Saturday, August 15, 2009

Life expectancy and infant mortality: a rerun

Because the hard Left, who favor state control of medicine (and almost everything else) are conducting a bogus campaign in favor of nationalizing care, I want to rerun a piece I wrote some time ago. The proponents of bureaucratic control of medical care insist on using bogus statistics to prove their case. They continue to resort to two numbers. One is the life expectancy rate and the other is infant mortality. Both measure many factors completely outside the control of the health system. Here is something I wrote almost two years ago to the day—so it was written long before Jesus Obama walked across the reflecting pool to the White House. Everything that follows is from the older article. A few minor typos were corrected but the article was not changed.

Life expectancy is the result of dozens of factors. At best it is a general indicator of life in a specific area. In and of itself, it does not tell you much about any specific policy.

I am convinced that life expectancy is only tangentially connected to health care, with the exception of birth. Once an infant survives the first year or so of life, health care is almost secondary. Prime factors include diet, safety, clean water and sanitary conditions, and lifestyle choices.

If you look at the history of the rise of life expectancy it was basic improvements in life that caused much of the increase. The problem our ancestors had was to survive birth and the first year or two of life, and then to have food to eat, clean water and to avoid disease. Get that out of the way and life expectancy shot up.

The second great advance in life expectancy was when we discovered how to immunize people against diseases like flu, polio, measles, small pox, etc. It should be noted that the great advances in this field predated nationalized health care systems for the most part.

Most of the major medical expenses in the world today actually have little impact on life expectancy. While for some people we are talking about adding a few years to the life of a person, for most we are talking of adding weeks or months at best.

The reality is that spending a bit less on expensive care, and a bit more on basic, preventative care and check ups, will do a lot more good. Americans could reduce their health spending dramatically without having much, if any, of a negative impact on their life. Individuals could easily repriortize their concerns. It isn’t that health care is too expensive as much as it is that Americans are over buying expensive care and under consuming basic, preventative care. A major factor that puts US spending, per capita, above that of Europe is that Americans tend to prefer to solve problems with expensive care rather than taking cheaper precautions in advance. That is a problem of individual choice, not health care systems.

Americans, no doubt, do overspend on health care for the benefits they receive. On the other hand the nationalized systems intentionally under spend on care. They brag they are cheaper but they are cheaper because they deny care that people want and often need. Cheaper is not necessarily the determinate of good care any more than more expensive is. Both could be serious misallocations of resources.

This said, I should get back to the main point, which is the role of health care on life expectancy. Life expectancy is only a general indicator regarding the qualify of life. It is not an indicator that says much about specific policies. And that is where some advocates of nationalized care get dishonest. They will argue that Americans have a slightly lower life expectancy than do people living in nations with nationalized health care.

Normally they are very selective as to which countries they choose. The truth is that Americans live, on average, longer than people in many countries with socialized care, but not as long as people in some countries. If one were to compare the EU average life expectancy to that of the average American the difference is only a matter of weeks.

But that small difference is used to champion socialized care. Somehow turning health care over to the people who run the post office is supposed to add a few weeks to our life expectancy, and this is supposed to be a vast improvement.

But are the differences in life expectancy between the US and some European countries (and not others), actually the result of different health care systems? Or are there other factors that directly lower US life expectancy?

Everyone knows that obesity, a result of affluence, is rampant in the United States. And this problem is worse in the US than in Europe. Having lived on both continents I can verify that observation personally. The size of some Americans is astounding to me. Micheal Moore is becoming far more the norm than the exception. This is having a major impact on life expectancy. Americans are still living longer than ever, but the rate of improvement has slowed allowing less obese nations to surpass the US average. This is a personal choice issue, not a health system issue.

Another cause for lower life expectancy can be crime. This is especially true for one group of American -- black males. The average life expectancy of black Americans is five years shorter than that of white Americans. And crime is a major reason. One study showed that a white male of 15 years of age had a 1-in-345 chance of being murdered before he turned 45. For black males those odds were 1-in-45. And in Washington, DC, the city in America with more politicians than any other, the odds were 1-in-12.

This study says that ending the criminal carnage in the black community would bring the average life expectancy of black males up by three years. This is not a health system issue. Yet, it severely impacts US life expectancy rates which is then used to “prove” nationalized care is better. In addition, the African-American community has higher rates of various unhealthy lifestyle choices, such as drug use, smoking and consumption of alcohol. All these factors drag down the life expectancy in that community and reduce US rates as well. While some European countries have similar communities with similar problems they are a smaller percentage of the population and thus have less impact on the life expectancy average.

A study out of Harvard says: “young black men living in poor, high-crime urban America have death risks similar to people living in Russia or sub-Saharan Africa.”

One study I looked at recently, from the Commonwealth Fund, showed that if you reach the age of 60 your life expectancy, in the US is another 17 years. Under the nationalized health systems in the UK and New Zealand the remaining years are also 17 years. No difference. Canada was higher at 18 years but there are still various factors that impact this, which are outside the health system -- as already mentioned.

MSNBC repeated an Associated Press report stating that “A relatively high percentage of babies born in the U.S. die before their first birthday, compared with other industrialized nations.” What they refer to is the infant mortality rates. Again this is slightly dishonest since different nations define infant mortality differently.

The U.S. has a much broader definition of "live birth" than does other nations. They aren’t measuring the same thing. US News & World Report explained the differences:
First, it's shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don't reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country.

Infant mortality in developed countries is not about healthy babies dying of treatable conditions as in the past. Most of the infants we lose today are born critically ill, and 40 percent die within the first day of life. The major causes are low birth weight and prematurity, and congenital malformations. As Nicholas Eberstadt, a scholar at the American Enterprise Institute, points out, Norway, which has one of the lowest infant mortality rates, shows no better infant survival than the United States when you factor in weight at birth.
Infant mortality rates are also connected to many factors not related to health care. For instance, teen mothers are more likely to give birth to sick infants. Mothers who smoke, or are obese, or simply lack education, have riskier pregnancies. And the U.S. has more of these problems than some other nations, yet these are not directly linked to the health system.

Nationalized health care won’t reduce crime rates. It won’t reduce obesity. The Harvard study indicates this. The main reason some communities, in the U.S., have lower life expectancy is due to injuries and some chronic diseases “including heart disease, cancer, and diabetes. These killers, in turn, are a consequence of well-known and largely controllable risk factors such as smoking, alcohol use, obesity, high blood pressure, and high cholesterol. In high-risk urban black communities, male mortality is increased by homicides and exposure to AIDS.” These are “largely controllable risk factors”. Controlled by whom? By the individual at risk, not by the health system.

The Harvard study looked at eight distinct groups of Americans and concluded: “"The variation in health plan coverage across the eight Americas is small relative to the very large difference in health outcome. It is likely that expanding insurance coverage alone would still leave huge disparities in young and middle-aged adults." Universal coverage, as envisioned by advocates of socialized care, will have little direct impact on U.S. life expectancy. But cheaper, if not free, individual changes in life style can have a major impact.

Another Harvard study found that Americans could add 6.7 years to their life expectancy by following healthier guidelines for living. Europeans could add only 5.5 years, implying that 1.2 years of the current difference in life expectancy rates between the US and Europe is due to lifestyle factors, not to health care systems. That difference would put US life expectancy on par with the UK and Germany, indicating that the differences in life expectancy rates is due to lifestyle choices not health systems.

Another indicator that health systems are not the main issue is that Hong Kong, not known for socialized health care, or much of a welfare state at all, has one of the highest life expectancy rates in the world, at 80.2 years. That exceeds all the European socialized states. Switzerland also has a high life expectancy, yet most health care is provided privately and covered by private, individual insurance policies. Recently, Swiss voters rejected a single-payer health proposal.

Singapore also has a high life expectancy yet they have little in the way of nationalized health care. Individuals in Singapore are expected to establish their own private, health accounts which belong to them or their heirs when they die. These private accounts pay for most care in the country. Out of these accounts citizens purchase catastrophic insurance to cover major problems and draw down the account for minor problems. About 10% of the population is deemed impoverished and are directly helped in health care by the state, but the bulk of the population pays for their care out of their own resources. They also have health care expenditures that are far lower than any of the nationalized systems.

Some countries, often with very little in the way private or public health care, have life expectancy rates that are still rather impressive. Costa Rica has a higher life expectancy than Luxembourg. And two U.S. territories, Puerto Rico and Virgin Islands, have higher life expectancies than the U.S. mainland. Yet, I know of no one who attributes this to greater access to health care, socialized or not.

Another indication that life expectancy is only tangentially tied to health systems is that every nation in the world, no matter their health care system, sees dramatic differences in life spans between men and women. And much of that is due to life style differences tied to biology. Men are more violent, on average, than women. That means they get killed more often. They also tend to be risk takers, more so than women, and that also means they are more likely to die young.

In most socialized health systems women live five to seven years longer than men, on average. Yet this is not because women receive superior health care. At least I’ve yet to hear that claim.

Life expectancy is primarily a matter of factors outside the health care systems. As such it can not be considered evidence, one way or the other, that nationalized care is superior to private health care.

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