Americans Don’t Live as Long as We Should
We're falling further behind for many reasons.
NPR (“‘Live free and die’? The sad state of U.S. life expectancy“):
Just before Christmas, federal health officials confirmed life expectancy in America had dropped for a nearly unprecedented second year in a row – down to 76 years. While countries all over the world saw life expectancy rebound during the second year of the pandemic after the arrival of vaccines, the U.S. did not.
One would naturally jump to the hyper-politicization of vaccination, masking, and other pandemic-related countermeasures but that doesn’t seem to be it.
Then, last week, more bad news: Maternal mortality in the U.S. reached a high in 2021. Also, a paper in the Journal of the American Medical Association found rising mortality rates among U.S. children and adolescents.
“This is the first time in my career that I’ve ever seen [an increase in pediatric mortality] – it’s always been declining in the United States for as long as I can remember,” says the JAMA paper’s lead author Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University. “Now, it’s increasing at a magnitude that has not occurred at least for half a century.”
Across the lifespan, and across every demographic group, Americans die at younger ages than their counterparts in other wealthy nations.
How could this happen? In a country that prides itself on scientific excellence and innovation, and spends an incredible amount of money on health care, the population keeps dying at younger and younger ages.
The answer, alas, is that there are many, many answers, each contributing a bit to the puzzle.
One group of people are not surprised at all: Woolf and the other researchers involved in a landmark, 400-page study ten years ago with a name that says it all: “Shorter Lives, Poorer Health.” The research by a panel convened by the National Academy of Sciences and funded by the National Institutes of Health compared U.S. health and death with other developed countries. The results showed – convincingly – that the U.S. was stalling on health advances in the population while other countries raced ahead.
The authors tried to sound an alarm, but found few in the public or government or private sectors were willing to listen. In the years since, the trends have worsened. American life expectancy is lower than that of Cuba, Lebanon, and Chechnya.
Ten years later, here’s a look back at what that eye-popping study found, and why the researchers involved believe it’s not too late to turn the trends around.
I don’t take comparisons with less developed countries seriously, as they’re as likely to be a function of differential methods and degrees of diligence in record-keeping. But there’s no denying the larger trends.
Americans are used to hearing about how their poor diets and sedentary lifestyles make their health bad. It can seem easy to brush that off as another scold about eating more vegetables and getting more exercise. But the picture painted in the “Shorter Lives” report could shock even those who feel like they know the story.
“American children are less likely to live to age 5 than children in other high-income countries,” the authors write on the second page. It goes on: “Even Americans with healthy behaviors, for example, those who are not obese or do not smoke, appear to have higher disease rates than their peers in other countries.”
The researchers catalog what they call the “U.S. health disadvantage” – the fact that living in America is worse for your health and makes you more likely to die younger than if you lived in another rich country like the U.K., Switzerland or Japan.
That just seems weird, even downright implausible, no?
“We were very systematic and thorough about how we thought about this,” says Woolf. The panel looked at American life and death in terms of the public health and medical care system, individual behaviors like diet and tobacco use, social factors like poverty and inequality, the physical environment, and public policies and values. “In every one of those five buckets, we found problems that distinguish the United States from other countries.”
Yes, Americans eat more calories and lack universal access to health care. But there’s also higher child poverty, racial segregation, social isolation, and more. Even the way cities are designed makes access to good food more difficult.
“Everybody has a pet thing they worry about and say, ‘it’s oral health’ or ‘it’s suicides’ – everyone has something that they’re legitimately interested in and want to see more attention to,” says John Haaga, who was the director of the Division of Behavioral and Social Research at the National Institute on Aging at NIH, before he retired. “The great value of an exercise like this one was to step back and say, ‘OK, all of these things are going on, but which of them best account for these long-term population level trends that we’re seeing?’ “
The answer is varied. A big part of the difference between life and death in the U.S. and its peer countries is people dying or being killed before age 50. The “Shorter Lives” report specifically points to factors like teen pregnancy, drug overdoses, HIV, fatal car crashes, injuries, and violence.
“Two years difference in life expectancy probably comes from the fact that firearms are so available in the United States,” Crimmins says. “There’s the opioid epidemic, which is clearly ours – that was our drug companies and other countries didn’t have that because those drugs were more controlled. Some of the difference comes from the fact that we are more likely to drive more miles. We have more cars,” and ultimately, more fatal crashes.
“When we were doing it, we were joking we should call it ‘Live free and die,’ based on the New Hampshire slogan, [‘Live free or die’],” Crimmins says. “The National Academy of Sciences said, ‘That’s outrageous, that’s too provocative.’ “
Some of these things are interrelated. We’re fatter because we drive more and walk less than just about anybody else. And, because cars allow sprawl, that makes it harder to have high-quality healthcare and great selections of fruits and vegetables close to everybody.
But we’re also more prone to suicide and drug addiction than our wealthy counterparts. And more violent.
There are some things Americans get right, according to the “Shorter Lives” report: “The United States has higher survival after age 75 than do peer countries, and it has higher rates of cancer screening and survival, better control of blood pressure and cholesterol levels, lower stroke mortality, lower rates of current smoking, and higher average household income.” But those achievements, it’s clear, aren’t enough to offset the other problems that befall many Americans at younger ages.
This suggests that we’re investing our healthcare resources poorly. We decided six decades ago that old people shouldn’t have to worry about paying for healthcare so established Medicare. But we’re left to fend for ourselves for the first 64 years of our lives.
We’ve also apparently done a better job of convincing young people not to take up smoking that to take up exercising and healthy eating. Or, you know, not killing themselves.
The NIH should undertake a “thorough examination of the policies and approaches that countries with better health outcomes have found useful and that may have application, with adaptations, in the United States,” the authors wrote.
In other words: let’s figure out what they are doing that works in other places, and do it over here.
That’ll never catch on, unfortunately. Americans are practically allergic to doing things the European way.
Dr. Ravi Sawhney, who helped conceive of and launch the “Shorter Lives” study at NIH before he left the agency, had high hopes that the report would make a mark. “I really thought that when the results came out, they would be so obvious that people would say: Let’s finally do this,” he says.
Ten years on, how much of the detailed action plan has been done?
“To be brief, very little of that happened,” Woolf says. At the time, he says, NIH officials didn’t seem very interested in raising awareness about the panel’s findings or in following up on its proposed research agenda. “There was some media coverage at the time that the report rolled out, but NIH was not involved in trying to promote awareness about the report.”
Crimmins agrees. “There was a little bit more research, but there wasn’t any policy reaction,” she says. “I thought there might be, because it’s embarrassing, but it just tends to be ignored.” Those who are interested in this issue, she notes, tend to be those invested in “marvelous things they think are going to delay aging,” even though people older than 75 are the only age group in the country that already does comparatively well.
But they’re the only ones organized on this issue, so their voice is amplified. Plus, all of the leaders are old, too!
Woolf calls it a misconception to assume that America’s great scientific minds and medical discoveries translate to progress for the health of the population. “We are actually very innovative in making these kinds of breakthroughs, but we do very poorly in providing them to our population,” he says.
The nature of our fee-for-service distribution system means we do a really good job of providing the best care to those who can pay the fees. If you’ve got good insurance—which you do if you’re elderly—and near a good hospital, you’re getting world-class care. Otherwise, your mileage will vary.
Sawhney thinks the federal government should try harder to fix the problems documented in the “Shorter Lives” report. He doesn’t think lack of public awareness is the problem. “I really think that most Americans know that Americans are more overweight and obese and that we have higher rates of disease and live shorter lives than other countries,” he says, “It’s just the NIH and the CDC that don’t want to take the responsibility for that failure or to do anything about it.”
Crimmins says, in her experience, lawmakers and federal health officials don’t like talking about how the U.S. is lagging behind other countries.
“I convened a meeting in Washington with the National Center for Health Statistics [part of CDC] about increasing healthy life expectancy,” she recalls. “It was a relatively small meeting, but we brought experts from Canada.” An official at the time gave what she calls a “typical” response, saying: “Oh, we can’t have anything but an American solution to these issues – we can’t listen to other countries.”
“International studies are not the flavor of the month – they never will be,” says Haaga. “The problem with foreign countries is that they’re not in someone’s congressional district.”
It’s more than a missed opportunity, says Woolf. It’s a tragedy.
“If you add up the excess deaths that have occurred in the United States because of this unfolding problem, it dwarfs what happened during COVID-19, as horrible as COVID-19 was,” Woolf says. “We’ve lost many more Americans cumulatively because of this longer systemic issue. And if the systemic issue is unaddressed, it will continue to claim lives going forward.”
Again, it’s not so much “an issue” as dozens of little ones.
Rather than feel overwhelmed at the immensity of the problems, Sawhney suggests, the focus should instead be on the fact that every other rich country has been able to figure out how to help people live longer, healthier lives. That means that Americans could do it too, he says.
He believes that the changes might not be as hard as some policymakers and health officials seem to think. “You look at these healthier countries, they’re free countries – England, France, Italy – they’re not banning delicious foods. They’re not chaining people to treadmills,” he says. “Americans love to travel to Europe, to Australia, to Canada to enjoy their foods and their lifestyles, and so the idea that we might say, ‘Hey, maybe we could bring some of those lifestyles back’ – I don’t think people are going to go up in arms that we’re taking away their freedoms.”
Getting policy ideas from other countries is just an obvious move, Woolf adds. “If a martian came down to earth and saw this situation, it would be very intuitive that you [would] look at other countries that have been able to solve this problem and apply the lessons learned,” he says.
In historical research he’s been doing, “I found that there are dozens and dozens of countries on almost every continent of the world that have outperformed the United States for 50 years,” he says. “It’s worth taking a look at what they’ve done and Americanizing it – you don’t have to take it right off the shelf.”
Some of the policies he’s identified as helpful include universal, better coordinated health care, strong health and safety protections, broad access to education, and more investments to help kids get off to a healthy start. These policies are “paying off for them,” he says, and could for Americans, too.
Even on a purely monetary basis, this would likely pay for itself. But we’re societally allergic to much of this.
More than 70% of Americans want universal health care. Our system is set up, however, to allow the minority to overrule the will of the people.
Health care is but one area where corporate power overrides the desires of most Americans.
Until we decide, as a nation, that we want to be a country of the people, by the people, for the people, this will not change.
But even that makes no sense. Aside from the healthcare industry itself, every other business in America would be better off off-loading the cost of health insurance to the taxpayer. Indeed, I’m shocked that the fact that American corporations have to compete on an uneven playing field because other governments subsidize healthcare hasn’t been a bigger talking point.
Yeah, but look at the progress we’ve made banning drag queens…
I’d posit that those Americans that are traveling to Europe, Australia and even Canada, have adopted life styles that result in their having life expectancies similar to the citizens of those countries.
@James Joyner: Yes, the silence of business regarding having to compete with business whose employees receive subsidized healthcare is deafening.
@James Joyner: They have done the math. Control over their employees is worth the cost of health care premiums.
That control prevents employees from leaving and starting competing businesses.
The money balances out by keeping wages lower because people can’t quit because they could literally die if they do. It also forces people to work until age 65 (or try to), which keeps the labor supply elevated – again, reducing wage pressure.
In short, there’s a ton of power and little, if any, added expense.
Yes sir, you are correct. It was to everyone’s benefit that the commons remain fallow in English villages. Clever person could have proved it. Didn’t matter.
I agree it’s a problem, and fixable ones, but I don’t understand the tone of the articles. Like it would require just small, easily achievable changes, as opposed to changes that would require large modifications to the way a lot of Americans live. And, again, they’d be good changes. But they wouldnt be easy, any of them.
Food deserts are generally in rural areas or urban cores. Health care shortages similarly. The suburbs, usually regarded as the prime example of sprawl, have both in abundence. I suspect that there’s a balance there: dense enough to support a robust medical infrastructure. Sparse enough to keep land prices down to the point that supermarket produce sections and all the specialized warehousing that supports those are possible.
If it were offloaded to taxpayers, taxes would have to be raised to cover it. Under the current system, employers can leave employees uncovered (which is free) or with fake insurance that doesn’t really cover anything (which is cheap).
We’re Amurikans! The gratest country in the world! We do everythin better than everbody else! Yu don’t git to tell me how to live! Ya kin have my gun when ya prize it frum my cold dead fingers!
This is the sort of basic issue – how long we live – that shows how unique America is. And it always makes me wonder if one of the factors is how diverse we are as a nation. We have so many different cultures and factions that we never seem to accomplish some big change that would help the common good. (Obamacare was but a messy, small step towards something that didn’t happen and won’t happen in the foreseeable future.) The very culture of capitalism, one that dominates but hardly everybody agrees with, creates a lot of stress for a lot of people. And stress is, without a doubt, a massive detriment to health. I hear from conservatives that people are poor and government is corrupt in the cities because of a “cultural problem.” Any solutions to this so-called problem? Crickets, or “just work harder,” which isn’t actually a solution. Because maybe they don’t want there to be a solution. Are there any improvements to gun safety? No, because that has its own culture.
I’m sort of babbling, but my main thrust is this: we can’t agree on anything in America because we start from such different places. Yeah, everybody in Finland is supposedly happy – but they all have some significant common causes and culture. China crushes dissenting cultures, etc.
This is disturbing information, and we should be paying attention. I find maternal deaths especially unsettling. African Americans seem to be the most vulnerable population. Economic status might pay a role, but the story of Serena Williams who almost died shortly after delivery, https://www.livescience.com/61411-serena-williams-blood-clot-pregnancy.html, suggests other factors might have a role. I don’t want to say anything that would open me up to being woke or CRT, but it does make you think.
I can’t help but connet our dysfunctional health care system to the phenomenon of Trump.
The connection is the observation that Trump’s most devoted followers are actually among those most harmed by his policy decisions, and who would be most helped by a European style public health service, or postal savings bank, or trade unionization, or whatever.
But as has been pointed out many times, they prize their racial and class identity over even self-preservation. This isn’t new of course- the New Deal had to be watered down and made less egalitarian in order to bring racist white people on board.
But what is new is the velocity- the combination of the force of their race/ class identification, and the direction it is taking them.
Vaccine rejection is another example, where antivax nuttery has morphed from being a bipartisan and mostly fringe belief, to a mainstay of Republican thought. There is no reason for it really, other than the Enemy was identified with vaccines. Other examples might be good dietary choices instead of bad, exercise versus being sedentary, etc.
Until the number of people who put their identity ahead of the commonweal, the vector will be in a bad direction.
Even in my small company, the amount of time and effort, the sheer number of employee hours that HR reps and the employee committee spend on insurance issues is absolutely mind boggling. And not a single one of those hours produce a sellable piece of equipment, which is of course how everyone’s salary actually gets paid.
Yes, this would be shocking if Americans could think far enough ahead to consider how a rising tide lifts all boats. But not so shocking once you realize how the Club For Growth, the Federalist Society, and Fox News helped brainwash certain demographics into believing drag queens, trans kids, and wokeness are a bigger threat to America than rampant socioeconomic inequality. And that liberal attempts to address said inequality and its affects are sOciALiSm.
The whole country — the whole world — would be better off with a USA that embraced affordable universal healthcare and debt-free education (and mass transit, and sensible gun control, and renewable energy etc). The longterm downstream effects of a healthier, smarter American populace would be tremendously positive, from reducing crime rates to increasing housing stability.
The 1% and the Ayn Rand drones on the new right don’t see it that way. The rich and their corporations would rather provide junky healthcare to slaveployees than pay their fair share in taxes so we can form a more perfect union, establish justice, insure domestic tranquility, and promote the general welfare. And certain demographics are happy to keep electing the Republicans (and Sinema and Manchin) who endorse a) Reagan’s trickle-down voodoo economic nonsense and b) the dumb, self-defeating, pyrrhic ‘I got mine, screw the rest of you’ neoconservative mindset that forces all to settle for mediocre-or-worse quality of life.
…That’s it. That’s the punchline.
You are right. It is easier to govern a culturally and ethnically homogenous people, as the Roman Empire found out and as the United States is living out.
But our supposed differences would look much less intractable if we had more represebtative democracy in our constitutional democratic republic. In Finland and the other European countries of note, the politicians and political coalitions that get the most votes get control of goverment.
Conversely, in the US the upper chamber of Congress is often controlled by a party that represents tens of millions fewer citizens, and half of the presidents elected thus far this century got fewer votes won by getting fewer votes than their opponents but in the ‘right’ states. So now our legal system is controlled by jurists placed by presidents and senators who were opposed by most voters.
So yeah, we disagree on a lot in the US. But it looks worse than it is compared to Europe also because of our often-undemocratic political system.
Ultimately, the issue is there’s a large group of people who financially benefit from being able to treat other people as economic resources that can be used up and then discarded when there’s nothing left, and they put a lot of effort into maintaining the systems that allow this and their ability to force people into it.
Everybody in the OP is very careful to say this isn’t partisan, but that’s a pretty good list of stuff Republicans would never support. Plus big direct and indirect effects of racism. Is the problem that we have ethnic and socio-economic divides or is that Republicans, having nothing positive to offer, are so eager to exploit them?
We don’t live as long as people in our peer nations, but is that really not as long as we should? Maybe we are just bad people, who should exit this world a little earlier than others.
Sure, I’m being mostly facetious, but look how old people vote in this country. If we as a species are ever going to get control of global warming, the US has to go from being an active hindrance to a leader.
Can you imagine the horrors that would be unleashed if Americans lived as long as people in other wealthy nations? Or, god forbid, longer? What would marinating their aging brains in front of Fox News for another decade bring?
Be careful what you wish for, Dr. Joyner, because you might just get it.
it does not matter much what facts and evidence tells us about our declining metrics with respect to health care.
All those metrics andevidence don’t stand a chance against the occasional anecdotes from Canada and over the Atlantic that someone had to wait 10 weeks before he/she could get knee surgery (nevermind the fact that in Americas is you don’t have good insurance you might not be able to schedule or afford the surgery anyway.)
There are many reasons for this but, to me it comes down to fundamentally who we are as Americans. Americans see healthcare (at least until we need it) as a consumer good – you have access to and purchase as much of it as you can afford. If you have good insurance and great financial resources you can purchase the very best healthcare. If not, too bad, work harder, accumulate more wealth. Bottomline: We’re quite willing to spend more per capita on healthcare than any other advanced nation, and up with (put up with) poor results/metrics, inefficiency, and millions of uninsured people (which all of us pay for in so many ways).
In Europe and other advanced nations, healthcare is a not a consumer good, it is a social good. As such those people have decided to tax themselves in to provide access to all their citizens.
Guns, Fentanyl, cars and food. We shoot people, we shoot ourselves, we OD, we drive everywhere and we eat anything within reach. Remove guns and opioids, change zoning laws so we have walkable neighborhoods, install bike lanes, and make Ozempic and Mounjaro over-the-counter. .
@al Ameda: yeah…I usually fire back about how it took 6 months for my clinic that was tied into the Denver Health system 6 months to figure out who to refer me to in order to start the process of getting a prosthetic foot, much less the 3 month lag time to get to see PT once they figured it out. I had to leave the state for 6 months before the full process could start. When I returned, I signed up with Kaiser and because they are so integrated (much like an NHS style system) I had an appointment with PT 10 days after my first visit and appointment with the prosthetist 4 days after that one (there was a weekend in between). Went over a year with no left foot.
@James Joyner: I think that you’re missing that what is good for business(es) and what is good for the owners of capital is not necessarily the same set of values/conditions. It may be that the owners of capital consider themselves as part of “the taxpayers” to whom those healthcare costs would be transferred (although why they think this is really beyond me). The current system allows them to transfer the costs of healthcare back to the taxpayers in toto while allowing them to control costs on their end of the equation and yielding a net better ROI.
That computation my also be false economics, but I’m not an uber rich, so I have no understanding of how math works in that plane of existence. Either way, when the problem comes, the market will handle it. That’s what markets do.
So much as mention “15 minute” neighborhoods and some GOP goes off on freedumb!!, the gubbmint wants to take my car away.
This is clearly not just due to lack of or poor medical care. Homicides, suicides, OD deaths, accidental shootings, etc are significant contributors. On the medical side lack of access to care is a big deal and how it is handed out based upon ability to pay are also big, but it goes beyond that. Its always complicated.
Anyway, rather than rave on link goes to a nice piece on OB care in Texas. Note that their issues predate Dobbs and they also have a shortage of physicians and nurses in general. Our maternal mortality rate really is awful and hard to see it getting better in laces like Texas.
@Slugger: @Franklin: [CRT TRIGGER WARNING!!!] Indeed! And part of those differences about where everyone comes from involve having had a social contract that provided that though all men are created equal in principle, some men are significantly more equal than others and that some categories of human life weren’t men at all, but property. Add that our nation held on to that particular difference significantly longer than our peer nations and that even now our nation is better at paying lip service to the principle than living by it
@Slugger: Don’t worry about not being willing to “say it.” You always have cracker to pick up the cudgel.
As myself and my peers rapidly approach Medicare eligibility, I’m thinking back on conversations with Republicans I grew up with who are absolutely convinced that Medicare – a type of universal health care – is a hell before death.
I managed my mother’s health care for the last decade of her life. We both belonged to the same healthcare organization. The difference between the care she received as a Medicare patient and the care that I was paying through the nose for as a contractor carrying my own insurance was – nothing. My wife has had the same experience with her mother.
Now, this makes sense as it’s well known that Medicare has lower costs and higher customer satisfaction than private insurance. But discussions with people I grew up with that identify as conservatives usually ended with something like “why don’t you move to North Korea, you commie?”
I don’t know if there is a solution to this. As it’s already been pointed out, bosses like having the power to deprive you of both your income AND your health insurance. The rich like having low taxes. We are leaving, or have already left the historic anomaly that was post-WW2 America, and returning to a more normal historical pattern – a small group of people owns and controls pretty much everything, and everyone else fights for crumbs.
@Michael Reynolds: As a person with currently inactive Type-2 diabetes*, and insulin resistance from metabolic syndrome, I have to say that I suspect that making Ozempic and the 2 or 3 other similar meds over the counter products will probably cause more problems than they will solve. I’m glad it worked for you, but working for you doesn’t make it any better an idea for everyone than selling weed to 5 year olds because you can get baked with no trouble at all.
*Current A-1c level of 5.2% and wasn’t a candidate for Ozempic because we started treating me for type-2 when my A-1c level was still below 6.5%. Both my doctors were aggressively interventionist. And even now, my average fasting glucose level is normally 110-120, so the A-1c level may well be an anomaly.
A) Are they willing to give up the not-insignificant percentage of their take-home pay to make that happen? I frequently hear people point to Germany as an ideal we should strive for, with universal health care and free university. I know a few Germans. They hand over 45%-50% of their income in taxes. Those aren’t the tax rates, those are the actual percentages of income that they pay.
Ask someone making $20k/year if they’d be willing to give up 50% of their income in order to have universal healthcare.
B) We have universal healthcare–it’s just not entirely socialized.
Medicare covers anyone over 65 (and some others). It needs to be simplified*, but it’s in place.
Medicaid covers a large number of people who are need-based.
The ACA (aka, “the Marketplace” or “Obamacare”) is an actual thing that actually exists–and it provides low-to-zero cost, top-notch insurance for anyone and everyone in the US. I’ve used it. I got a “silver plan” health insurance for $100/mo (based on my income). If I hadn’t been teaching online a couple days a week, I could have gotten it for free.
Democrats (and progressives) won the “insurance for everyone” battle. Why do you keep pretending that win doesn’t exist? Why aren’t you telling anyone and everyone who does’t have insurance through their workplace to go to the Marketplace and sign up?
It’s cheap (or free!), it’s universal (open to everyone from a dishwasher to a Fortune 500 CEO), it’s high quality, it’s not tied to your employer, and you actually have choices about your plan.
Why the fuck aren’t you all screaming about this from the rooftops rather than pushing a “socialized medicine” dream that can be used against you?
See: Democrats have a messaging problem.
* One of the big reasons I’m opposed to “Medicare for all” is just how amazingly complicated it is, and how much it’s actually subsidized by hospitals (because one wrong code can invalidate an entire chain of treatment).
@Just nutha ignint cracker:
As you know I live in LA – or as the world knows it, Hollywood – and it might as well be OTC here for people with money. I got Mounjaro from a legit endocrinologist, but there’s telemedicine, and there are ’boutique’ doctors. I had one day of nausea, and to date I’ve lost 28 pounds, or a quarter of an actress.
@Mu Yixiao: Man…Germans must be clamoring for a system like the US then if it is such hell for them. Oddly, they aren’t and no country’s population is clamoring for a system like ours. Heck, one of the lies that ukip and Johnson put forward for Brexit was the supposed financial gains to be put into the NHS.
BTW…the only reason you were able to get your insurance through the ACA website is because your employer didn’t offer it in the first place, or did you conveniently forget that aspect? My last employer based coverage was 300 a month for just me with a 20% copay and denials that would tie me up with multiple calls. Do you consider your time free? I don’t, but you do you.
I guarantee with all factors (increased interest and loan rates due to credit hits; the hospital you are in is in network, but the surgeon handling your emergency surgery is not; etc.) considered, it is costing us more…way more.
I’ve had Obamacare for some years now. It works well for me. These days I’m doing contract & freelance work. At my age, it’s unlikely that there is another Fortune 500 employee job in my future (not sure I would want one at this point anyway).
The last year I was carrying my own health insurance, it was $1000+ a month (just for me, my wife had insurance through her job), with years of increases ahead before I was eligible for Medicare. Now I’m paying less than half of that – but only because Democrats won battles over funding – temporary funding.
So I am in good shape. There’s enough funding in CA to keep my healthcare affordable until I can get Medicare (assuming of course that Republicans don’t eviscerate it, which they absolutely want to do).
Democrats have won some battles, but they have definitely not won the war – in fact, the war is probably an endless one. Social Security is nearly a century old now, and the GOP still has it in its sights.
That also isn’t factoring in the overhead of Dr’s offices and clinics having to administer claims from multiple insurance carriers. Much like most libertarian economic philosophy, the arguments for free based healthcare wilts in the sun of reality like a week old celery stalk left in the kitchen counter on a humid Alabama day.
Damn…meant to say, “increased interest and insurance rates” above.
And fee based not free based. Autocorrect wasn’t my friend there and no edit
I have a friend in Canada who was born with a life-threatening heart defect. She says that without universal health care:
A. She would have died
B. Her family would have gone broke in the process
She also says that she has never had an unreasonably long wait for care, been drowned in paperwork, received inferior care, or any of the other supposed horrors of universal health care that Fox News viewers hear so much about.
If you are ever talking with a libertarian this piece by Matt Welch is good to send them. Remember that Welch is an editor at Reason magazine where this was published, perhaps the leading libertarian magazine. It will make you sad when you realize how easy health care could be.
I’ll get on my soapbox here to say again that life expectancy is mostly a bullshit number. It takes current conditions, age-specific death rates, and demographics and then extrapolates out from there.
Most Americans like the idea of universal healthcare until they hear the price and understand the tradeoffs. There’s a reason that actual universal healthcare proposals that have identified funding and regulations, even in blue states, don’t get enacted.
“There’s a reason that actual universal healthcare proposals that have identified funding and regulations, even in blue states, don’t get enacted.”
And market based health care is never even tried in red states, but for slightly different reasons but with some similarities. Universal health care does cost a bit more, especially if you can effectively keep people coming from other states to take advantage of it. Also, the Medicare population is going to vote against since their health care is already paid for and they wont want to pay more taxes to benefit others.
Market based insurance probably needs for most states a big population to maybe work, but adjacent red states could work together. It doesnt happen because there is no model anywhere, anytime where quality market based medicine reduces costs. That’s why no one tries it. So of the two universal care with significant govt involvement has been shown to work everywhere else in the world and has the potential to work in the US.
@steve: A good piece. He was, at the time, THE editor at Reason, having succeeded Nick Gillespie. He assumed emeritus status some time back but still works at the magazine (as does Gillespie) and participates in their podcast (as does Gillespie).
@Michael Reynolds: Glad it wurkt fer yu and that yer endocrinologist agreed with yu. Still don’t think it’s ready for OTC tho.
On the other hand, you are the famous kid lit author. That’s close to being an endocrinologist, right?
ETA: I’ve known that rich people get stuff that ordinary mortals don’t. Doesn’t make their choices wiser, either.
Oh, and if dealing with Medicare is so complicated for providers; imagine the complications of dealing with, like, 12 different companies with 12 different claims processes. Our system is wildly inefficient all in the name of a flawed idea of freedom.
” I know a few Germans. They hand over 45%-50% of their income in taxes. Those aren’t the tax rates, those are the actual percentages of income that they pay.
Ask someone making $20k/year if they’d be willing to give up 50% of their income in order to have universal healthcare.”
I seriously doubt that someone in Germany making $20k is paying 50%. I can believe that the Germans you know are paying 45-50% when you include all the various taxes they pay. Do you know their income? What else does that 45-50% pay for? I don’t know anything about social programs in Germany. I know that in some European countries things like college and nursing homes for the elderly are “free”, paid for through taxes.
“Democrats have a messaging problem.” Couldn’t agree more.
” One of the big reasons I’m opposed to “Medicare for all” is just how amazingly complicated it is” To me it seems that Medicare for all would be much less complicated than what we have now.
As we’ve discussed over at Dave’s place ad infinitum, there is no “health care” market. And you should know that I’m not an advocate of turning health care into a pure market activity. The reality is that the majority of revenues spent on health care come from the government already, and most everyone else gets whatever their employer offers which is “private” but not “market.” Those two are often confused.
It’s certainly possible to have some market mechanisms to provide incentives (as other countries do), even in a socialized system, but the devil is in the details, and that doesn’t address the long pole in the tent, which is cost. Health care currently consumes about 1/5 of all US GDP and is still increasing at 2-3 times the inflation rate – as it has for decades.
Pointing out that other countries have more socialized systems and lower costs doesn’t mean the same thing will happen here if we adopt their systems (and there are a wide variety of systems). And it would be dumb to assume it would. The US isn’t like other countries, especially our political system. If you want an example, I would point to defense. That is a “single payer” system, we spend more than any other government on the planet, yet somehow we cannot “negotiate” for cheap F-35’s. Why? Our political system. Defense is 3.5% of GDP, Health care is over 18%.
We also pay much more than peer countries for roads, schools, and many other things because of our political system.
So there is little reason to believe that single-payer health care would be any different.
I really, really like the idea and concept of single-payer. I’ve benefitted from a quasi-single payer system. But I’m reluctant that handing 1/5 of GDP over to our political system would reduce costs, particularly given the constant failure to control costs in the past, particularly with Medicare.
I honestly don’t know how to solve this problem. I don’t believe those on the right and their market theories, and I don’t believe those on the left who promise that single payer will be just like Denmark, but only require tax increases on “the rich.” TANSTAAFL.
@Mu Yixiao: I have never understood the argument that Medicare for All would somehow cost more than what we are paying now.
First of all, we have the most expensive health care system in the world. And all that money doesn’t buy good outcomes.
Secondly, why would people rather pay money to a private insurance company that takes 15% off the top instead of paying into a single system with no provider networks, uniform billing practices, and universal coverage for everyone. Check a person’s ID and provide care. Easy.
Third, the current expensive system that still leaves 15% of Americans without coverage of any sort, means that small issues are left lingering to become big issues. Big issues are expensive! If we can take the homeless guy and get the cut on his hand treated at an outpatient clinic before it becomes an abscess that requires major surgery and multiple courses of inpatient antibiotics, that’s a win for society and for the patient too.
I can’t even mention problems with my health to my doctor during a wellness exam because that causes the exam to become “diagnostic” instead of “preventative”.
Obamacare is great. I would not have been able to retire young without it. But it is not the final form of healthcare for America.
We need to either remove the age qualification requirement for Medicare, or build up an equivalent system that covers everyone universally.
@Andy: Medicare treats our oldest and sickest patients today, and does so at lower provider costs than private insurance. Many hospital finance departments overcharge private insurers in order to make up for “losses” caused by Medicare’s lower reimbursement rates.
Of course, if every patient resulted in Medicare’s lower reimbursement rates, then those would just become the reimbursement rates and hospitals wouldn’t be able to afford champagne fountains in the lobby anymore – but I could live with that.
The fact is that removing the age requirement for Medicare would allow younger and healthier people into the system, which would reduce per-capita costs significantly. Smaller problems would be addressed while they are still small, and American-only issues like surprise billing by out-of-network providers would just go away.
It is disingenuous to suggest that our military spending is a model that would be followed by healthcare simply because the government writes the checks. The VA and Medicare are already doing a great job for their patients, and satisfaction levels are high for both agencies – despite their populations requiring far more health care services than the average American.
We, as a people, have been inundated with reasons why it can’t work here by self-interested groups for at least 40 years, yet there is still a 70% support. Some will drop off when it is presented solely as a huge tax increase on everyone and the dreaded “s” word is bandied about. We are a selfish, short attention span culture that easily falls prey to anything that requires longer than three sentences to sell. Those of us that have experienced the hot garbage that is our current system deeply will not be persuaded by the simplistic, “muh taxes” argument after facing the things mentioned prior and possible bankruptcy because of something like a premature birth, or, as in my case, a spinal injury requiring emergency surgery followed by an amputation. Especially seeing the amount of truly obscene wealth being hoarded here.
As an aside, I always find it rich when retired military pontificate against it, but start hemming and hawing when you ask them when they are planning on dropping out of Tricare to go into a private plan.
And one more thing that is never mentioned is that reducing staff overhead for having to deal with multiple payors could revitalize rural health care clinics and “mom and pop” doctor offices instead of having them bought up by large conglomerates and then shut down due to a lack of profitability.
Leaving aside the predictable party political ping-pong
This is unwise and ill-founded.
While applying a cautious discounting to Least-Developed Country data as comparison is statistically wise, it is regrettably mere rich country reflexive prejudice to dismiss broadly less developed country data, notably for those in the middle-income category where it is not uncommon to have quite robust statistical services (and frankly given the hodge-podge reporting in the USA with your peculiar federalism, more robust national unitary data).
Otherwise, the comments treating the US approach to health care as some feature of capitalism or economic benefit of exploitation in some recycling of 19th century Marxist reflexion or the like are ideological knee jerking, more on point are the evocation of Randian influence. The USA’s eccentric ideological – not economic but ideological strain on its Right for Randian inverted Bolshevism is not a rational economic analysis, it’s irrational ideology.
Andy- I very carefully did not use the word single payer. I simply noted that more government involvement is associated with lower costs. Yes, we have discussed that America is different and what they do might not work, but then again it might but we dont try. Besides, no one who writes or thinks about the topic seriously advocates for wholesale adoption of someone else’s plan, but we could certainly adopt parts of them. And also yes we can incorporate some market like mechanisms. Almost everyone does.
Wildly false. I’ve been to Germany six times since August of 2021, visiting my large friend group there which includes a psychiatrist, a teacher of Norwegian, pilates instructor, a barista, and a retired US military guy (my best friend’s dad), among others. We have had these discussions because I am considering moving to Germany and have feared the propaganda that I’ve heard about European tax rates. Only one of them — the psychiatrist — is paying anywhere near close to 45% of his income in taxes. The rest, by their own self-report, pay progressively from 0% to ~30%.
Conservatives obsfucate about this so they continue can continue to trick is into accepting America’s ludicrous regressive tax code which favors the rich at the expensive of our well-being. Do not fall for it.
@Mu Yixiao: @DK: According to the OECD,
Which pretty much confirms my priors: Germany is a rather high-tax country, even by the standards of the world’s richest countries, but compensates by providing a lot of benefits. And it really depends on who you are.
I agree with you in principle – the point is that the medical lobbies don’t look at it that way and they have a lot more influence in Congress than you or I do.
That was the point of bringing up defense spending. There’s little incentive to try to reduce defense costs or get more value for the dollars we spend because there are a lot of people eating from the trough and Congress has little interest in attempting to implement cost control.
The same thing is true with medical care, only the numbers are much, much larger as is the influence of medical lobbies. They already claim they lose money on Medicare, Medicaid, and Tricare patients. We can sit here and say they are wrong, and promote the idea of expanding Medicare and then finding the money for it from whatever source, but who is Congress going to listen to? Is Congress going to keep reimbursement rates low or increase them? Given the numbers involved these aren’t trivial problems and can’t be waived away.
@Andy: I contend that Medicare could be lobbied up to current Private Insurance reimbursement rates – and we’d still save money by putting everyone on Medicare.
Firstly, there would be no profit slice off the top for the insurance companies. Next, the whole issue with small issues being dealt with before they become big issues would reduce spending. Lastly, small business growth would be a boon for innovation and overall economic growth.
This is 100% an issue of pushing money to the top .1% or down to the people.