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PaperclipPerfector  12d ago (text post)   30512 thread views

Culture War Roundup for the week of December 9, 2024

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US life expectancy at birth sucks versus peer countries, and even still sucks around age 40. But as you get into retirement years it reverses, and the US eventually climbs to 4th place among the 18 countries

Thanks for the link - this is fascinating data. My interpretation:

  • The big reversal (when US age-specific mortality drops below the OECD average) is around age 80 for men, 85 for women.
  • This isn't an advertisement for "the US healthcare system" as discussed in political ranting (i.e. mostly-private insurance and a freeish market for providers) because the age groups with good results get almost all of their healthcare via Medicare, which is a single-primary-payer system with price controls on providers.
  • It isn't an advertisement for Medicare either, because the age at which US relative mortality starts to improve is well above Medicare eligibility, and in any case the pattern of falling US mortality relative to peer countries predates Medicare.
  • The authors thought that smoking would be a big driver (US boomers smoked more than European boomers, particularly women, and smoking kills you before 80 so smokers don't really show up in the over-80 mortality rates), but it doesn't seem to be. Excluding smoking-related deaths makes a big difference to the figures, but not enough to lift the US off the bottom of the league table for under-75 mortality.
  • A big cause of the difference, but by no means all of it, is resource allocation decisions. At the margin, Medicare is more likely to pay for advanced cancer treatments or open heart surgery for older patients who a European system would send to palliative care. [As someone who is involved in UK politics, I can confirm that the NHS does discriminate by age making resource allocation decisions, and that a 65-year old is much more likely to get their cancer treated aggressively then an octogenarian] This is a choice, but not one that has really been discussed with the demos on either side of Atlantic. In the case of the UK, it was a deliberate choice taken by elites. (It isn't covered up, but we aren't exactly trying to make the issue salient in the public debate either - we think, mostly correctly, that the plebs are incapable of engaging in discussions about healthcare resource allocation in a sane way). In the US, it appears to have been a decision stumbled into rather than taken deliberately. I have no idea what is going on in Continental Europe.
  • Guns and car crashes aren't big enough to explain the effect, although they contribute by raising US mortality at lower ages.
  • Obesity-related deaths don't have the correct age structure to explain the effect.
  • I suspect this is related to the black-white crossover - US black mortality is higher than US white mortality at almost all ages, but increases more slowly with age leading to a crossover in the late 80's. The paper also suggests this, but doesn't come to a conclusion.

So the age pattern doesn't answer the key political question, which is "Is the high working-age mortality in the US an indictment of how the US healthcare system performs for non-Medicare-eligible Americans?"

Coming up for air here, and approaching the #assassinbae story from a different angle, at what point can we consider misinformation surrounding this life expectancy vs health expenditure chart as stochastic terrorism?

Only if all political discourse is stochastic terrorism. Indicting the US healthcare system doesn't incite violence against any particular group. I suppose you could argue that "The US spends most and gets least, ergo executives of for-profit health insurers are bad people who should feel bad." is stochastic terrorism, but "The US spends most and gets least." is no more incendiary than "taxes are too high" or "someone should fix the potholes".

US boomers smoked more than European boomers, particularly women

Really? I guess it shouldn't surprise me, but it does. It's startling how quickly the cultural changes happened in the United States, nowadays smoking tobacco is rare and even vaping is uncommon. Although I do notice a much higher rate when I visit the south. The US went from a smoking society to a smoke-free society; I'm old enough to remember when restaurants had smoking sections, but in hindsight I'm astounded they ever did.

I don't have anyone in my extended family who smokes, but I do have several who used to, including my father, grandfather, great grandfather, etc. Getting people to quit smoking is possibly the greatest public health triumph of the late 20th century.

At the margin, Medicare is more likely to pay for advanced cancer treatments or open heart surgery for older patients who a European system would send to palliative care. [As someone who is involved in UK politics, I can confirm that the NHS does discriminate by age making resource allocation decisions, and that a 65-year old is much more likely to get their cancer treated aggressively then an octogenarian]

I get why saying this out loud is bad politics, but this approach is the only sane way to deal with terminal illness. In general, I seriously question the value of non-palliative treatments for advanced or aggressive cancer and I worry we put people through unnecessary suffering to prolong their life for miniscule amounts of time. I've seen too many family members go under the knife and come out butchered, only to suffer for a few more months and die anyway. We place so much value on life extension and so little on life enrichment.

Very good post. There's a lot of detail here and I appreciate the inside baseball.

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