
Link between health spending and life expectancy: US is an outlier (2017) - ColinWright
https://ourworldindata.org/the-link-between-life-expectancy-and-health-spending-us-focus
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rcdmd
A few things off the cuff as a physician-- the US has dangerously unequal
access to care. I suspect most of the "drag" on life expectancy is from
patients without access (this is conjecture but based on personal experience).
Even patients eligible for medicaid don't necessarily go through the steps to
get it. Often we see patients show up to the hospital who haven't seen docs in
a many years until they've developed terrible sequelae like gangrene requiring
an amputation. At that point, during admission, the hospital generally helps
get them on medicaid. Also, obesity is becoming the new normal in US with all
of its associated co-morbidities (a common morbidity/mortality sequence is
obesity -> diabetes, hypertension -> coronary artery disease, end stage renal
disease, general vascular disease -> death. More healthcare spending is
required to treat patients, but the root cause for a growing part of the
population's illnesses can't be cured by medicine _yet._ Also, economically
speaking-- the US spends a lot more per capita on mostly everything-- its GDP
per capita is higher than these other countries. But, mostly, I suspect the
US's health mortality problem is access related. We're spending a lot of money
on things that don't help people with poor access to care until their original
diseases have done irreversible damage.

~~~
quizotic
Do you have any insight into the reason for the unequal access? Is it that
poorer or uninsured patients cannot afford non-emergency healthcare? Is it
that they are too far away? Is it education/knowledge/social - belief that
they shouldn't go to a doctor for "nothing". Are they "too busy".

Also, are there any studies to show that populations in other countries use
their medical systems more frequently across the board, or that they use more
frequent preventative visits?

You mention the problem with obesity and its co-morbidities. Are there any
studies or plots that show health outcomes (lifespan, infant mortality,
maternal mortality) as a function of % of population who are obese? I wonder
if poor health is linearly correlated with obesity, without regard to
healthcare spending...

~~~
bluedino
It's common for baby boomers (at least the males) to refuse to the go to the
doctore.

Refusing to go for checkups, screenings, even after mild heart attacks,
refusal to take prescribed medications for blood pressure or diabetes...

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skookumchuck
> but also in child mortality

Different countries have different definitions of infant mortality. When is it
categorized as a miscarriage and when an infant death? The US tries very hard
to save premature babies, and counts the failures as infant death rather than
miscarriages.

~~~
jillesvangurp
I think you'll find that the US is not alone in trying that and that other
countries simply don't limit that kind of efforts to the well insured elite.
When visiting a hospital is a potentially bankrupting event, a lot of young
uninsured mothers might end up not going to a hospital or going too late.
Also, prenatal checks are not optional. The attitude towards abortion combined
with religious conservatism also pushes a lot of young women to look for
solutions outside the traditional healthcare system; which has all sorts of
risks for the mother.

I find it ironic that the net result of pro-life policies is increased
mortality rates for babies and mothers.

~~~
skookumchuck
> I think you'll find that the US is not alone in trying that

It's all over the map, there are even societies where the baby isn't
considered a person until some time after birth.

It's certainly enough to question the relevance of the statistics.

~~~
iagovar
In Europe? Who?

~~~
vonmoltke
Why are you restricting this to Europe?

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dwighttk
I’ve always wanted to see this chart with the US broken down by state.

~~~
dwighttk
I'd also be interested in how Life Expectancy at Birth is calculated in
advance.

~~~
gumby
It’s really just death rate at the time the newborn is born: if x% of the
population died in 2016 and that never changed going forward, how long would
the mean person born that year live (given that people born in earlier years
would be dying at _their_ rate, contributing to the formula.

So technically not actually predicting an expected lifespan (thermonuclear war
could happen after all) but allows longitudinal and secular analysis.

~~~
dwighttk
ok, so infant mortality from that year doesn't effect the number?

(any more specifically than those deaths adding to the overall death rate)

~~~
gumby
Yes it does

~~~
dwighttk
How?

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gumby
I described the approach in my first comment: for 2018 (now it's over) look at
the death rate and then apply estimate it uniformly going forward for all
recorded births during the year until the surviving population goes to nil.
The death rate is all the people who died, whether 1 jan or 31 dec regardless
of the age of the deceased.

If you want greater resolution on a process like this you'll do better to
search yourself than to reply on HN commenters like me.

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11thEarlOfMar
It would be interesting to see a chart normalized to Americans vs. Others with
similar BMI ranges. For example, Americans with 18-25 BMI (I know you're out
there!) vs. French with the same.

By taking out those with a very general correlation for 'does not take care of
their own health', we'd get a truer measure of the relative effectiveness of
the respective health care systems.

~~~
door5
BMI is a poor indicator of health and and even poorer indicator of whether one
takes care of themselves. In the US, unhealthy food is abundant and strongly
advertised. Much of the country is sprawl where the only way to really get
around is by car. People are more stressed and work longer hours & don't have
the time to cook for themselves or exercise. The US lacks universal
healthcare, some people live in food deserts where healthy food is not
accessible, etc. The United States has such terrible infrastructure and social
programs that it's unfair to pin people's poor health entirely on their own
decisions

~~~
smileysteve
> BMI is a poor indicator of health

But it's an available statistic.

If we had doctors report on body fat % (even done with shotty capacitance) or
hip/waist ratio we'd be better off.

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somberi
Asking to learn. What is this kind of graphing, the one that plots the trend
over animated time, called?

~~~
kbouck
Gapminder's moving bubble charts seem to be called "moving bubbles"

[https://www.gapminder.org/tag/moving-
bubbles/](https://www.gapminder.org/tag/moving-bubbles/)

~~~
2T1Qka0rEiPr
I thought that was Rosling's company, awesome!

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brianjoseff
What is going on with Greece in the first life expectancy chart? Large
reversal in cost increase coupled with unperturbed steady increase in life
expectancy.

Also has impressive numbers in other charts.

~~~
pjc50
2008 financial crisis forced drastic cost-cutting.

The question is what the lag on health effects of that was. We know from
things like smoking prevention and childhood diseases that the lag can be
huge, anything up to half a century.

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calebm
So in the last 25 years, the medical costs more than doubled in the US and
maternal mortality actually went UP?

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chrismeller
Has anyone ever disputed this? Isn’t what we should be trying to prove whether
or not that increased spending is actually providing innovation in drugs and
procedures and thereby enabling other countries to put varying degrees of
price controls in place without severely limiting the quality of care?

Framed in the opposite direction: could the US put in any form of price
control to equalize this metric without significant impact to the continued
investment in the field?

~~~
adrianN
If the US managed to save money on healthcare, that extra money should go to
universities so that the results of the research are not proprietary to pharma
companies, but instead can be used by anyone.

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shaftoe
That's not how it works. Commercialization of drugs from University research
is what already feeds a multi billion dollar industry.

~~~
adrianN
That's how it could work.

~~~
chrismeller
How exactly do you see a system working that way? We establish a single payer
plan and just start taxing everyone based on the current estimated healthcare
expenditures and blindly shove money at universities?

~~~
adrianN
You shove money at universities and don't patent the drugs they come up with
so that companies can compete on the price of manufacturing them.

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skookumchuck
Unfortunately, there are no free market health care countries to compare with.

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FartyMcFarter
There is free market health care. It's called "veterinarians".

Granted this won't do for comparing all metrics, but it's still an interesting
reference point. Here's one article about this:

[https://hbr.org/2017/01/what-the-cost-of-a-trip-to-the-
vet-t...](https://hbr.org/2017/01/what-the-cost-of-a-trip-to-the-vet-tells-us-
about-why-human-health-care-is-so-expensive)

