Healthcare in the US has consistently been one of the most unfriendly places for middle age and elderly people. Life expectancies for 40 and 65 years olds have has made very little progress in the US compared to other high income countries for 20 years from 1980 to 2000, and is only now beginning to catch up with the average rates of growth in other high income countries. Life expectancies for 80 year olds are much better, but the US has been losing ground to other high income countries.
Yet the opponents of health care reform have the nerve, the brass, the swank, the depraved ignorance and dishonesty, to say that reform will result in neglect of older people. The US long neglected middle age and older people to an extent that has not been tolerated in other high income countries. Actual historical data and evidence, as opposed to ignorant bloviating, indicate that health care reform would make the US more like Australia, France, Switzerland, even Canada (take your pick) and will produce LONGER life expectancies for older people in the US; the absolute opposite of what opponents of health care reform claim.
Below is a summary of the performance of the US with respect to life expectancy over the last 45 years or so for people age 40 and over.
In 1960 40 year old men had less than average life expectancy among high income countries, and women in the US had about average life expectancy compared to other high income countries. After a spurt of growth in life expectancy to about, or above average, during the 1970s, progress in life-expectancy came to standstill compared to most of the high income countries. The growth rate in life expectancy started catching up to the high income country average in the mid 1990s for US men, and after the late 1990s for US women. But the life expectancy in 40 year old women now lags FAR behind the average of other high income countries.
In 2003, for 40 year old men, the US ranked 16 of 22 high income countries, behind. Australia (2), Switzerland (3), Canada and Sweden (tied for 5), France (11), and the Netherlands (12).
In 2003, for 40 year old women, the US ranked 19 out of 22 high income countries, behind Switzerland (2), France, Australia and Spain (tied for 3), Canada (7), Sweden (8), the Netherlands (17), and Portugal (18), and The US life-expectancy in the US is about the same as in the dreaded UK
In 1960, 65 year old women in the US had one of the highest life expectancies among high income countries. The growth in their life expectancy relative to other high income countries has been similar to that for 40 year old women. As of 2006, their life-expectancy was 15 among 22 high income countries. Among countries with higher life expectancies for 65 year old women are France (2), Switzerland (3), Australia (6), Canada (7), Sweden (10), and Germany (14). The progress in life-expectancy for 65 year old women over the last 25 years has been horrifically bad compared to other high income countries.
In 1960, 65 year old men in the US had about average life expectancy. After a spurt of growth in the 1970s, putting their life expectancy above average, the rate of growth in the life expectancy in the US slowed to below average, and 65 year old men in the US have about average life expectancy compared to other high income countries.
For 80 year olds in the 1960s, men and women in the US has among the highest life expectancies, along with Canada (for men and women), and Norway (men). Life expectancies showed rapid growth from the late 1960s through the end of the 1970s and then remained at a near standstill compared to other high income countries until around 2000, when they started growing again. Eighty year olds in the US still have relatively high life-expectancies compared to other high income countries, but have lost ground.
For 80 year old men, in 2003, the US was tied for 2 with Canada, behind Japan (1) and just ahead of Australia and New Zealand (tied for 4) and France (6).Eighty year old women have lost ground, as in other age groups. The US ranked 5 in 2003, behind Japan (1), Canada (2), and Australia and France (tied for 3).
Common patterns can be seen in the time series of life-expectancies that seem to be due to several factors. For example, Canada shows some short run variations that parallel those of the US, which indicate some common factors operating in North America. However, the US shows medium term trends that seem to be unique: an increase in life-expectancy relative to the average of other high income countries from the mid 1960s through the late 1970s, then stagnation relative to other high income countries for the 1980s and 1990s, then a recovery in growth in life expectancy in the early (men) or late (women) 1990s.
I believe that the period of stagnation in US life expectancies occurred during the heyday of the attempt to introduce more poorly regulated competition into the US health care system, due to various forms of ‘managed competition’ in the health care market, the introduction of HMOs,(1,2) and the introduction of physician self-dealing in medical enterprise such as lab tests, physician-owned specialty outpatient clinics and inpatient hospitals (3).
I’m tempted to speculate that the renewed increase in life-expectancies occurred after the popular backlash against HMOs and other poorly designed attempts to ‘for-profitize’, and incentivize health care, which forced more controls on competitive behavior, but I have no data to support that. To be honest, the renewed increase in life-expectancies for older Americans after the early to late 1990s may be due to something else.
Several countries have been better on average at increasing life expectancy over the last 20 and ten years for most of these age groups: Australia, France, Japan (current champion for older men and women) and Switzerland.
Australia and Germany are countries that have had comparative effectiveness programs that opponents to health care reform claim will result in death to the elderly, but they have consistently performed as well or better than the US for most of these age groups, including the 80 year olds. Germany still does not perform well in absolute terms, but its life-expectancies have been steadily increasing at a greater than average rate, and are now approaching the average for high income countries.
The fact is, the US has had the most free market (and most poorly or unregulated free market), the most rapaciously competitive, and most costly system for health insurance and health care among high income countries, and its performance at increasing the life expectancies of middle age to very old people has been very bad for most the 1980s and 1990s, and only beginning to emerge from being disgraceful and the very worst among high income countries. Older Americans have lost ground in life expectancy compared to other high income countries.
Please contact your government officials, and the media, and tell them to give the US population the facts, stop ignorant and dishonest propaganda against health care reform -stop false propganda that endangers the welfare of middle age, elderly and very old, Americans.
Tell the media to stop passively broadcasting the fantasies and nonsense of ignorant political operatives, hacks and office-holders and extremists.
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The high income countries used in this analysis are Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Luxembourg, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, Switzerland, United Kingdom, United States.
The rankings for life-expectancies for 2003 and 2006 are for all countries that year, including the US. Where data were missing for non-US countries, data lagged one or two years were used (giving an advantage on aveage to the US, which always used the latest available data). Tied rankings are listed as first rank of tie (rather than averages). So, a two way tie for second place produces the rankings for the first four places as 1, 2, 2, 4.
Data are from OECD Health Statistics 2007 and 2009.
You can download 65 year old life-expectancies for free.
Order complete data with 40 and 80 year old life-expectancies, or get for free at subscribing library. Journalists should be able to download all the data from OECD for free.
(1) Managed Competition: The Future, Not the Past
By Martin Sipkoff
Manage Care Magazine
(2) How Managed Competition Controls Costs: The CALPERS Experience
By Ray LaRaja and Jeremy Rosner
Progressive Policy Institute
(3) Did Warren Burger Create the Health Care Mess?The 1975 antitrust decision that gave you physician-owned hospitals.
By Timothy Noah
(found via Ezra Kelin blog)