The Tremendous Value of Increases in Life Expectancy

In this post I shall argue two things which together may confuse people. First, that life expectancy is so valuable that the money the US spends on healthcare relative to Europe could be well spent. Second that the extra spending is not in fact due to higher quality and does not explain rising prices over time.

What explains rising prices in some sectors of the economy? A common argument, at least from economists, is that there may be unmeasured improvements in quality. I don’t think that there have been marked improvements in quality in education so that argument doesn’t get off the ground (see my earlier post and the book for evidence). But health care quality has increased. Moreover, the value of life is so high that the improvements in quality could justify the cost increases. Here from Why Are The Prices So D*mn High is a back of the envelope calculation:

The United States spends about 5 percent more of GDP on health-care than do other developed countries. US GDP is almost $20 trillion, so 5 percent is approximately $1 trillion. The US population is 325 million, so the United States spends an extra $3,000 per person each year on healthcare. Is the expense worthwhile?

A value of a statistical life-year of around $200,000 is a mid-range, widely used estimate in the United States. Thus, if the extra US spending generated an extra $3,000 per $200,000 of a life-year, it would pay for itself. In other words, for the extra US spending to be worthwhile it must generate 3,000/200,000 × 365 = 5.45 extra days of statistical life, and, of course, it must do so every year. In recent years, life expectancy in the United States has increased by about 52 days a year. Thus, a little more than 10 percent of the increase in actual life expectancy must be a result of the extra US spending for that spending to be worthwhile. That hardly appears impossible. It’s also not impossible that the increase in life expectancy was not caused by the extra spending.

The bottom line is that the value of life is so high that US levels of spending could be worthwhile, but the high value of life and the difficulty of measuring the effectiveness of healthcare makes the question impossible to answer with certainty.

Nevertheless,I don’t think the increases in quality explain the increases in cost:

…even if the spending on healthcare is well justified by the improvements in life expectancy, it does not follow that the cause of higher spending is the improvement in life expectancy. As with education, many of the increases in life expectancy come from better knowledge, which does not necessarily cost more to use. It does not cost much more to treat an infection with antibiotics than with bloodletting; perhaps it costs less. We do use more technology in healthcare than in previous years—this includes computerized tomography (CT) scanners, magnetic resonance imaging (MRI) systems, and positron emission tomography (PET). Technology, however, is falling in price. At some point one would expect that decreases in the cost of existing technologies would overwhelm increases in costs owing to the introduction of new technologies. As with education, it would be peculiar if the only place in which technology raised costs was in healthcare (but see Joseph P. Newhouse for a strong argument that healthcare costs are driven by technology.)

Let’s put this argument more generally. Most increases in quality *over time* are similar to increases in productivity, i.e. A in A*f(K,L), an unpriced factor. Computers today are much higher quality than in the past. Indeed, so much so that today’s computers couldn’t be bought at any price not that long ago but we don’t pay more because what makes them higher quality is general knowledge.

In my view, most quality increases over time are due to improvements in knowledge. In other words, quality increases over time are much more about better recipes than better cooks. As a result, at a given point in time, higher quality is associated with higher prices but over time higher quality is more often associated with *lower* prices. Thus, in general, higher quality is not a good explanation for higher prices over time.

Tomorrow: The Baumol Effect.

Addendum: Other posts in this series.


" life expectancy is so valuable "

then why are we so fat? most of America's poor health is the result of poor decisions like eating too much of the wrong stuff.

'then why are we so fat?'

A quantity increase is probably not the same as a quality increase, which are apparently due to improvements in knowledge.

Which makes one wonder how many people are actually unaware that the common American diet is less than stellar for a long healthy life.

I am with you. Life expectancy is greatly over rated.

Yeah, I'm also looking for quality rather than quantity improvements.

You have made some decent points there. I checked on the web for
more info about tthe issue and found most people will go
along with your views on this website.

Our diet was not that bad to begin.

Early April, the Warden was confronted with dangerously high BP and overweight, fairly obvious. She was able to get a referral to a nutritionist. Ergo, for the past six or eight weeks, I've been a (not 100% for me) vegetarian. I hate vegetables. Don't much like salmon, either.

Quickly, her BP is way down and she's beginning to drop pounds. I lost (not trying) a few pounds and the two-a-days are easier. However, I'm debating whether living to 100 is worth it. I hate butternut squash.

Not sure how expanding life spans are economical. FDR instituted the social security boondoggle knowing that the average life span was below 65 years. Now, SS is going bankrupt while as people are collecting benefits until age 100.

SS is going bankrupt because of congressional decisions to award SS to people who did not pay into the system. Also it is important to remember that beginning in the 1950's congress began taking money out of the SS trust fund and replacing it with IOU's. The federal government owes the SS trust fund about $4 trillion today and that would keep the SS in the black for many years to come.


No one paid for Social Security and Medicare, people were taxed like they were taxed to pay for defense, TANF and SNAP. Paid for it implies a quid pro quo, but a quid pro quo is not even possible. The current congress has no ability to bind a future congress.

You are taxed to pay for public goods and congress has ostensibly (though some would consider it more a case of vote buying) considers taking care of those over 62 a public good. (BTW Medicare is funded primarily from general revenues (41 percent), payroll taxes (37 percent), and beneficiary premiums (14 percent) (Figure 7))

Look up contract law. As written SS was indeed paid for and the future retiree had a contract. What you are spouting is the modern belief since congress began calling it a tax and rolled it into the general fund. But they cannot "alone" rewrite the contract. Don't get me wrong, I assume if this were to go to court that the court would simply fall in line and take the government's side. BUT, as written the SS law was a contract with the future retiree.

You got it wrong on Medicare too. Funded from general revenues? Yes but that is where the monthly payment is sent, to general revenue. Every future retiree will pay into the medicare system for 47 years, considering the value of that investment it is a considerable amount of money when they reach age 65. Additionally the retiree will pay a substantial percentage of their retirement (SS) to Medicare every month. Additionally the retiree will pay at least 20% of the medical costs out of pocket. So your data is inaccurate. Having said that I would agree that Medicare is supplemented by taxes. But Medicare too is abused by congress and many people will become eligible for Medicare without having to pay into it for 47 years. This is congresses fault and not Medicare's fault.

SS 'bankruptcy' is not about completely running out of money. It's about having to lower payments to 70-75% of current levels. You would still get payments, just not 100% of the current level.

However, Medicare will have to drop to 50% of current levels. That's liable to have a bigger impact.


That is 70-75% of the benefits projected to be being received then, not now. As of now, that is more than what people get now. You are making a very common error. If you want to see more on this, google "Rosser's equation," really.

I appreciate the work you did in putting together an actual equation, but I don't believe that SS recipients after the benefits drop to 75% will be receiving more than the "real" benefits that someone with a similar contribution is receiving today.

But please feel free to show me the math. (please set if for someone receiving the max contribution in both periods to remove income variance).

There is a Wikipedia entry on this. Read it, Rat. The numbers are there, although a bit out of date.

It is not what you eat but how much you eat. Very few USAers are deficient in vitamins (although some very dark skinned USAers might need more vitamin D) or essential amino acids, the problem is we eat too many calories.

Truth. And, too many carbs, fats, salt.

Less than 10% of the population fasts more than 12 hours each day. If you want to be healthy, you should fast for 16 hours each day and make sure that the food you eat is nutritious.

And take 300 mg of NR each morning! No breakfast is complete without it.
(140 person study will be out soon.)

Because we're talking about average life expectancy. Prolonging the life of a great surgeon or business manager more than compensates for however much time John H. Barbecuebeerwingsandwich wastes licking his empty chip bowl during the commercial breaks of Sports Center.

Well, if we are going to talk about a single average life span for an entire nation, with the sub-demographics dumped together in one bucket, and ignore every other nations in the process as well, I see no reason to get all granular about incomes.

You sound like an elitist bigot.

good point!

Correction: I sound like a long-lived elitist bigot.

Long live the bigot! I guess ...

It doesn't matter how logical you are if you base your calculations on so absurd a proposition as "A value of a statistical life-year of around $200,000 ..."

Different point: should it matter that life expectancy in the US is somewhat less than in some other developed nations?

I've seen attempts to explain away this fact that have succeeded in the view of their authors. But I've never seen an attempt to explain it that seemed satisfactory to me.

Mind you, I accept that essentially all attempts to effect valid international comparisons of darn near anything are very hard to carry off. On the other hand, age at death might be one of the easier ones.

'But I've never seen an attempt to explain it that seemed satisfactory to me. '

Or basically to anyone who isn't an American. Americans are firmly convinced, regardless of whatever data is presented, that their health care is exceptional in a certain way that is unshakable. It is just that the American definition of exceptional lacks any awareness of how the rest of the industrial world defines 'exceptional' when looking at the American health care system.

America is exceptional!! But needs some helping being made great again apparently.

Don't bother me with facts or details, especially about socialist countries or sh*tholes with brown people in them.

We won WWII you know.

&after amerika won ww2
amerika also figured out how to almost routinely
cure early cancers of the lymph system,
prostate, thyroid, juevos, breast & skin

And the commies cured poor eyesight. Your point?

By the way, radiation treatment was not invented in the US, and chemo originated from WWII use of mustard gas.

well 2 points actually
- spraying people with mustard gas is not actually
cancer chemotherapy
-inventing radiation treatment is not the same as
refining& utilizing radiation treatment therapeutically

America = exceptional.

if you hold the camera just so.

amerika = exceptional
if you hold the camera like this

I would certainly trade the last five years of my life to give my children $1M nest egg. Does seem pretty dumb.

Healthcare (as reported in budget line items around the world), is about making sick people healthier.

The US does a better job of this than anywhere else in the world.

Unfortunately prior determinants of health in the US are so relatively bad that the US only closes a sizeable fraction of the expected gap.

I can reach higher than Yao Ming if I start two steps higher than him on the stairs too. This is why you want to measure your health outcomes based on your change from health inputs.

As I always offer. Name for me a single disease where matched patient populations (same disease staging and general comorbidities) where another country has lower mortality. There are a few, often tied to genetics (e.g. Japan is an outlier), but for all the biggies: stroke, CVD, most cancers, etc. You want to be in the US.

Nor is this really that hard. How often has a new drug or a new practice habit migrated from Europe to the US? It happens. How often have US innovations gone the other direction? Well there were all the TPA protocols, CABG, curing Hep C, HAART, HPV vaccines, and MRI. More important than merely discovering these things, American health care has turned them into products that scale and can be used in general healthcare practice (much how Pfizer stole CT scanning from the British and made it massively more cost effective).

The day Europe stops adopting our technology and best practices ... a decade or so after we hone it. I will consider the US system possibly inferior.

May have something to do with race? The life expectancy of white american men is still comparable to the norodic countries. Both are around 80 years for white men but african americans are mid to low 70s.

The top two reasons for the lower American life expectancy are lot more driving and a higher murder rate.

That did not take long, though the higher murder rate is a bit of a red herring - U.S. murder rates are much lower today than a generation ago. A simple citation (with reasonable caveats in the link concerning fluctuation at the margins) - 'From 1991 to 2016, the murder rate fell by roughly half, from 9.8 killings per 100,000 to 5.3.'

The U.S. does have a more violent society, but basically, violent crime has been decreasing, and while still a valid point, using violence as an explanation in this fashion has to show how a declining murder rate actually leads to the desired result, which is likely to be finding a satisfactory explanation without actually considering what is evidently flawed when comparing various health care systems.

But yes, Americans are demonstrably more violent - and have the industrial world's easiest access to firearms.

You dont think the fact that 1/3 of americans are obese has nothing to do with our lower levels of life expectacny?

The data is here.

'You dont think the fact that 1/3 of americans are obese has nothing to do with our lower levels of life expectacny? '

You do know that American obesity rates are not that exceptional, right? This is a bit older, but the UK is comparable to the U.S., though the UK is lower across the board. You are welcome to look through the table - you will discover that European levels of obesity are close enough to American ones, though again, a bit lower across the board. In other words, while the U.S. truly stands out when comparing violence, for obesity it is merely at the head of a fairly large group that is similar.

Like smoking, drug consumption, high American levels of obesity, diabetes, etc. all happened earlier, so have deeper effects across the age distribution. Using present day levels as a fixed estimate is not good enough.

Once you account for ethnic effects and lifestyle differences (consumption and risky preferences), adjust for improvements in health over time, the US probably does have some bit of preventable early death limiting mortality from different allocation of resources (proportionately more money going to old, hard to treat persons). But not really very much.

As prior states above: Americans are firmly convinced, regardless of whatever data is presented, that their health care is exceptional in a certain way that is unshakable. which is correct if you take it to mean a certain class of "Americans are firmly convinced, regardless of whatever data is presented, their health care is exceptional in poor quality that is unshakable".

Nope - the major problem in the U.S. is pretty well illustrated by the luxury car quip, where Americans feel that the absolute best health care is just as accessible for a middle class worker as it is for Steve Jobs (of liver transplant line jumping fame, not that it helped him that much).

That the peak of American health care is very good is beyond question. Much like its high cost is beyond question. The problem rests in the fact that the sort of health care that is taken for granted in Germany - feel sick? go to any doctor, and if actually sick, get as much paid time off from work as the doctor feels appropriate - does not seem to exist for most Americans.

The amusing thing is how a British woman pointed out some of the flaws in the German health care system following an accident. After she sliced her finger open at work, she had to wait 10 minutes and answer questions about her health insurance and how and where the accident occurred (due to it being work related, basically). She said that in the UK, no one would have asked her those questions, she just would have seen a doctor immediately to have her bloody sliced finger dealt with.

If you are not familiar with what 'out of network' means in terms of American health care, you may want to explore a bit more - it is hard enough to explain to Germans.

The American system is a mess in so many ways. Obvious ones to even a 22 year old German who lived in South Carolina for 6 months last year, who could not imagine how Americans were of even the most basic aspects of taking care of their health. Admittedly, she didn't know that if you have a fever on a Sunday evening, you should go to the urgent care clinic - which costs around $400 apparently, compared to the $1600 she (well, her insurance company) was charged to be told she had a fever, and given a prescription for some antibiotics.

Sadly, I can no longer find the article from an American amazed at how well he was handled by NHS for a minor eye infection - without basically any waiting time, in a facility very similar to anything found in the U.S. A significant part of his story is how frantic he remained worrying about the bill, and whether Kaiser would pay any of it. As it turned out, the British doctor did not care about charging to look at a traveller's minor infection and giving him some antibiotic eye drops, and otherwise treating him the way that would be equally considered normal in Germany (or France or Italy, from my personal travel experiences).

But hey, maybe you could enjoy the benefits of the American health care system, and tell us about it. Just like that unknowing German, who just assumed that the process in the U.S. would be like that she was familiar with - especially after Obamacare made things better in the U.S., finally making the U.S. comparable to Europe in this area (another virtually unshakeable belief among Germans).

"If you are not familiar with what 'out of network' means in terms of American health care, you may want to explore a bit more - it is hard enough to explain to Germans."

German's can't understand that Out of Network means you pay more? IE 80/20 coverage in network (patient pays 20%) versus 60/40 Out of Network. (patient pays 40%).

I think the German's I've met are smart enough to grasp that.

I think it's fair to say that Western European health care systems are generally better at dealing with routine, low-cost illnesses and the American system is better at dealing with the serious, high-cost ones. (Sir Mick Jagger is in the United States recovering from open-heart surgery which he had done here.) Yes, if you have a toothache or a fever you are better off in England, France, Ireland, or Germany.

By the way, you can get treated in an urgent care clinic in a drugstore in the US for $75, not $400.

Much like its high cost is beyond question.

High cost for the same procedures is in fact in question. Read -

The US has some very high consumption which is probably not too effective at life expectancy increases. Its not clear there is much higher cost other than some Baumol effect, which may be virtually unavoidable, regardless of system (and suppressing medical wages may not help you very much).

Very long anecdotes!

Per the who current rates of obesity in the US is 38.2%. Using the same methodology the UK is 26.9%.

Best data suggests that being obese throughout your lifetime is ~10 years of lowered life expectancy.

Life expectancy in the UK should be about 13.5 months longer than the US to a first order approximation, other things being equal. This is just barely shy (2 months) of the observed difference between the two for women. Men is larger, but then there is much larger delta between men when it comes to violence, cigarette history, and driving.

Long before we get to the effects of the healthcare system, we should expect the US to lie several years behind the UK.

"Best data suggests that being obese throughout your lifetime is ~10 years of lowered life expectancy."

Where does this come from?

If morbidly obese, then a loss of 6.5 years for those with a BMI (when they were 20 to 39) from 40 to 45. It goes up to 13.5 years for those with a BMI of 55 to 60. That is, a 5 foot 10 man who weighs between 350 and 420.

I realize that the American murder rate has fallen a lot since 1995 but that doesn't make it a red herring. Here are a few murder rates:

(per 100,000)
U.S. 5.4
Canada 1.7
U.K. 1.2
Japan 0.3

The U.S. murder rate is 15 times higher than Japan's and that definitely affects the difference in life expectancy,

Only a bit of a red herring - because a generation ago, the murder rate was 30 times higher than Japan's, basically.

In other words, America's murder rate contributes 50% less than it used to in terms of reduced life expectancy. It is a real factor, no question - but one that has been shrinking for several decades at this point.

rising suicide rates are affecting life expectancy
particularly in adolescent girls
we blame sociologists

If I am not mistaken, a back to the enveloppe calculation shows that a 5.3
per 100,000 murder rate is responsible for about a loss of 0.25 year (or three months) in life expectancy (I had to make some assumptions to make the calculation. I assumed that people normally live 80 years and that they have the same chance to be killed by a firearm each year of their life until 50 and then they have no chance to be killed after 50 -- this is to account for the fact that most people killed by firearm are gang members who are relatively young.)

As for car accidents, the 37,000 deaths per year (that is a rate of about 11 deaths per 100,000 persons end per year) on the road are responsible for the loss half a year of life expectancy.

Obesity is an even more important factor. To make the computation, it is important to distinguish between light obesity also called class I obesity (30 < BMI = 35, class II and class III obesity). According to statistics I got by googling "obesity Class I, II, III in US", about 18% of the US population is "lightly obese" and 16% is "extremely obese". According to several medical sites, light obesity cause on average a three year loss in life expectancy, and extreme obesity 10 years. It is then easy to do the computation : obesity costs about three years of average life expectancy to the US. That's huge.

Other countries also have murders, car crashes, and obesity. Let's make a comparison with France. Its murder rate is negligible. Its car crash death rate is about half that of the US, so that causes a loss of 3 months in life expectancy. As for obesity, the rate for light and extreme obesity are (according to wikipedia "obésité en France" are respectively 11.4% and 4.4%, thus causing a loss of about 9 month of life expectancy.

Bottom line:

Obesity (first), car deaths, and firearm deaths together cause a loss of about 3 years and 9 months in the US, as compared to an ideal US without car crash, firearm death and obesity).

In France, those 3 factors cause a loss of one year as compared to an ideal France.

Thus, those three factors explains out 2 years and 9 months of lower life expectancy in the US. In fact, the life expectancy is about 3 years and 9 month lower in the US than in France. Thus beyond obesity, ,firearm murders, and car crashes, it remains to explain one year of difference in life expectancy. Other factors must come to play (Healthcare, maybe).

+1, awesome post!

One correction to this post:

" it remains to explain one year of difference in life expectancy. "

Clearly the US will be better on some metrics than France (smoking, etc) so there will be more than 1 year of negatives and some amount of positives to be factored in.

I don't know about your back of the envelope numbers but two economists concluded a few years ago that if Japan had the same rate of fatal accidents and murders, their life expectancy would be a year lower than the U.S. life expectancy.

Tyler wrote about it in 2013:

And here is the Forbes article that he linked to:

I have inadvertently erased a part of my sentence about light and extreme obesity. To make it clear:
light obesity = class I obesity = 30<= BMI = 35.

The WHO claims that in 2017, France's obesity was 24%.

Wikipedia says 15.1% for 2016, citing a source that I don't know. I can't explain the difference.

But I have made a more serious mistake -- in my mental calculation of the
loss of LE due to obesity in the US. The computation is very simple : 16% of 3 years + 14% of 10 years = 0.48 +1.4=1.88 years of loss, so about one year and 10 or 11 months,nstead of three years as I wrote -- I don't know how I made this mistake. So let me rewrite the bottom line with those corrector figures.

Obesity (first), car deaths, and firearm deaths together cause a loss of about 2 years and 8 months in the US, as compared to an ideal US without car crash, firearm death and obesity).

In France, those 3 factors cause a loss of one year as compared to an ideal France.

Thus, those three factors explains out 1 years and 8 months of lower life expectancy in the US. In fact, the life expectancy is about 3 years and 9 month lower in the US than in France. Thus beyond obesity, ,firearm murders, and car crashes, it remains to explain about two years of difference in life expectancy. Other factors must come to play, positive or negative as RatInPutinsMaze said: tobacco use, drug-related deaths, genetics, the health-care systems, etc.

A potentially huge and under-appreciated difference in the statistical calculations for life expectancies across countries is how "live births" are reported--or not. Ironically, the more resources that are put into trying to save an at-risk fetus/child, the lower the reported overall life expectancy might be. The effects of reporting a case "still born" and a case as an infant mortality of one week are very significant. For an example, see here:

For example, this site reports an infant mortality rate for the US at 6.2 per thousand compared with 3.3 in France. I suspect that large difference is not due to the difference in the quality of healthcare in those two countries.

Unfortunately for that argument, life expectancy in the US is also lower than other major countries at 1 year old.

And it's always so satisfying to be reminded how long the French live even though they consume vast amounts of animal fats. Why, it's almost as if the government propaganda ( the US and UK) about the 'orrible consequences of eating animal fats is false. And has been false for many decades past. And since the evidence against it has always been good, it's not merely false but actually lies.

you left drug overdoses and sequalae of etoh abuse

'May have something to do with race?'

At least 2 more common excuses to go. Oddly, the idea that America actually is simply not that great by a variety of health csre measures is seemingly consistently avoided by many. Which at least makes not even thinking about any concrete ideas of how to improve American health care much easier.

Here is some less than the current data, to give you a view of how things look when compared to Europe - 'Among men, total mortality among U.S. black men was similar to that in Eastern European countries, which had the highest mortality rates in Europe (see Table 11-2). U.S. white men had lower rates than Eastern European countries and rates comparable to Belgium, Denmark, and Finland, which had the highest rates in Western Europe. Mortality was higher for U.S. black women than for women in any European country. U.S. white women had higher mortality rates than women in all Western European countries but Denmark, while their mortality rate was comparable to that in Eastern European countries, which had the highest rates in Europe (see Table 11-3).'

Essentially, using that race filter puts white American men and women in the lowest rankings of the various European comparisons. But don't worry, you still have at least two more excuses to use instead of actually exploring how the U.S. could improve itself in this area, even after looking at only one sub-group in particular.

The article concludes that white American man have comparable mortality rates to Belgium, Denmark, and Finland. It was lower than Eastern Europe.

You do know the difference between mortality rates and life expectancy, correct?

'have comparable mortality rates to Belgium, Denmark, and Finland'

The three worst nationalities in mortality rates in Western Europe, one should note.

'You do know the difference between mortality rates and life expectancy, correct?'

Merely trying to show how using race as a filter does not actually help in comparisons trying to show the U.S. actually near the top of any list.

Here are the wikipedia links -'Mortality rate, or death rate, is a measure of the number of deaths (in general, or due to a specific cause) in a particular population, scaled to the size of that population, per unit of time.'

'Life expectancy is a statistical measure of the average time an organism is expected to live, based on the year of its birth, its current age and other demographic factors including gender.'

Clearly, they are as different as chalk and cheese, to use a British expression. Or not, depending on your perspective concerning death as a characteristic of a population.

We should try to model Italy in LE, they do great. Scotland part of the UK does bad. How different are the medical systems in the rest of the UK and Scotland.
(BTW Greenland part of Denmark also does very poorly in LE.)
If I was given power and tasked with raising LE, I'd look at making roads safer and reducing OD deaths and murder by legalizing all drugs without prescription. I would not try to improve healthcare delivery although you might want to send social workers around to new mothers to try and reduce SID.

It is nice more fitting for a government to monitor and manage life expectancy than to monitor and manage the time it takes the average person to solve a Rubiks Cube. This is true least of all for the United States where government's duties and powers are explicitly listed and expressly limited.

Social welfare states, beginning in the early 20th century, promised free health care as a perquisite of citizenship. This was never a facet of governance anywhere, anytime before. It was part of the socialist movement to control the economy and appease the populace with goodies.

In other words, debates such as this are FRAMED through a socialist lens. The criticism is not that we live shorter lives, but that we are less socialist. If you look at various indices of health care quality by country, the main driver is "access," a variable that directly measures cost to the end-user. The rankings are rigged to reward socialist systems for being socialist.

We all eventually die. Health care does not prevent death. It merely prolongs life in a minority of cases where it is able to do so. If a gunshot victim survives, that may be a testament to a good healthcare system or just merely good luck. He might die despite the best health care in the entire history of the world.

Life expectancy does not measure the quality of a health care system. And it also doesn't measure the quality of a government.

"It is no more fitting..."

'Social welfare states, beginning in the early 20th century, promised free health care as a perquisite of citizenship.'

This does not describe Germany, even today. But then, since Germany was the first country with broad health insurance programs (back in the 1880s), maybe the Germans simply have yet to catch up to other social welfare states?

'It was part of the socialist movement to control the economy and appease the populace with goodies'

Well, it is true that Bismarck was not around in the early 20th century. However, it is also true he was never part of the socialist movement.

'Life expectancy does not measure the quality of a health care system.'

Nope - it just measure how long people are statistically anticipated to live. And the U.S., even when controlling for various factors, does not do particularly well compared to many other industrial societies.

Governments, including official religious bodies that were quasi governmental bodies, have been involved with the provision of healthcare since very ancient times. "Socialized medicine" has a very long pedigree.

Primitive and rudimentary "health care." Probably amounted to mere palliative care and voodoo.

Pre modern healthcare certainly wasn't up to modern standard but premodern anything wasn't. I'd suggest studying what the past could and could not do. It wasn't all voodoo and it also didn't come cheap . Complaints about profiteering doctors are also ancient.

"should it matter that life expectancy in the US is somewhat less than in some other developed nations? "

Blame our diversity. Thanks to a decent diet and good health care Americans of European descent live longer than the European countries and longer than Canadians. Some ethnicities have genetic differences that tend to lead to shorter lifespans and when they are factored into the statistical average it lowers the average lifespan.

The bigger challenge is that the data underpinning Alex's assessment is not comparable across countries. For example, different countries use different methods to describe a live birth, which has a significant impact on infant mortality rates. Different countries also have different patterns of care and definitions of health care. When "Social Care" is added in to the national spending for health, America falls squarely in the middle of the pack. Lastly, the best analyses I've seen (U Wisconsin School of Public Health) estimate that only 20% of life expectancy is driven by medical care--the remainder driven equally by genetics and by social determinants of health (which include lifestyle factors such as smoking, diet / access to healthy food, drug / alcohol consumption).

If a different definition of life birth leading to counting non viable infants as live birth rather than stillbirth were they reason then you would see a higher mortality rate in neonates and then a developed world average. This is not what we see. The pattern is neonate mortality is pretty much they same. It's between six months and two years that there is substantial excess mortality in US figures. It looks like a serious failing in the benefits system for very young children rather than something medical.

'It looks like a serious failing in the benefits system for very young children'

The phrasing of that remark suggests you are not American.

Broadly speaking, the U.S. does not have a benefits system for very young children, as found in most other industrial countries. And many Americans seem to feel that avoiding such 'socialist' ideas is one of America's greatest strengths.

Yeah, we do, and they spend millions advertising the crap out of them to get people to use these programs.

@Brett Dunbar
I've looked at it and it seems to correlate rates of alcohol & drug abuse.
That is it is higher in Denmark and Germany that in Italy. It is higher among USA whites and blacks than USA Hispanics. The correlation could be nothing but it is interesting.

Here is a link:

It is bizarre to say something so obviously false with such confidence.

The neonatal mortality rate (first 28 days) in the US is 83% higher than the comparable country average and there have been multiple studies illustrating the impact of reporting differences driving that discrepancy.

It is worse than that.

Western European early neonatal death rate (0 - 6 days): 8221/100K (2017 data, The Institute for Health Metrics and Evaluation)

US early neonatal death rate (0-6 days): 15,958/100 K (2017 data, The Institute for Health Metrics and Evaluation).

Western Europe late neonatal death rate (7-28 days): 980/100K
US late neonatal death rate: 1,311/100K

Not only do we see a spike in neonatal death rate in the very earliest ages, but differential magically shrinks after day 7 of life. Worse, the US is universally acknowledged to have the best neonatal care in the world.

In any event for the time period you claim there is a huge spike, the US death rate is 25/100K while Western Europe is 15/100K.

I will not pretend that there is no US death discrepancy after the neonatal period, but the neonatal period is the single largest driver of excess mortality in the US. It is almost like a sizeable percentage of the US population will carry children to term that are simply terminated as nonviable during pregnancy elsewhere.

'that life expectancy is so valuable that the money the US spends on healthcare relative to Europe could be well spent'

Well, first the U.S. needs to achieve European level lifespans as found in countries like France or the UK.

Or having Canadian roots, perhaps Prof. Tabarrok would be more open to information from the Globe and Mail - 'Here's a fact most Canadians probably don't know: Canadians live longer than people in the United States. Specifically, women in Canada live an average of 83 years, compared to 80 in the U.S.; men live more than 78 years on average compared to 75 in the United States. Why is this the case? There are clear links between mortality rates and the way countries invest in health care and improving social conditions.'

'Moreover, the value of life is so high that the improvements in quality could justify the cost increases.'

Well, in isolation maybe. Compared to other countries spending less with higher life expectancies, clearly the U.S. is wasting money in comparison. Might want to keep looking for an explanation that is actually not contradicted by readily available data.

No, the US does NOT need to achieve lifespans equal to any other nation. This is not a race. Our government has no duty or power to monitor and control life expectancy. None. Zero.

Shorter lifespans are strongly explained by lifestyle choices. People consciously and freely make tradeoffs. It is not the role of government in a free society to alter people's free choices. We do not have nor need a "nanny state."

'No, the US does NOT need to achieve lifespans equal to any other nation.'

Of course not - but maybe the U.S. could stop spending a third more on health care compared to the next most expensive systems, with worse results as measured by life expectancy?

'Our government has no duty or power to monitor and control life expectancy.'

Why would it need to be the government? Basically, the entire German health care system is in private hands after all. And it is pretty much everyone's interest to pay less for health care, while still living a long life. Why would government be the only way to imagine this happening?

Okay, prior, I'm with you here. What are a couple of suggestions you'd make, that you think might help?

1 - Embargo Red China.
2 - Make clear for all contries that "either you are with us, or you are with Red China".
3 - Impose price controls on essential goods and services.
4 - Slash taxes on the Middle Class.
5 - Invest heavily in infrastructure, research and the real economy.

Well, Dean Baker would suggest - and I am agreeing with his suggestions - that allowing free trade in medical personnel would certainly reduce American health care costs. European doctors make about half of what American doctors do, for example.

Another change would involve allowing Medicare to use its market power to negotiate for lower pharma prices, as happens with major European purchasers.

Another suggestion, though one that strays from the pure market perspective of the first two suggestions , is to reduce the unbelievable administrative overhead that arises in the U.S. This has nothing to do with single payer as apparently defined in the U.S., but simply recognizing that the entire billing structure of the American health care system is exceptional, and need to be changed to something that costs considerably less. In other words, why does any doctor need two or three employees just to handle paperwork? No doctor in Germans does - and the German health care system is basically private.

But the most fundamental suggestion is simple - look around at all of the other health care system models and implementation, and learn from them. Obviously, there are going to people who currently profit from the American system that will spend the same amount of time and energy as they have for decades to prevent such a comparison, but maybe it is time to recognize that they are driven by self-interest, not some dedication to greater ideals.

Great. I think I am agreed on all four points, but for me it might depend on how the last two are implemented. I think there are better and worse ways to implement #2, also, but for the most part we agree.

Bravo to Dean Baker, those are good suggestions

How has Medicare/Medicaid negotiating non-pharmacy related services resulted in lower prices for people not in those programs? Why are drugs different that Medicare negotiations would result in lower drug prices for people not in Medicare?

Secondly, if having three admin per physician for claims processing is unnecessary bloat, why haven’t physicians pushed each other to streamline their billing? Why do so many physicians make their pricing/billing so opaque that they require 3X the staff just to bill someone?

'Why are drugs different that Medicare negotiations would result in lower drug prices for people not in Medicare?'

Um, you do know that basically every single American over 65 uses Medicare, right? Or something like 20% of the American population. The prices would be reduced for them - the effect on the other 80% is non-existent. Nonetheless, the effect for that 20% would not be minor by any normal measure.

'Why do so many physicians make their pricing/billing so opaque that they require 3X the staff just to bill someone?'

It isn't because of the doctors - it is because of the insurance companies. Which just might mean you are not American, as this is pretty much common knowledge among most Americans, who are all too familiar with the whole mess.

Umm you do know that the 20% of the population on Medicare doesn’t actually drive down prices for non-pharmacy related medical services. Umm and you do know it would be extremely silly to think that any negotiation by Medicare for prescriptions drugs would magically result in lower drug prices for anyone outside of Medicare. Next I suppose that drug negotiations in Canada and Europe result in lower prices in the US. Of course then you would have to argue that the VA negotiating a price of $0.00 for the drugs they don’t cover results in lower prices.

Oh so it’s the insurance companies that make physicians hire additional staff. And just what benefit do insurance companies gain from the increased bloat of physician administration. I honestly want to know because after 20 years on both sides of the industry it would be fascinating to learn.


The other big item Dean pushes besides opening up the US for foreign medical personnel to more easily move here and practice (something unsupported by either political party) is to reduce the strength of drug and other medical patents, which also contribute substantially to the ridiculously high US health care costs.

And I'll voice my agreement with that one, too.

Care at the end of life is free (medicare), and, the "beneficiary" of the good (patient) is not the purchaser or decider (children of the patient are); hence, more of the good is purchased than the patient desires.

So, for example, my daughter, the pathologist, tells me that a brain dead/comatose patient is on life support at the hospital. No chance of recovery. Tubes should be pulled, but, the kids say no. Until. The hospital has to move the patient to a nursing home and the kids will have to pay for part of the ambulance. They agree to pull the plug.

My solution is simple: Medicare covers all but the last six months of medical care at the end of your life. The rest comes out of the estate as estate tax (if there is a surviving spouse, there is a deferral until that spouse dies). Kids will make better decisions. And, if they want to cover the last six months, they can buy insurance for that to preserve their share of the estate.

Fill out your power of attorney now.

Clear example:

I don't know a lot about this, but I do believe Medicaid has clawback provisions of a sort. At least in terms of my understanding is that the care system is oriented to get all your money, then push you into medicaid for the remainder of time.

Medicare remains of course despite right wing whining and hamstringing, because a powerful voting block along with their children are benefiting from it.

Medicaid does have clawback but not Medicare. Tells you that the sons and daughters of the middle class will have their inheritance preserved and passed on while everyone without an estate pays for this pleasure.

It's an easy fix to Medicare. It raises money; Medicare expenditures are weighted toward end of life, which would make the estate tax option proportional to medical expenditures. It would also make children and parents more responsible and cognizant of cost/benefits for end of life care.

Hospice anyone?

+1 this is a big part of the problem.

+2, this idea plus Dean Bakers' paraphrased by prior would go a long way towards reigning in costs.

No, Bill, Medicare is not free. Actually, to be more precise, it does not cover a lot of things, so old people on Medicare need to get supplemental insurance. You are not well informed.

Barkley, my argument does not depend on supplemental insurance. You know that. You are the one who is trying to obfuscate by confusing the issue and not addressing the proposal. Usually you are a better commenter, but this time you know and I know that Supplemental insurance is irrelevant to the issue: What the GOVERNMENT pays, which is the topic and not what Supplemental pays, which is not.

By the way, you forgot to mention the donut whole and Part D.

Another irrelevant point.

They did a retrospective study, the majority of healthcare at end-of-life is consumed when the experts believe the patient has >6 months left to leave. This should not surprise us. If you want to accurately predict when the average person has a 50/50 chance of dying next year, you need to go out to something like 103.

In any event, by the time you are on tubes and brain dead, you have sadly long ago racked up your major bills. Yeah ICU is a few thousand a day ... but your last surgery is typically 5 or 6 figures (e.g. we try to resect your colon cancer and it mets to the brain). Your chemo costs, on average, around $12,000 a month (and most people stop chemo for medical futility with less than 2 months to live). ESRD patients costs about $6,000 per month and die about 14 days after stopping dialysis (and typically spend years on dialysis).

All the stats about end-of-life costs are silly and worthless. They calculate retrospectively when our choices are actually made prospectively. Often times the way we know the end is nigh is because some very costly treatment just failed. Heck, there are many treatments that actively hasten patient death when the fail. If you can accurately predict which patients that come through the ED doors have 6 months or less, let me know. We can get the Nobel.

There is this fantasy that it is nothing but a bunch of brain-dead patients racking up bills. The truth is, most of the final spend comes before we know that you are the unlucky one who falls below the expectation value.

As far as taxing this, please. You basically just turn inheritance into a lottery with a high incentive for murder (particularly for things like dementia).

You believe that the children would deny their parents care based on their own selfish interests? So, Medicare is there to help our better angels?

What happened before Medicare? Did the kids kill the parents?

I bet there was less futile care.

How common is it for people's families to keep them alive past the point of viability? I'm sure it happens, but I think it's uncommon. I've never known a single instance of it among friends or family. In all cases where someone was gone past the point of recovery and was unconscious, resuscitation was not allowed and plugs were pulled as necessary. I have no reason to believe that my family and friend circle is unusually callous.

Come on, say it with me:

"Life expectancy does not measure the quality of a health care system."

Life expectancy is based on genetics, diet, exercise, body fat, smoking, alcohol, demographics, violent crime, automobile accidents, etc. ad infinitum.

The contribution of health care to life expectancy is minimal. Even when health care does contribute, its effects are marginal. For example, if someone is shot in the head during a robbery, first responders and doctors MIGHT keep that person alive to live another 30 years. But if he dies, that doesn't imply the health care quality was low. If a country has excellent prostate cancer survival rates, but insured people REFUSE to get physical exams, those deaths have nothing to do with the quality of health care.

Treatment survival rates, albeit flawed for reasons I state above, are a better measure of quality.

Life expectancy and infant mortality are canards that leftists roll out to support socialized medicine. Looking through my copy of the Constitution, I can't seem to find anything delegating power to Congress to prolong individual lives.

Hahaha. Yeah, we should judge a system for how many limousines rich people have, not for how well common people fare under it. Not surprising, back in the time, conservatives couldn't find in the Constitution anything delegating power to Congress to end slavery.

Actually if you are judging the healthcare system you should look at how you do after you get sick- in most of those studies the US does quite well ( ie survival after diagnosed with cancer etc).

The goal of healthcare is keeping people alive as healthier as possible.

Finally someone mentioned slavery.

Let's not forget racism.

"Life expectancy does not measure the quality of a health care system."

That's my suspicion too. Any country, to invent an example, where people were truly Christian and therefore not afraid to meet their maker, might have lots of frail old people committing suicide to avoid the degradation of dying with dementia.

Clearly then there would no reason to link life expectancy to quality.

If one is truly Christian, it is a mortal sin to commit suicide.

Thanks, Willitts. I was hoping someone would say this.

There's lots of words that don't appear in the Constitution.

Yet in a democracy, the People (as in the We the People people), consistently in fact prioritize prolonging individual lives at the top of the list.

We are are a republic, if we can keep it.

California is a democracy.

Whenever I hear the word Republic, if is usually appended with a call to restrict democracy.

You seem to be saying that the "Pledge of Allegiance" is a call to restrict democracy.

Well, now that you mention it, around the time that they added the word "God"...

Is that why it has all the billionaires and smart people and growth?

Or the highest poverty rate in the nation?

So you have a problem with excessive inequality? You must prefer socialism to democracy.

"So you have a problem with excessive inequality?"

No, just with poverty. If Bill Gates wants to move his wealth to my city and thus cause a sky rocketing of our local Gini Coefficient, I'll gladly help him move. But I'd like to avoid California's high poverty rate.

California has 57 million people in it. It's basically a country. A country with a pretty high Gini, which is typical of successful capitalist democracies like the US

40 million. Argument stands.

Well ok, but I still don't want the poverty. Furthermore, California didn't have a higher poverty rate than Mississippi 20 years ago, but still had plenty of high income people.

The state policies over the last 20 years appear to made the state worse.

No one wants the poverty, but that's capitalism, winners and losers. The hope is for the impoverished to have a little help from the wealthy, and to find ways to rise from poverty.

Countries with smaller Gini coefficients tend to be more socialist or poorer in general.

mississippy& neuvo mexico have much higher poverty
rates than california

California is a good place to be rich or poor. It's also hilariously, bizarrely under-developed. Marin County is basically a white hippie playground--those have got to be the most politically powerful hippies on earth.

Y'all can talk about democracy when you let people vote with their feet and their dollars for more housing outside the major cities.

Take it up with EdR, he's the one who claimed "California is a democracy"

Apologies. Lost track of the threaded replies.

In many cases because of the advent of new and expensive medical/surgical technologies, patients can be saved today. Whereas not too long ago they would have been a lost cause. My wife was so saved with new surgical technologies in 2017, and again in 2018 with new medical technologies. She would have been dead day #1 the first time, and dead already from the 2nd. Many people can now be saved after a formally lethal car accident. And many people can now be saved from formally lethal cancers. Both at great expense. My wife has $4-5M in medical billings since 1/1/17.

When you get down to it, there's a handful of trauma and infection protocols, along with some disease treatments that are truly remarkable and unambiguous improvements.

But there's a lot that's unnecessary, counterproductive, treats symptoms rather than causes, or really deserves some cost-benefit scrutiny.

Lumping that all together into "health care" is as misleading as measuring by life average expectancy.

Nonsense. If it were simple to fix Amazon (or Ford or IBM or Vermont or Exxon) would just self-insure and cut the fat.

Heck right now you have plenty of monopsony-monopoly pairs for Obamacare. If it was easy the insurer and the provider network would just do it and split the windfall.

Because frankly, I expect that over 3/4ths of medical care does nothing. After all, virtually no treatments have a NNT under 3. Most of the time, humans get better. The average person encounters over a dozen potentially lethal conditions in their lifetime (child birth, MVC, serious infectious disease, cancer, lung disease, AKI, etc.) On average most people will survive any of these without treatment. If we are lucky, for any one of your dozen, medicine will actually covert 2 of your 3 failures into successes. The other 9 times you get treated we, at best, reduce morbidity.

Sure you can hope to ferret out which ones you really need; and we have been doing that for literally decades. It just is impossible. The ground shifts to quickly. Things like laproscopic surgery or endovascular intervention go rapidly from being massively inferior to being superior. Populations change so all the old literature about the effects of recreational drugs has to change every decade or so as something new enthralls the junkies.

Finding "unnecessary, counterproductive" care is like separating the wheat from the tares - easy to do once the results are in, but hard and frankly damaging before.

Let's just give up then

&more nonsense
"treats symptoms rather than causes"
treating symptoms is frequently not counterproductive or unnecessary

treating symptoms is frequently productive & necessary

Where did I say it was easy to fix?

Of course it's not easy to fix, that does not make it untrue.

Come on, say it with me. Willwtts is a profoundly immoral person who should be exiled to Venezuela.

Even "survival rates" can be suspect. For example, the survival rate for a patient with cancer is measured from the day the cancer is discovered not from the day when the cancer developed. Hence, in a country like the US with all the diagnostic tests, cancers are far more likely to be discovered early and, therefore, the "survival rate" in the US is longer than in other countries.

earlier detection of cancer
usually leads to more effective
less invasive treatment& sometimes cure of cancer
which is sorta the point

It certainly is! But what is rarely discussed or considered is the value created (beyond life extension). Including the value of the quality of life for the patient. And not just for the patient, but spouse and family. The worry, the insecurity, stability, the stresses of care giving. Anyone having been closely involved with caring for these patients will understand.

that gets discussed all the time around here

Maybe if China hadn't hollowed out America, Americans would be able to afford healthcare.

"Maybe if China hadn't hollowed out America"

Lol. China has helped a great deal in making the U.S. rich, its just that only very few saw those gains. If you're looking for the culprit in who" hollowed out America" you need look no further than capital interests and the banking class which decimated the middle class through lobbying, deregulation, and socializing risk taking behavior.

Let us be blunt: Red China steals American jobs and are trying to destroy American business. They are wagering total war against America and I support the deployment of nuclear weapons against Red China.

Yes! We must murder millions of Chinese men, women, and children before they do the same to us!

So you prefer Munich!

What are you talking about? I just agreed with you that we need to use nuclear weapons to murder the Chinese. What does a city in Germany have to do with that?


Are you aware that the problem in the US is that health care is far more expensive than anywhere else in the world, about twice the average of what is the case in other high income nations, nearly all of whom have longer life expectancies and lower infant and maternal mortality rates than the US. But you think somehow China is responsible for this? Personally I blame Bolsanoro for his homophobia and unleashing gunmen to kill people in the favelas.

"nearly all of whom have longer life expectancies..."

Don't forget that according to Zeke Emanuel, the years over 75 are the ones that we don't want to stick around for.

I usually find Alex quite credible, but this chain of logic is quite unsupportable.
First, whence $200,000 per year, when per capita GDP is $60,000 per year?
And certainly those receiving the vast majority of healthcare are well past prime productivity-- most are at zero or negative productivity even without taking their healthcare costs into account.

Well, they're productive from the perspective of health care spending...

And I think you give Alex too much credit. This blog has increasingly descended to barely coherent phoned-in troll baiting.

Sorry, man, I'm just an observer but you are one of the most sarcastic and flippant commenters here. But at least your posts are brief.

Did I miss a rule about tone?

There's more than one way to make a point. Hell, most of the blog posts are phoned in these days.

Then why are you still commenting here? No, your continued diatribes against the content of the blog posts reveals that you believe they actually are effectual.

'they actually are effectual'

They actually are entertaining.

Yes, and enlightening. The hosts regularly post about topics which don't get a lot of attention in a thoughtful manner. Even when I disagree, I often find they've made a good argument to support their case.

Not always, Tyler's latest Bloomberg article was well below his usual quality. But overall, the posts are high quality and entertaining.

No not effectual. As stated above, im here because im entertained.

I used to come for the quality of the top posts but that has digressed badly.
Now i stay for fun

Ask yourself if you would be willing to give up the last five years of nursing home dimensia to leave your kids a $1M nest egg.

Of course you would.

$200k/year is absurd, especially at the end of life (which is usually miserable)

Not everyone has dementia the last 5 years of life.

Nevertheless it makes no sense to assign a fixed value. Some use the concept of a quality-adjusted life year.

A year of irreversible vegetative coma is not worth 200 grand. And some end-of-life experiences are so awful that they have negative value.

Sure, but asdf's point was it's better to die and save your family money than to 'live' in distress like dementia or a coma or whatever. And that's definitely true. However, many folks have last years not nearly so dire.

I do agree it's impossible to put a simple $ figure on this. My grandfather died at 95. For 94 1/2 years he was hale and hearty, the last 6 months were awful. But he had lived a long life and he was glad to have those last months to say goodbye. There's no easy heuristic here.

This post aggressively ignores the fact that the US pays far more for healthcare with substantially lower increases to wellbeing compared to our industrialized peers. This is especially true for chronic conditions such as diabetes and heart disease:

That article doesn't exactly support the gist of your comment. The thrust of your link is that the US health care system spends more on administrative costs and branded pharmaceuticals. This is true, but not "especially true for chronic conditions like diabetes and heart disease."

In fact, drugs for heart disease and type 2 diabetes are mostly generic products, and the US has very low-cost generic pharmaceuticals.

And while chronic conditions may incidentally incur more administrative costs by virtue of the fact that they are chronic, that's not a particularly interesting or helpful insight. Administrative costs are directly related to the insurance industry's relationship to medicine. Migrate patients toward cash markets, and administrative costs plummet.

We in the USA are so rich that we are fat and are more likely to die from overeating, alcohol consumption, smoking, and lack of exercise.

Poor people in third world tend to be skinny. If you are poor, you can't sit your fat ass in a car and drive a half mile to the store. You walk. Poor people do quite a bit of walking and even the bus costs money you don't have. Cigarettes a

Cigarettes and alcohol are expensive.

Even excellent healthcare can't compensate for a lack of impulse control and piggish consumption of cake, cookies, candy, and Coke.

In fact, poor Latin American migrants in the US pig out on sugar and fat and suffer disproportionate levels of obesity, type II diabetes, and kidney failure. We have a lot of dialysis centers in the US.

It's hard to be rich - you have to exercise self-discipline and self-control.

A democratic republic that emphasizes personal freedom requires a virtuous people. Once a people loses their virtue, some people think the state has to play mommy.

As a famous Brazilian anthem says, "But it won't suffice to be free/Being strong, bold and brave/People lacking virtue/Is fated to be enslaved/Let's be Greek regarding glory/and, regarding virtue, let's be Romans.

Brazilian virtue allows Brazil to have a successful single-payer system. My grandma died when she was 90.

Yeah, single payer - everyone steals but nobody pays. Poor nobody, he owe alot.

Everyone pays an affordable value. It is like a standing Army. One hops not to have to use it, but one staffs and supplies it for victory.

No the US pays substantially more for lower wellbeing outcomes. Given our violence, driving miles, obesity, smoking history (worst consumer of cigarettes till the 1980s, did not fall behind the pack until the 90s and peaked higher), and inactivity we start in a hole.

Measuring INCREASES to wellbeing has to take into account where you start before healthcare contributes. All the other determinants of health are far worse in the US and the fact that we are within spitting distance requires either the most successful healthcare system of all time ... or an act of God.

"The Tremendous Value of Increases in Life Expectancy": somehow, this does not look like a strictly academic title, which perhaps boasts explanatory power of its own. (If in doubt substitute the locution "Death Postponement" for Alex's hearty "Life Expectancy".)

Nudging "life expectancy" with aggrandized statistical methodology in itself does nothing to promote "quality of life" with any assurance or even likelihood. (If in doubt go visit ANY nearby "retirement center", "nursing home facility", "hospice house", et cetera et cetera et cetera.)

"Tremendous value of increases in life expectancy" is little more than a highly ludicrous exaggeration unless or until our bioengineers can preserve young adult physiologies intact for eight or ten or twelve decades (ah-ah-ah-ah-AH--COSMETIC SURGERIES AND PROCEDURES DON'T COUNT!): and who'd want to see those pernicious specimens parading in relative health and vigor for decades?

The utility of medical science (and/or geriatric "medicine") is not nearly as high as Alex might here prefer to claim: the only fate it can yet deliver remains mighty close to that of Swift's Struldbruggs.

we think "tremendous" might be
a sorta allusion/jab in the nads
to the donald

Of late I prefer the first half of the eighteenth century to the second half, so I no longer follow current events too closely (no dedicated TV or service, no radio or stereo, no current subscriptions). Glad to hear that our able academics stay tuned, I'm sure.

true dat
here is what has been going on
-the view is still the stupidest show on television and thanks to them&
their minions the measles is back in a big way
-Stubbs is finally getting inducted into the Barbecue Hall of Fame

The real truth about Japan:'s%20Picks%20OC . Maybe Fascism is not so great after all.

There is one slight problem with this statistic that we spend categorically more on medical care in this country than in Europe. In the US, would be doctors mostly finance their own education, and they take out loans which they have to amortize by charging patients or their insurance companies. This money therefore counts as medical expenditures.

In Europe, the government mostly funds education, so doctors do not have to charge enough to repay the student loans they don’t have. That money comes out of the education budget, not out of the healthcare budget.

Back of the envelope calculations show this at about five to $10 billion per year. Not decisive, but significant.


The math is wrong.

Life expectancy will be extended at the end of life, that is, usually just before death related to old age.

If a life year of, say, an 85 year old is worth $200,000, then extending that person's life for six months by, say, chemotherapy is worth $100,000, with a payback period occuring at the same time, that is, the expense will have paid for itself even if the person died on the first day of the seventh month. What a fantastic use of funds!

By extension, therefore, this was a far better use of funds than, say, putting a student through college, which, to be fair, will not achieve a payback of the $100,000 investment for many years. By implication, we should focus on maintaining the elderly for an extra few days, weeks or months at the expense of educating our youth.

This is an absurd proposition on the face of it, an example of great analysis with zero common sense.

It's absurd that someone as smart as Tyler can start a calculation working from the premise that simply having the average elderly person around for another year produces 200k in value.

* Oops. Alex, not Tyler.*

+1, I was scrolling down to see if someone had made this point.

"A value of a statistical life-year of around $200,000 is a mid-range, widely used estimate in the United States. Thus, if the extra US spending generated an extra $3,000 per $200,000 of a life-year, it would pay for itself."

This is a flawed argument. The $200K is for an average life. Obviously a younger person would skew higher and an older person would skew lower. Furthermore, the $3K per person skews the opposite direction. So, we are paying the most for a year with the lowest value and the least for a year with the highest value.

What? No. That's not how any of this works. If you increase average national life expectancy, then you're taking on days to the average life in the nation. Average life, meaning the average of people who are infants, children, young adults, mid-lifers, and seniors. It makes no sense to calculate the value of life based only on one of those groups.

Nope. If you're increasing life expectancy, then you're by definition extending it from the last day of the individual's life otherwise.

Now, if we had high infant mortality rates, then you'd have a better case. But the vast majority of people who die, do so at an advanced age.

Here are the SS mortality tables. Even at the age of 73, two-thirds of those born are still alive.

The vast majority of people who die do so at an advanced age, yes. Now let's talk about the vast majority of living people who can benefit from the most potent life-extending strategies.

Heart disease: 635,260
Cancer: 598,038
Accidents (unintentional injuries): 161,374
Chronic lower respiratory diseases: 154,596
Stroke (cerebrovascular diseases): 142,142
Alzheimer’s disease: 116,103
Diabetes: 80,058
Influenza and pneumonia: 51,537
Nephritis, nephrotic syndrome, and nephrosis: 50,046
Intentional self-harm (suicide): 44,965

Many of these are life-style related for those under 65

Nonsense. If you want to increase life expectancy by six months, you don't wave a wand and give everyone six more months.

Rather what happens is that you give a small number of people many months or more often years and everyone else nothing. Take Hep C. Curing Hep C gives people back over a decade on average. But only around 1 in 100,000 in the US has Hep C. Or take HIV. In 2000, life expectancy for HIV+ individuals was around 55 years, by the end of the decade it was pushing 70. Only about 1 in 300 Americans had HIV. So the net effect on life expectancy was about 18 days.

And on it goes. Because the truth is "cures" don't work on the highly comorbid and frail. Most of the wonder drugs out there cause some manner of immunological, renal, or hepatic toxicity. Likewise, CABG is great if you are in good enough shape to survive the anesthetic and recovery, but at 85 very few people can manage that.

So most of our life expectancy gains come treating one disease (which the vast majority of us will not be subjected to, at all) and the lucky few gaining years or decades of live. Even using BS bins like "heart disease" and "cancer" there just is nothing that kills more than 25% of us. In reality even the "heart disease" patients require radically different treatments - heart failure is a completely different ball of wax from acute STEMI.

^^^ Precisely.

You've clearly never sat in a chemotherapy ward.

"I don’t think that there have been marked improvements in quality in education so that argument doesn’t get off the ground"

By that you might mean that PISA test scores are not higher, but PISA tests are too close to IQ tests to measure schooling very well.
It seems to me that school might be getting less laborious and annoying for the students.

Flawed premise + cherry picked factoid + unsubstantiated blanket assertion + pop hot take + dubious research report = MR

What I don't understand is why we - myself included - spend so much time and money obsessing about the least relevant factor (healthcare) when it come to how long and how well we live.

Because arguing about people's life choices is considered "shaming people," focusing on genetic factors can be misconstrued as "racism," and addressing environmental factors involves making enormous changes to aspects of our lifestyles that we take for granted, like not driving so damn much and not turning every device into something electronic, radiation-emitting, and made of petroleum.

The health care debate is the only good conversation about health we have left!

LOL... you're right. Maybe it's not that hard to understand after all.

First off, other nations have similar, even higher, life expectancy stats while spending less money on healthcare. Secondly, the most important reasons for the increase in life expectancy over the last 150 years involve sanitary reforms, and the general trend toward antisepsis, and only a fraction of that has involved healthcare spending

'zactly. esp if you add pacemakers and a couple basic surgical procedures that avert imminent problems.

1) As Alex notes in his long version, people have actually looked at the contribution of longevity from health care. It accounts for roughly 40%-50% of the increase.

2) There is way too much emphasis on longevity. 50 years ago if you had a cataract operation you were hospitalized for a week. Now you go home in 30 minutes. A gall bladder operation used to keep you out of work for at least 6 weeks. Now you are back next week. Arthritis used to be permanently crippling (still can be in some cases) but now you have better medial treatments and joint replacements. Premies used to die if born at 36 weeks. Now they have almost 100% survival at that age and good survival much earlier. We really need a hedonics measurement for medicine.

3) Longevity is the stat focused on bay those who dont really study health care very much.


I'm interested in $400,000 in exchange for two of my life-years, please.

I accept your bargain. I'll be around on your next birthday to collect.

Don't you need to pay the $400,000 first?

First? No that wasn't stipulated. As always, one must be careful with the wording of the contract.

Quick question: is there any relationship between the value of a "statistical life" and population change?

"As with education, many of the increases in life expectancy come from better knowledge, which does not necessarily cost more to use. It does not cost much more to treat an infection with antibiotics than with bloodletting"

Maybe that was true many years ago, but medicine has a deep understanding of diseases today and as such most of the increases in life expectancy result from new technology. Medicine is a highly technical field nowadays and the rate of advancement continues to be brisk. Catheter valve replacements, new interventional radiology procedures, new cardiac pacemakers, better MRI imagine protocols, new cancer drugs- the last goes on and unfortunately these advancements have required tremendous investment from industry. Unfortunately, this adds significant costs for marginal benefits. We are scraping the bottom of the barrel at this point, but the new technology keeps coming.

Maybe marginal benefits looking at the whole, but for the individual patients receiving the new benefits, the impact can be huge.

"Unfortunately, this adds significant costs for marginal benefits."

And this will flip in the 2020s.

And this will flip in the 2030s.

Not if I have anything to say about it.

the late great Leon Redbone dead at 127!

The value of longevity probably has a high discount rate. How much would a twenty-year-old pay for additional decade after age seventy? I'd guess few would pay much of anything. But a 69-year old ...

The dramatic increase in the SVL over the last 30 years (as computed by the DoT, the EPA, FDA, and DoA) is criminally under reported. It is likely a strong driver of many "cost diseases".

Life is too short for longevity discussions

This post is over a week old, so I haven’t bothered to read through the comments to see if this has been said already. But “quality increases over time are much more about better recipes than better cooks“ is great.

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