From the comments: who lives longer?

by on July 31, 2009 at 7:08 am in Medicine | Permalink

Adam reports:

At birth, someone living in the Netherlands can expect to live 2.35
years longer than someone born in the US, but at age 65, the difference
is reversed, and someone living in the US can expect to live 0.4 years
longer than someone living in the Netherlands. This difference can be
explained by assuming that semi-socialized health care is better for
young and worse for old people, or, at least as likely, different
policies are not the main cause of the difference

Sources: CDC national vital statistics 2004,
www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_09.pdf and RIVM 2007
levensverwachting, www.rivm.nl/vtv/object_document/o2309n18838.html (in
Dutch)

One interesting feature of this data is that it can be used to argue for a number of different points of view.

1 Gorgasal July 31, 2009 at 7:23 am

Another explanation: different rates of child mortality. Which have been explained by differences in neonatal care – an almost-stillborn child may die within minutes in the Netherlands, be classified as stillborn and not counted as a child death, but it may well be kept alive for hours in the US, die later on, be classified as a live birth and counted as a child death.

Life expectancy statistics at birth are very tricky indeed. I would not try to meaningfully compare anything before about one year of age.

2 ross July 31, 2009 at 7:48 am

The key difference is the prognosis of the population at age 65. If more people survive until 65 in the Netherlands, then that population likely has a poorer general prognosis at that point, possibly because that country has done a better job helping them survive until that point. Choosing 65 as the starting point of analysis without any controls is cherry picking.

Plus, Dan is right, how could the commenter not know that the US has essentially socialized health care for those over 65? And how can you pass the comment off as valuable enough to warrant a post if the person is unaware of basic facts.

3 bellisaurius July 31, 2009 at 7:54 am

Don’t forget homicide. That skews are stats in the 20-35 range as well.

4 a student of economics July 31, 2009 at 8:10 am

“Don’t Americans over 65 also have “semi-socialized” health care?”

Yes, or more specifically, a single payer system that is arguably more socialized than the Dutch system for people over 65.

How would Occam’s razor solve the life expectancy puzzle?

5 spencer July 31, 2009 at 8:14 am

Don’t both countries have semi-socialized health care for those over 65.

the difference is the degree of semi-socialized health care for the under 65 population. It is not 100%.

6 Stan July 31, 2009 at 8:21 am

What this shows is that “semi-socialized” health care is good both for infants and for the elderly. Considering the ideology of the proprietors of this site, it shows great fairmindedness for them to link to Adam’s report.

7 Andrew July 31, 2009 at 8:56 am

No, they don’t have socialized healthcare over 65. They have socialized insurance. Sheesh. That’s why this distinction is important, because it is a financial question until you start messing with the incentives, which we have not done to the extent other socialized medicine countries have.

What the post means is that the numbers are rubbish. Average life expectancy that changes depending on what is used for infant mortality…rubbish.

8 Zbicyclist July 31, 2009 at 9:03 am

There are too many possible explanations to make simplistic causal statements about small differences.

Occam’s Razor might suggest that any simple explanation will not be able to be proven.

9 Andy July 31, 2009 at 9:17 am

OK, so… I don’t have kids yet. I’m going to go to the Netherlands to have my kids, raise them there for a few years, then come back. They’ll never die!!!

10 anonymous July 31, 2009 at 9:33 am

What is the exact methodology being used to make this comparison? Which lifespans and calendar years are being used?

Presumably, to make an apples-to-apples comparison, you’d have to look at the subset of life-expectancy-at-birth dataset that consists of people who lived past age 65, in order to come up with your life-expectancy-at-65 data. But then your infant mortality statistics would reflect neonatal care standards of 65 years ago and would tell us nothing about modern medical practice or modern social policies.

More generally, World War II ended almost 65 years ago, and in the final year of the war there was near-famine in the Netherlands. If you’re 65 years old, what has a greater impact on your remaining life expectancy: the way you live now and the policies of your current government, or environmental factors that affected your early childhood?

I think some of you previous commentators might be jumping to meaningless conclusions.

11 Anon July 31, 2009 at 9:48 am

The differences are small enough that they can be overwhelmed by non healthcare factors. Life expectancy is a poor tool for comparisons when the life expectancy is close at all.

12 Alex R July 31, 2009 at 10:05 am

Lots of good comments. Another relevant point: life expectancy for 65+ year-olds is determined by looking at death rates for those over 65. Someone just turning 65 today would have been born in 1944 — during World War II. So basically all of the over-65-year-olds would have been children (or in a few cases, young adults) during the war. I would suggest that the experience of young people during World War II in the Netherlands would have been considerably more adverse with respect to long-term health effects than young people in this period in the United States. (I’m basing this in part on having met an older gentleman in the Netherlands with serious health problems caused by wartime experiences…)

13 Andrew July 31, 2009 at 10:14 am

Spencer,

Perhaps, but which 50% do plan on cutting? I propose the blue states.

14 Andrew July 31, 2009 at 10:29 am

Also keep in mind that the economists making the biggest deal about this stuff don’t believe in mal-investment.

15 John Dewey July 31, 2009 at 10:47 am

A couple of relevant statistics:

Homicide rate per 100,000 population

U.S. …………. 5.8
Netherlands … 0.97

Traffic deaths per 100,000 population

U.S. ………… 14.7
Netherlands …. 4.5

Not sure about traffic deaths, but I think homicides are more likely among younger folks. The much higher incidence of homicides in the U.S. will have an even larger impact on life expectancy at birth than if homicides were spread evenly across age groups.

16 Yancey Ward July 31, 2009 at 11:31 am

There are a lot of unknowns here, and some of them have been mentioned in the previous comments. There are probably two factors at work here, however. How are stillborns counted, and how similar are the rates of death by homicide for the two nationalities for those above 65 and below 65. Since I know that those under 35 are most likely to be victims of homicide, I would guess that the rates for US citizens and the Dutch converge somewhat from age 35 onward.

spencer,

If it were demonstrated that cutting US healthcare spending to the level of France cut US life expectancy by a year or two, what would your position be then?

17 dearieme July 31, 2009 at 11:51 am

When I click the link it takes me to “South Korea fact(s) of the day”.

18 John Dewey July 31, 2009 at 12:02 pm

spencer: “It still comes down to the point that we spend about 50% more to get roughly the same results.”

That’s only a valid point IF we assume that the goal of all medical spending is to increase lifespan. But it’s not, of course.

U.S. consumers spend more money than Europeans for dental work, hair implants, breast augmentations, facelifts, fertility treatments, lasik surgery, end of life care, mental health counseling, and on and on.

U.S. consumers spend more money than Europeans to reduce queues.

U.S. consumers spend far more money than Europeans for medical research.

Non-U.S. consumers spend money in the U.S. for all sorts of treatment.

The U.S. spends more money for health care than any other nation because we have more money to spend.

19 Ryan July 31, 2009 at 12:40 pm

The system will never face systemic collapse. One thing that bugs me about healthcare reform “debate” is that all sides seem to believe that we will all lose any semblance of healthcare unless reform takes place.

This is absurd for Econ 101 reasons. The costs will rise to the point where they are no longer supported by any economic agent or aggregate thereof until a little Creative Destruction takes place.

People in America need to learn that you can’t have your cake and eat it, too. You can’t fully regulate the health industry and avoid rationing. You can’t bail out banking leviathans and “avoid systemic risk” in the future. Economic systems don’t ever change until the actions of economic agents change. They will never change so long as some regulator is propping up their behavior.

20 Danny July 31, 2009 at 1:34 pm

http://politicalcalculations.blogspot.com/2007/09/natural-life-expectancy-in-united.html

According to these calculations, fatal accidents contribute highly to our low life expectancy.

As our lives progress, our individual probability of suffering a fatal accident declines, and therefore our life expectancy increases.

21 Dan July 31, 2009 at 2:02 pm

We do have higher rates of homicide and traffic accidents, but if you isolate the deaths that could have been prevented with better health care (and look at the rates of amenable mortality), the United States still doesn’t look good.

22 MPO July 31, 2009 at 2:17 pm

And as a follow-up to the above, that is not to say other countries do not possess, have not created or cannot import medical technology. But the fact is that they frequently are slower to do so, and the larger issue is one of degree and availability.

23 Mike July 31, 2009 at 2:38 pm

Dan at Jul 31, 2009 7:33:47 AM got me to thinking when he observed that “Don’t Americans over 65 also have ‘semi-socialized’ health care?”

I don’t agree with the implications of the following logic but it is what it is. Can anyone tell me the error of my argument?

This data would suggest that our semi-socialized health care for the elderly (Medicare) is better than Europe’s and Europe’s semi-socialized health care out performs our semi-free market health care system. Therefore, under semi-socialized health care for all, we would do better than the Europeans and should, therefore, have even better overall performance statistics than the Europeans and phenomenally better than what we have now. So let’s go to the single payer, semi-socialized medicine solution!

whow! Katie bar the door!

24 Ed July 31, 2009 at 3:15 pm

I’ve seen the argument made that Medicare is very generous, because US government health care spending is essentially concentrated on the elderly. But if the government ran a health care system for everyone, it would have to spread the resources more evenly across generations and spending on care for the elderly would be reduced. Even if it wasn’t reduced they would lose their relative advantage over younger generations.

Of course the implication of that argument is that the main purpose of government should be to benefit the elderly, and screw everyone else. I’m not sure if I buy that.

Politically you handle this by grandfathering the current level of benefits. The spending will get less out of control as the current generation dies off.

25 J July 31, 2009 at 5:02 pm

“This difference can be explained by assuming that semi-socialized health care is better for young and worse for old people, or, at least as likely, different policies are not the main cause of the difference”

Or more likely by the fact that the biggest factor in a population’s life expectancy at birth is infant mortality, a self reported statistic with no standard criteria.

26 Andrew July 31, 2009 at 6:31 pm

I was being somewhat facetious (only somewhat) about them making sure Medicare’s problems were everyone’s problems, but then I read this:

http://finance.yahoo.com/insurance/article/107408/5-freedoms-you-would-lose-in-health-care-reform.html?mod=insurance-health

Like clockwork, the only real solutions, HSAs and high deductibles, really are in their cross-hairs (for blowing up, not promoting, that is).

What these people really are trying to do is ram through a redistribution policy in the guise of medical equality. I’m not even sure they understand what they are doing, but that’s what it is.

27 Dan H. July 31, 2009 at 9:10 pm

You can’t say that the U.S. gets ‘roughly the same results’ without considering a host of other factors. For example, about 66% of the U.S. population is considered overweight or obese. This is the highest rate in the world. Canada, for example, has an overweight/obese percentage of about 44%.

Obesity is a strong predictor of overall health and longevity. The fact that the U.S. can keep its people alive as long as other countries despite their obesity might suggest that the U.S. health care system is better. It might also help account for the higher cost of U.S. health care, since obesity carries with it a higher risk of many diseases and other problems that are extremely expensive to treat.

But the main point is that you can’t directly compare two populations against a simple measure like life expectancy and draw any meaningful conclusions. You need to control for a host of other variables.

28 Branko Collin August 1, 2009 at 5:18 am

Sampling without replacement is indeed likely to yield such results. After you’ve killed off all the unhealthy Americans, you’re left with the healthy ones.

29 pvenkman August 1, 2009 at 5:17 pm

To date the most comprehensive analysis on this subject has been from the Cato.institute. And while I disagree with the premise of the paper as a whole, the interpretation of life expectancy statistics and its use in determining the health of a nations health care, is still the most in depth, and unchallenged analysis to date. (“See Myth No. 4: Although the United States Spends More per Capita on Health Care Than Countries with National Health Insurance, Americans Do Not Get Better Health Care” here – http://www.cato.org/pubs/pas/pa532.pdf) Not surprising, Wanna know how to analyze a fact, figure, or statistic, and use it? Ask a Libertarian, that’s what I always say. Those yahoos do everything in extreme, even analysis and fact checking. They’re crazy but they know their issues inside and out.

30 pvenkman August 1, 2009 at 5:50 pm

Soooo like, how many Hispanics, Blacks, Asians, Native Americans, and Arab’s live in the Netherlands?

“While a good health care system may, by intervention, extend the life of a small percentage of a population, it has very little to do with the average life span of the whole population. Instead, the number of years a person will live is primarily a result of genetic and social factors, including lifestyle, environment, and education.

Data, data, data, analysis, data, well duh, and duh† Ahhh, here’s a novel approach to the subject! *smacks head* It’s so obvious, important, and relevent, I don’t know WTF I didn’t think of it to begin with! HA!

“A better measure of a country’s health care system is mortality rates for those diseases that modern medicine can treat effectively. Take cancer, for example. As Figure 7 illustrates, in New Zealand and the United Kingdom nearly half of all women diagnosed with breast cancer die of the disease. In Germany and France, almost one in three dies of the disease. By contrast, in the United States only one in four women diagnosed with breast cancer dies of the disease. This is among the lowest rates of any industrial country. Similarly, in the United States the mortality rate for prostate cancer is lower than in most other OECD countries (see Figure 8). †¦ Continued – http://www.cato.org/pubs/pas/pa532.pdf†

31 理想を貫く強 March 10, 2010 at 9:51 am

lcz
「自分自身を発見し、理想を貫く強い意志を持つこと」。new balance1918年、ボストンに小さな店をオープンしたティンバーランドの創業者airmax 95 、ネイサン・シュワーツが残したシンプルな企業理念は、アメリカのみならず、ティンバーランドのその名が世界的に知られるまでになった現在でも、経営陣から社員一人ひとりにまで浸透していますtimberland ブーツ。ティンバーランドには利益を上げることと同様に力を傾けている大きな目的があります。それは、より多くの方に新しい自分を発見していただけるような物を作ること。たとえば、大自然に囲まれての野外活動において、その愉しさを周囲の人々と分かち合えば、その喜びはきっと増すでしょう。timberland 6インチそうした目的を実現させるための商品作りにティンバーランド全員が取り組んでいます。
また、1989年、あるコミュニティ活動組織にブーツを50足寄付したことから始まり、ティンバーランドは現在までさまざまな社会貢献活動に携わってきました。そして今、timberland 6インチそれらの活動は世界中の人々とティンバーランドのスタッフがつながる重要な手段となり、さらには、私たちと協力することでお客様の社会貢献活動を実現していただくという理想的な関係が保たれています。ものづくりだけに執着することなく、顧客、社会との関わりを深めることで、ティンバーランドがどのような企業体なのか理解していただけると私たちは信じているのですtimberland 6インチ。

32 となり日本を沸 March 10, 2010 at 11:50 am

lxq
どのジャージにおいても、タテに走るネイビー色のラインは生地に直接染めてありますNIKE ジャージ。
レプリカジャージはナイロンメッシュ生地です。NIKE ジャージほぼ同じ倍率にも関わらず、メッシュ穴の大きさが他の2つに比べて、小さく非常にきめ細かに入っていることがわかります。またナイロン独特のテカつきがあるのも特徴ですNIKE ジャージ。
一方、スウィングマンジャージはポリエステルメッシュ生地で出来ていますNFLジャージ。レプリカジャージよりもメッシュ穴が大きく、目を凝らすと生地の織り目まで見えます。オーセンティックジャージ(≒実使用)にも同じ生地素材を採用してい用いるチームが多いため、より選手が着用する実使用の物に近い仕様になっております。また、手触りはレプリカジャージと異なり、reebok ジャージザラザラしているのも特徴です。
オーセンティックジャージは、reebok ジャージ同じチームでもホーム・アウェイ・3rd(現オルタネート)の種類ごとに生地の素材が異なる場合が多く、レイカーズ ジャージ今回は偶然にも、スウィングマンジャージの生地素材と同じでした。見た目はほとんど変わりませんが、オーセンティックジャージの方がメッシュ穴がきめ細かに入っています。また、触った感じではオーセンティックジャージの方が厚手に感じられます。

33 となり日本を沸 March 10, 2010 at 11:56 am

lxq
どのジャージにおいても、タテに走るネイビー色のラインは生地に直接染めてありますNIKE ジャージ。
レプリカジャージはナイロンメッシュ生地です。NIKE ジャージほぼ同じ倍率にも関わらず、メッシュ穴の大きさが他の2つに比べて、小さく非常にきめ細かに入っていることがわかります。またナイロン独特のテカつきがあるのも特徴ですNIKE ジャージ。
一方、スウィングマンジャージはポリエステルメッシュ生地で出来ていますNFLジャージ。レプリカジャージよりもメッシュ穴が大きく、目を凝らすと生地の織り目まで見えます。オーセンティックジャージ(≒実使用)にも同じ生地素材を採用してい用いるチームが多いため、より選手が着用する実使用の物に近い仕様になっております。また、手触りはレプリカジャージと異なり、reebok ジャージザラザラしているのも特徴です。
オーセンティックジャージは、reebok ジャージ同じチームでもホーム・アウェイ・3rd(現オルタネート)の種類ごとに生地の素材が異なる場合が多く、レイカーズ ジャージ今回は偶然にも、スウィングマンジャージの生地素材と同じでした。見た目はほとんど変わりませんが、オーセンティックジャージの方がメッシュ穴がきめ細かに入っています。また、触った感じではオーセンティックジャージの方が厚手に感じられます。

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