Sweden, Medicare, and what really matters

Tino writes:

Medicare was introduced 1965 in the US. Public health coverage for the elderly existed by 1950 in Sweden, but full universal coverage dates to 1955 in Sweden (a public health insurance was founded in 1891, and public municipal public health existed for even longer).

In 1950, before Medicare, and before Universal coverage in Sweden the difference was +2.6 at birth and +0.3 at 65. In 2001-2005 the difference between the Sweden and US was +2.7 at birth and +0.3 years at 65. Identical!

First, regarding the life expectancy at birth we can note that 50 years of different health policy, labor mark policy, welfare state coverage seems to have had zero effect on total outcome.

And:

Last note: around 1900, before the expansion of the welfare state, the estimated life expectancy at birth was 54.0 years in Sweden and 47.3 years in the US, a difference of 5.3 years, twice the current gap.

If you scroll through Tino's blog, you will find various critiques of The Spirit Level.  On the health care point, I would stress that Hansonian results also can be used to argue for the extreme exercise of monopsony power, so don't think the policy implications of this are so simple.

Comments

I totally disagree. First of all there is a natural upper limit on life expectancy, so no wonder the U.S. level converges to the (higher) Swedish level over time (between 1900 en the present). Even stronger, the fact that since universal health insurance in Sweden the convergence appears to have halted could warrant a very different conclusion.

But more importantly: universal health care and the welfare state in general arent necessarily about maximizing average life expectancy but minimizing individual risk. By that metric you should look at medical bankrupcy, for example. Im quite positive Sweden has a much lower rate than the U.S.

Having public health insurance for elderly, but not for young, doesn't make much sense. The reason must be that elderly wage more influence over politics. I've no idea what USA should do about its medical costs, but I suppose eating fewer calories helps.

So let's pretend that life expectancy differential is the only indicator that matters for measuring differences in health care outcomes.

My question would be: what was the change in the share of national income allocated to health in Sweden and the USA over that period of time.

The suggestion in the article is that implementing public health care has no net effect on health care outcomes when compared to the American way.

I suspect that answering the question I pose would show that public health care has achieved the same result at a much lower cost.

I suspect that answering the question I pose would show that public health care has achieved the same result at a much lower cost.

And tbat's important because - why? Because Sweden is as a result a wealthier country than the U.S.? I don't think so.

Why is life expectancy the metric for discussions about health care?

Because it's measurable and it's one that is routinely used by proponents of socialized health care. Now that Tino demonstrates its flaws in that regard, all of a sudden it's not a good measure?

so they hunt for quantifiable parameters even if those parameters are tangential to the issue.

How in God's name is life expectancy tangential to the issue of health care? It may not be the whole story, but to call it "tangential" is truly bizarre.

Having public health insurance for elderly, but not for young, doesn't make much sense.

Gee, uh, maybe because they need health care more than young people and generally have ceased the productive aspect of their lives? Granted, if Medicare were a genuinely self-funding system it would make a lot more sense - i.e., each generation should be funding their own health care costs while they're working instead of the prior generation's.

Looking closer at Tino's numbers:

In 1950, before Medicare, and before Universal coverage in Sweden the difference was +2.6 at birth and +0.3 at 65. In 2001-2005 the difference between the Sweden and US was +2.7 at birth and +0.3 years at 65. Identical!

It's unlikely these figures were controlled to account for the demographic differences between the two nations' populations - a more direct comparison would be to compare the life expectancy differential between the "white" population of the U.S. with the population of Sweden. Going by the available data for 2004, the difference in life expectancy at birth would be +1.8 years, favoring Sweden, while the same +0.3 difference would apply for the expected remaining life expectancy at Age 65.

Picking up on the Lonely Libertarian's comments, the black population of the U.S. is far more likely to suffer from a variety chronic health conditions (not just hypertension), which accounts for the greater mortality rates observed in this portion of the U.S. population. However, this disparity becomes smaller with age, with blacks outliving whites after Age 80.

As for why blacks have greater mortality rates at younger ages, see here. The hypothesis we advanced is supported by the findings of recently published research.

It strikes me to wonder if this analysis is flawed in the same way that analysis of average income might be. The US has been much more open to immigration than Sweden. My guess is that these immigrants will pull down the average life expectancy in the US even if the "natives" are on pace with the Swedish averages. Is this aspect explored in the data? I wonder if there is a state in the Union that can be accurately compared to Sweden over such a long time frame.

So Andrew, u prefer to steal relatively small amounts of money from each of us to insure that person who had a catastrophic event leading to unpayable medical expenses rather than letting that person "stiff" the providers of the expensive treatment through bankruptcy...

Strikes me as a rather right wing point of view - me - I am fine with the stiffing option rather than the stealing one...

In my opinion the healthcare debate is NOT about life-expectancy, or "increase in health" but about making patients the sole-determinant of health care. Right now, Health-care is determined by pharma/hospitals and insurance agencies without any care for what patients want.

My husband went to an emergency clinic and was charged 200 dollars for a prescription of Over the Counter Tylenol. This is what is wrong with healthcare in US. If you do not have insurance (or in my case, used it in hospitals which do not accept your insurance), you have to know how to administer medicines yourself, or healthcare will bankrupt you.

The demand for pharma/hospitals comes from Insurance Companies and not people. Medicines are created according to what Insurance Companies think will get them most bang for the buck.

This is not the case even in Singapore (Singapore has a partial medicare system) or in India.

Since we seem to be drifting into an "access to health care" discussion two points are worth remembering...

1. Access can have both positive and negative consequences - we too often assume away the negative - Al Haig died of an infection he got - guess where.

2. Access as I said in an earlier post does not assure effective treatment - drugs have side effects and the data shows that diabetics and blood pressure patients - and others struggle with balancing quality of life with the effect on them of their meds.

DanC - embedded in your post is a great questions...

The major improvements in health care over the last 60+ years.

1. Better sanitation - which could be better - make your health care provider wash his or her hands more often,
2. Vacines
3. Antibiotics.

After you factor those things out what's left has had very little real impact and often has a negative side that offsets the positive...

I have no idea what this is supposed to show. What about 1950-1965? Wouldn't that be a useful number?

Is it that Sweden's universal health care program didn't really change anything with respect to life expectancies? We start pre-1950: old-age coverage in Sweden, nothing here. Then we jump to 2001: old-age coverage in the US and universal coverage in Sweden, and find that the difference in life expectancy didn't change.

What conclusion can we draw? That the under-65 universal coverage makes no difference in the quality of outcomes? OK. But then why not adopt Sweden's system of coverage. It costs less than two-thirds of what we spend as a % of GDP, a savings of over 5%.

So isn't this the biggest all-you-can-eat free lunch we've ever seen? Call the Swedes. Ask them to send us the details of their plan, documentation, etc. , and adopt it wholesale. Bingo!! Five percent of GDP saved.

DanC...

I would urge you to do a bit of digging - and not accept the PR...

But taking one - cancer survival rates have not moved a lot - if at all in many areas - yes there have been some gains in specific types of luekemia and some others - but the data is often confounded by the effect of early detection - if we see survival go from 4 to 6 years - but we are discovering tumors 2 years earlier we may just be measuring the effect of early detection [and early treatment and side effects].

The Swedes did a comprehensive study of prostate cancer that has led to more frequent reliance of watchful waiting for many patients.

I would not be surprised that a closer look at the cases of John Murtha and Al Haig will show that they may have died from the treatment - not the condition being treated - both will be investigated - hopefully we will not see a white wash of those responsible.

If you look at changes in life expectancy over time, it had mostly plateaued in the US in the 50s until the introduction of medicare when it started rising again. This was also the time when smoking came under assault which may have had a greater impact than medicare, but it would unbelievable that the increase in spending did not advance technology and treatment. Even then it shouldn't be assumed medicare would necessarily produce an immediate impact as the most significant changes only become evident over time, so 10 years difference between starts likely isn't worth considering as material.

Tom,

I would? Based on what, pray tell? And are you going to measure this per cost?

So there seem to be two interesting arguments being made

1) Since nationalized healthcare has no positive impact(according to Tino), then there is no need to go to nationalized healthcare.

2) Since nationalized healthcare has no negative impact(according to Tine), then we should go to nationalized healthcare because its cheaper. We, the consumers, may be denied services, but there won't be a net negative impact to society.

Ujjwal Deb brings up the issue of life variance, which is pretty interesting. Assuming that's true, that Sweden has lower variance, then the push for nationalized healthcare boils down to some people requesting longer life expectancy at the expense of other getting a shorter life expectancy. As one of those people at the upper end, I'll keep my long life thank you.

Lord,

I would argue that the eradication of Polio had a bigger impact than our efforts to punish smokers - in 1952 we had around 3,000 deaths from polio - today we have 0 - something like half a million Americans are alive today - and adding to the life expectancy calculations who would have died had we not developed an effective vaccine.

Bernard Yomtov,

If we're assuming that Tino is correct, and that nationalized healthcare did not increase the average, or mean, life expectancy, then we can't adjust the mean by switching to nationalized healthcare, we can only reduce the variance(which is generally good, unless you're one of the people riding the upper tail).

If disagree with Tino's findings that's fine, but its a separate argument.

According to the OECD which Sweden first contributed data according to standard OECD guidelines in 1970:

total spending:
In 1970:
Sweden: 6.8% of GDP, US: 7.0% of GDP
In 2006:
Sweden: 9.2% of GDP, US: 15.3% of GDP

Total health care cost per capital PPP$
In 1970:
Sweden: $312, US: $351
In 2006:
Sweden: $3202, US: $6714

Life Expectancy at birth:
In 1960:
Sweden: 73.1, US: 69.9
In 1970:
Sweden: 74.1, US: 70.9
In 2005:
Sweden: 80.6, US: 77.8

Male Life Expectancy at 65:
In 1960:
Sweden: 13.7, US: 12.8
In 1970:
Sweden: 14.2, US: 13.1
In 2005:
Sweden: 17.4, US: 17.2

Female Life Expectancy at 65:
In 1960:
Sweden: 15.3, US: 15.8
In 1970:
Sweden: 16.8, US: 17.0
In 2005:
Sweden: 20.6, US: 20.0

The only difference that I can see between the US and Sweden is that Sweden has universal coverage and much lower rates of increase in health care costs. As this pattern of much lower rates of health care cost increases repeats for all nations that have universal coverage, the only logical conclusion is universal coverage reduces health care costs without affecting health of the population.

Barkley Rosser:
Blaming
this on our demographics may work for Sweden, but not for some other countries such as France who have a lot of
immigrants,

You can't possibly be that clueless/dishonest, could you. Please tell me you posted in haste without thinking this through. Do you really believe that France is 13% black and 13% Latin American? NO? Perhaps you think it's 26% Islamic? I know France doesn't publish official ethnic breakdowns, but according to the CIA World Factbook, it's 5 - 10% Muslim, which is probably a good approximation.

It's also worth noting that Mexican life expectancy is higher than Mexican-American life expectancy. It's a fair bet that French diet might be better for Third World immigrants than the American diet. But this is all speculation. Still, it's a lot better speculation than your "France has a lot of immigrants" sophistry.

WindyCityEagle,

If we're assuming that Tino is correct, and that nationalized healthcare did not increase the average, or mean, life expectancy,

That's not at all what I read him to be saying. He seems to make no claim whatsoever about the means in Sweden and the US, but rather is interested in the difference between them, regardless of the change in the means themselves.

Put simply, you guys and your medicare effed up things by subsidizing and pushing medicine to expensive end-of-life hail Maries.

Now you want to sell us on the idea that you guys and your medicare are going to get it right this time.

Good luck with that.

@ziel:
You can't possibly be that clueless/dishonest, could you. Please tell me you posted in haste without thinking this through. Do you really believe that France is 13% black and 13% Latin American? NO? Perhaps you think it's 26% Islamic? I know France doesn't publish official ethnic breakdowns, but according to the CIA World Factbook, it's 5 - 10% Muslim, which is probably a good approximation.

You are being dishonest and pretty rude at it. As if all present and past immigrants to France are muslim. IN the first half of the 20th century there were many christian and jewish immigrants to France from eastern Europe. In the 1960s the decolonisation of Algeria*, sub-Saharan Africa and French Indochina all lead non-muslim immigration to France. Today eastern European labor migrants arent adherants of islam either.

*before you start again: the (decendents of) European colonists who went to France after independence (the so-called Pied Noirs) were definately not muslim.

On the cost issue, if Sweden can cheaply transfer medical knowledge and their population has a healthier lifestyle and perhaps better genetics, you would expect their system to be substantially less expensive under almost any delivery system.

Their is zero evidence that the Obama plan will deliver higher quality care at lower prices. It may be more egalitarian in the eyes of some, but at what cost to society to gain some socialist ideal. Especially given that many European countries are reported to be hiding the true costs of their social programs (See WSJ).

To JSK

Many diseases or medical conditions are inherited. i.e based on your genetic inheritance. Diabetes, heart disease, breast cancer, etc all have a genetic component. Not a very radical concept. Or do you deny that height and eye color are inherited too.

General medical knowledge is quickly spread amongst countries. Providers of medical technology, even those under patent, seek to quickly spread that technology around the world. Since they often have monopoly pricing power they may price discriminate in various markets to spread their technology as quickly as possible, as profitably as possible. Refusing to spread the technology only invites copycat devices to be developed in markets you don't enter.

Indeed if Sweden is a low demand country because of their delivery system, they may get a lower price on some technology then the inventing country. But in effect the high demand home country is creating a subsidy for the low demand country. Absent the ability to discriminate in various markets, or larger profits in the home country, the technology may never be created.

Not very radical ideas. Really pretty basic concepts.

For those who care, the Swedish system is under severs strain. Even with taxes over 50% of income and the ability to impose additional taxes on people with unhealthy lifestyles, hey are having a hard time getting the system to work

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1115567/

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