments, _you're going to be arguing forever_.
Whatever this guy wants to do -- and god bless him I hope he gets his way --
next year the same guy will be using statistics to tell us to do something
else. That's because you can slice statistics in an almost infinite amount of
ways, and I can guarantee you that one of those ways will show some kind of
imbalance or injustice that needs addressing.

That's all fine and dandy if the entire country could turn on a dime. I wish
it could but it can't. Not reality. Instead we live in a system where it takes
decades to make even one change, and it's extremely rare to stop doing things
that don't work -- we just do more new stuff. I hate to rag on the IRS, but
take a look at the tax code. It's so bad that I'm willing to wager nobody
alive knows how to file taxes exactly correct.

This puts us in an infinite cycle of where we're always measuring things with
statistics, finding some social cause worth pursuing, painfully making
changes, then making more measurements. Each time through the loop the system
gets more and more unwieldy and complex. It's a feedback loop that increases
government dysfunction.

So instead of arguing about one cause or another, I'd like to suggest a rule
for such discussions: if you want to make a case for some kind of social
policy change, then make it in terms of a trade-off from whatever the existing
status quo is. I realize there are a lot of problems with this suggestion, but
at least it starts putting things in terms of trade-offs instead of wish-
lists. Just from looking around, it seems to me that the real world is a lot
more about trade-offs and compromises than moral crusades and justice. But
that's just me. The only thing that I am observing is that this pattern can be
repeated indefinitely, and each time through the loop conditions will continue
to deteriorate. It's reactive leadership by statistics, and that almost never
works.

~~~
nihilocrat
On one hand you are suggesting "we can't know anything, let's not bother" but
on the other hand you are saying "let's talk about things we should actually
do".

Ok! I moved to Canada (Quebec) from the US. The healthcare system is
overloaded, there are weird things like a) it's extremely hard to get a family
doctor, b) you have to go to a clinic early in the morning to get a number +
time of day and then come back at that time to be seen, and c) you still need
to pay your own way (or get insurance) for dental / vision. You have to wait
weeks/months to have a surgery, but you have to do that in the US and then
promptly file for personal bankruptcy.

That's still a whole hell of a lot better than a random unexpected illness or
injury sending an employed, insured person into bankruptcy. Seeing a doctor is
now a possibility instead of a dangerous worst-case scenario that could ruin
my life. No more hoping the pain/infection/whatever just goes away on its own.

Thus, I still think moving towards a government program / single payer /
whatever you want to call it system is the best idea. Now, I based this all on
personal anecdotal experience and not statistics, so I wonder if anyone will
actually agree with me. :)

~~~
matwood
_You have to wait weeks/months to have a surgery, but you have to do that in
the US_

There are many things messed up about healthcare in the US, but I've never had
to wait for it. I had an emergency appendicitis surgery and from when I went
to the doctor to when I was put under was about 2 hours.

I've also had a non-emergency knee surgery (replaced ACL). I went to the
doctor one day and had an MRI that same day. I had to wait 2 days for the MRI
results, but when they came back positive for an ACL tear I had the option of
surgery 2 days later. I opted for 2 weeks later so I could get work all set up
for me to be out a couple weeks.

Now, I have insurance and paid a bit here and there out of pocket, but waiting
for care is one thing I didn't do.

~~~
michaelchisari
_Now, I have insurance and paid a bit here and there out of pocket, but
waiting for care is one thing I didn't do._

I think that may be key. I had insurance and appendicitis, and waited around
12 hours before surgery, but my brother was in a car accident without
insurance, and was almost sent home. Luckily, a family member who is a nurse
caused enough of a storm that he received the proper care.

Not having insurance is what really skews the statistics in the U.S. Cook
County hospital is an example of a hospital which provides care for the
uninsured, and the wait times are significant.

I haven't seen it, but I'd be interested to see the statistics on health care
in the United States for the uninsured versus the insured: Wait times, costs,
quality of care, quality of life, and life span.

