Tuesday, September 22, 2009

Taking on the myth of life expectancy.

Periodically I have taken on the myth that American life expectancy, being lower than many Western nations, is proof that the American health system is failing. This is clearly one of the more bogus claims that advocates of state controlled health care propagate.

I was glad to see John Tierney in the New York Times, take on the issue as well. (I have never met Mr. Tierney directly though we did sit in on the same press conference with Matt Stone and Trey Parker (South Park) in Amsterdam a couple of years ago.) Tierny basis his column on research published in Health Affairs. Here is the synopsis of that article:
The United States spends more on health care than any European country. Previous studies have sought to explain these differences in terms of system capacity, access to technologies, gross domestic product, and prices. We examine differences in disease prevalence and treatment rates for ten of the most costly conditions between the United States and ten European countries using surveys of the noninstitutionalized population age fifty and older. Disease prevalence and rates of medication treatment are much higher in the United States than in these European countries. Efforts to reduce the U.S. prevalence of chronic illness should remain a key policy goal.

What this means is that Americans have specific problems more often than Europeans do: in particular cancer and heart disease. Both problems are strongly related to lifestyle choices NOT to health care. As Tierney explains:
there are many more differences between Europe and the United States than just the health care system. Americans are more ethnically diverse. They eat different food. They are fatter. Perhaps most important, they used to be exceptionally heavy smokers. For four decades, until the mid-1980s, per-capita cigarette consumption was higher in the United States (particularly among women) than anywhere else in the developed world. Dr. Preston and other researchers have calculated that if deaths due to smoking were excluded, the United States would rise to the top half of the longevity rankings for developed countries
Dr. Samuel Preston, a demographer at the University of Pennsylvania did the study with several others. Tierney writes: "Dr. Preston says he saw no evidence of the much-quoted estimate that poor health care is responsible for more preventable deaths in the United States than in other developed countries." Tierney notes that the findings of the study show that Americans who do become ill tend to get better care in the United States. This shows up in statistics like the cancer survival rate. Tierney notes that: "Americans also do relatively well in surviving heart attacks and strokes, and some studies have found that hypertension is treated more successfully in the United States. Compared with Europeans, Americans are more likely to receive medication if they have heart disease, high cholesterol, lung disease or osteoporosis."

Preston is basically saying that Americans have a shorter life-span due to bad decisions they make, not due to bad health care. They do get sick more often and earlier in life as a result. But when the health care they receive is compared to that of Europeans with the same problem, the Americans do quite well. Preston believes that the difference in life spans will close very rapidly primarily as a result of the decline of smoking in the United States.

Dr June O'Neill, and Dr. Dave O'Neill of Baruch College, City University of New York, did a study comparing the actual treatment that Americans receive, on average, to the actual treatment that Canadians received from their nationalized health system. This was not studying the promises the two systems made but the actual delivery of care given to people with specific illnesses. In disease category after disease category they found Americans were more likely to be receiving treatment not less, with a couple of minor exceptions. In each case the compare Americans with a specific medical problem to Canadians with the same problem and then calculated the percentage who were actually receiving treatment.

Their study found that: "Out of eight conditions they investigated Americans have higher treatment rations in six categories with Canada leading in asthma and angina." But they found that for angina this was only true for younger patients not older patients. When it came to individuals over 64-years-of-age Americans had higher treatment rates than their counterparts in Canada. Their conclusion: "the U.S. generally performs better with respect to treatment of all conditions except that of asthma."

They also found that Americans are more likely to undergo preventative testing such as PAP smear, mammograms and PSA test for prostate cancer. For instance, 74.9% of all American women had a mammograpm in the last two years where only 54.7% of Canadian women did. For older men 54.2% have been checked for prostate cancer. In Canada is was only 16.4%. When it came to checking for colorectal cancer, Americans were six times more likely to be checked than Canadians. The O'Neills found that Americans had better cancer survival rates than did Canadians. A study in Lancet found the same thing when comparing American survival rates to those of Europeans -- the U.S. was well in the lead when it came to survival rates.

The O'Neills found something quite similar to what Dr. Preston found: Americans have higher incidences of health problems than do Canadians but they also had higher treatment rates. And Americans, when asked how happy they were with their care, had a satisfaction rate higher than the Canadians as well.

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