Who is healthy?

From MR comments:

Japanese Americans have the longest measured life expectancy on this
planet.  Mormons live 10 years longer on average than Europeans.  Black
men in the US live 8 less on average than Hispanic men…they [Americans] can get
“cheap” European care if they like, just create extremely bad American
HMO insurance, or don’t buy health care at all and go to Public
hospitals.  The reason the European systems are cheaper is not that they
magically have less costs, it is that they give the consumer much less
health care.  Of course the people in the US that go to public hospitals
in the US are not the same kind of people that consume government
health care in Europe.  This makes the health outcome different, even if
the quality of the health care is not.

Link here.  Another reader writes:

The single largest group (30% of all the [un]insured) are Hispanics. 
Hispanics have the same (actually slightly higher) life expectancy as
the average American.

Life expectancy statistics are tricky, but these claims hold up under the scrutiny of Google.  More importantly, the claims "sound right wing" but actually they provide the best argument for single-payer health insurance to be found: "The link between health and health care is murky, so let’s just save money on our health system."

That is another example of Stories You Won’t Often Hear

I’ve yet to see a fully convincing answer.  Of course this is not the kind of low-cost, government-run system we would end up with in the United States, but we can still debate whether Europe should switch to some other system, and for the time being perhaps the answer is no…

Should they simply wait for the day when health care matters more than it currently does?


Tyler, sometimes you're a complete breath of fresh air. So many other commenters (probably including fellow professors at GMU) would take this opportunity to offer up bromides against single-payer. Thanks for keeping an open mind.

Who don't smoke or drink, and live close to spectacular ski slopes.

I have found that spending less money on things always has a way of reducing your costs.

I recently heard that 1 of every 5 dollars is spent on healthcare and that that number would be rising. I have also seen the statistic that increasing the life expectancy in the USA has a marginal cost of 1 million per person and in poor African countries this number might be closer to a marginal cost of $100 per person, Has anyone seen other statistics of the marginal life expectancy cost in other countries? If you think of (assume) that quality of healthcare has the outcome of increased life expectancy (you would hope but my meaning is to ignore the other benefits) At what level should be set our marginal healthcare spending? It seems that at some points in life you could spend an unlimited amount but you are still going to die some time. I a government sets spending at what level should it set marginal spending or would it consider setting a budget without thought of marginal cost/benifit?

Of course this is not the kind of low-cost, government-run system we would end up with in the United States

Indeed. Consider that Professor Krugman and others have recently been touting the low cost increases in the VA as a model, together with the recent news and complaints. I see two possible explanations:

1) The VA's cost limitations were achieved with a reduction in care quality that is meaningful and bad, and the VA should not be held up as a model; realistic and efficient care would increase like Medicare instead.

2) The VA reduced spending model was precisely the same sort of fairly efficient, low-cost, government-run system as in Europe that would actually be better. However, the recent complaints and resignations demonstrate that such a model is politically infeasible in the USA.

And of course any discussion about whether "Europe should switch to another model" glosses over the differences among the various systems. The UK NHS is quite a bit different from France's model, which incorporates user fees and private insurance.

Walter Reed isn't a VA hospital. It's an Army hospital run by the Army and not the VA. That's why the Secretary of the Army resigned and not the Secretary of Veterans Affairs. Two completely different organizations.

The trade-off for cheaper health care is not generally lower life expectancy, it is lower quality of life. You just have to look at the long waiting lists for knee operations, etc. in the UK and Canada to see what the trade off is.

Uhh Tyler,

maybe you should provide some links comparing US health care with European health care?
Before making or posting such sweeping statements?

Surveys like these for example:
2006 International Health Policy Survey of Primary Care Doctors

Primary care doctors in the U.S. are less likely than those in
several other countries to be able to offer patients access to care outside regular office hours or to
have systems that alert doctors to potentially harmful drug interactions. U.S. primary care
physicians are also less likely to receive financial incentives for improving patient care, according
to the Commonwealth Fund 2006 International Health Policy Survey published today on the Web
site of the journal Health Affairs.

2005 Commonwealth Fund International Health Policy Survey of Sicker Adults

A new international survey supported by The Commonwealth Fund finds that one-third of U.S. patients with health problems reported experiencing medical mistakes, medication errors, or inaccurate or delayed lab results—the highest rate of any of the six nations surveyed. While sicker patients in all countries reported safety risks, poor care coordination, and inadequate chronic care treatment, with no country deemed best or worst overall, the United States stood out for high error rates, inefficient coordination of care, and high out-of-pocket costs resulting in forgone care.

Mind you, that doesn´t mean that European health care systems are perfect. However they don´t look that bad compared to the US system.

"The link between health and health care is murky, so let's just save money on our health system."

Between group comparisons are misleading here, since groups differ for any number of identified and unidentified cultural, social, and genetic reasons. No one ever claimed health care was the only variable affecting health or that a group with health care that gets drunk and sky dives every weekend should have a higher lifespan than a group without healthcare that watches PBS and eats celery every weekend.

The real comparison of interest is how does health care affect health either within groups or when all the groups are examined as one population.

John Thacker appears perfectly willing to propagate any misinformation that casts aspersions on the VA. Good job John.

Additionally Walter Reed has been substantially outsourced to a subsidiary (IAP) of the great bogeyman that is Haliburton.

The trade-off for cheaper health care is not generally lower life expectancy, it is lower quality of life. You just have to look at the long waiting lists for knee operations, etc. in the UK and Canada to see what the trade off is.

Tyler Cowen posted about European health care systems. I didn´t know that Europe consisted of the UK and Canada only? Sorry about mentioning continental Europe.

Tyler Cowen posted about European health care systems. I didn´t know that Europe consisted of the UK and Canada only? Sorry about mentioning continental Europe.

I only referenced UK and Canada, because they are the only systems I know anything personally about. However, the same point applies to all systems. If you hold down health care spending, you will get a lower quality of life.

You did read my comment mentioning the two Commonwealth Fund surveys? Both surveys mentioned that - while each health care system might have problems - the American one doesn´t come out as the winner.

You might think about it.

I read it, and I don't claim that the American system is perfect. In particular, the fact that insurance is tied to employment is something I really hate about it. However, IF you have insurance in the US, the amount of healthcare that is available to you is far higher. It's a big if, though, sometimes.

The point remains, though, that the people in the US who have insurance get a lavish amount of healthcare for the lavish amount we spend. That can be pretty significant for quality of life.

Hispanic-American infant mortality is also quite low, about the same as white and Asian infant mortality in America, while African-American infant mortality is much higher. Short pregnancies and low birth weights appear to be more common among African-American women even at the high end of the social scale, perhaps related in some fashion to the relatively narrower pelvis bones of women of African descent (which is related to the more efficient running stride of blacks), which make larger babies more dangerous to deliver.

On the other hand there is evidence that past a certain high age, such as 75, that African-Americans then have the longest life expectancies. There do seem to be a lot of black female centenarians.

Being Canadian, I've always looked at our healthcare system as the best way of rationing healthcare possible. We get, in my opinion, about 90% of the American healthcare levels for about 1/2 the cost.

Of course anyone who believes that America can improve their current healthcare levels *and* save money with a one-payer system is dreaming in technicolor. But if you want to restrain healthcare spending (and American levels of healthcare spending would bankrupt any other nation on the planet and may, in fact, be bankrupting the US), a one-payer system is the most humane method of doing so.

It's a heck of a lot easier to be told "Nothing can be done" to save Grandma than to be told "For only an extra $250,000, you could give Grandma a shot at life. Is it worth it?"

Regarding Mormons, they also eschew consuming caffeine.
No coffee, tea, or cola.

This business of "more" versus "less" health care is really
not very to the point. Details matter. Thus, the point about
care out of hours is probably non-trivially important. I remember
when doctors in the US made house calls. They simply do not
any more, and if you raise this issue with a US doctor you are
treated like you are out of your mind. But doctors in most other
countries do still make house calls. Is this a backward bending
supply curve of labor phenomenon? Our highly paid doctors cannot
waste their time making house calls?

So, sure, they are more likely to recommend specialist care to someone,
but you can die before you ever get it because they are not available.
I have long said that the US system is best for someone who is rich and
has a non-life threatening ailment requiring surgery.

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