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Americans Less Healthy, But Outlive Brits
An anonymous reader writes with this intriguing snippet: "Older Americans are less healthy than their English counterparts, but they live as long or even longer than their English peers, according to a new study by researchers from the RAND Corporation and the Institute for Fiscal Studies in London. Researchers found that while Americans aged 55 to 64 have higher rates of chronic diseases than their peers in England, they died at about the same rate. And Americans age 65 and older — while still sicker than their English peers — had a lower death rate than similar people in England, according to findings published in the journal Demography."
The UK is more depressing what with its annual 4 hours of sunshine and the best looking women maybe rating a 7. Who can forget the warm beer, bad food and lovable totalitarian government?
I'm not kidding. You don't think all of that stuff can have a negative affect on a persons psyche, perhaps affecting their health? Especially the warm beer...that's especially depressing.
If you ignore ACs because they are anonymous - you're an idiot.
It has been my experience that Americans hold onto life harder than almost anyone else on the planet. There is no saying "Well, that's enough then." There is no accepting the inevitable. No matter how sick, how weak, how miserable a person is, in the US it seems that it's still better than throwing in the towel.
"People who do stupid things with hazardous materials often die." -- Jim Davidson on alt.folklore.urban
Despite all this clever wording, Americans do not outlive Brits in the vast majority of cases.
USA - Male life expectancy 75.6 years, female 80.8 years.
UK - Male life expectancy 77.2 years, female 81.6 years.
Notice how one set of numbers are larger than the others.
How long old people still have to live heavily depends on medical treatment. Surprisingly (at first sight) bad healthcare can mean old people are more healthy. (It stops to be surpising if you consider that bad health care means only the healthy people live long enough to be old).
Thus you can get numbers that in the USA looking at the right age, you can get much longer life expectancy if you are black and poor than if you are rich and white.
Another nice paradox (numbers might not be totally accurate and might have changed over time): Getting older might increase the years you still have to live. Especially if you are 60 (or something short of retirement age in your country) you might have statistically less years before you than if you are 70 (or something a few but not too much years after typical retirement), because all those people dying between 60 and 70 lower the chances for a 60 year old more than the 10 years less do reduce the expected years for the others.
So be careful with those numbers.
I know some politicians will use a study like this to argue that single payer health care is a bad idea, but when you consider that this study looked at older citizens, who tend (in America) to be on Medicare (our single payer health care), it seems to suggest that that program isn't so bad after all.
Of course, you have climate, pollution, diet, genetics, and a dozen different factors that you can't control for when you compare Americans and Brits. So studies like this one are probably pretty useless.
It would be interesting if you could take a group of senior citizens and split them up three ways: no insurance, single payer (Medicare), and traditional health insurance. Then see who lives longest.
The article misses an important detail - the Yanks actually dieing earlier than Brits, it's just that all the extra preservatives they consume keep them in a state of animated death for a few extra years.
Shipman didn't "ethnically cleanse" He almost exclusively murdered old ladies who "wouldn't be missed", including the mother of one of my friends.
There're many other factors... Such as amount of money spend on health care... For instance the US spends more than twice as much on heath care per citizen as the UK (and the US doesn't even cover all of their citizen).
That's according to OECD: http://tinyurl.com/cr9753
The summary is misleading. Brits, on average, outlive Americans.
http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy
This study compares the survival of people with similar diseases once they become ill.
In the US, physicians tend to emphasize curative (disease-fighting, life-extending) care. Many American physicians view the death of a patient as a personal defeat. Thanks in large part to numerous advances in medical technology over the past half-century, physicians (worldwide, but especially in the US) have become very good at "keeping people alive." That said, keeping someone alive often comes with a price - namely, the patient's quality of life. Relative to their English colleagues, American physicians are generally more resistant to moving patients from curative care to palliative care - care that focuses solely on reducing/eliminating symptoms. It comes as no surprise, then, that patients with chronic disease are living longer in the US. Saying that longer lives implies "better" healthcare is naively simplistic at best. That conclusion is indicative of a fundamental misunderstanding of the goals of medical care. The goals of quality health care demand a balance between curative and palliative care. On one extreme end of the curative-palliative-care spectrum you have the physicians (think: Kevorkian) who want to focus solely on reducing symptoms - even to the point of death. On the other extreme of the spectrum you have those who want to extend life at any cost (think: Terri Shiavo case). On this axis, American doctors lean somewhat to the "right" of most doctors worldwide. The best doctors in any country are straddling the line between "excessive" and "inadequate" care. That being said, conflating palliative care with "giving up" on the patient is an all too common issue among physicians and patients. Though I have full confidence in this research team's statistical results, they (Smith, in particular) seem to be unfamiliar with how heavily differences in culture affect healthcare, especially among patients with chronic diseases.
65 years is an interesting age, namely thats how many years ago the war ended. While the war wasn't as hard on England as it was most of the rest of Europe there was significant shortages and rationing when compared to the youth of the US during that same time period. There are a lot of studies nowadays that basically say that malnourishment during childhood can have negative effects all throughout a persons life. I wonder if the war has anything to do with the people over 65 dying at higher rates than the US.
Indeed. In time honoured fashion, I hadn't actually RTFA at the time of posting. I have done so now. I found it rather unenlightening. What would be really interesting to see is the difference in death rates across different wealth demographics. I.e. do we see larger discrepancies in one country than we do in the other. But I've now noticed that this is the RAND corporation, so I wont hold my breath on anything that shows the US system to have conceptual problems.
Aide-toi, le Ciel t'aidera - Jeanne D'Arc.
The numbers are badly skewed by the fact that what happens earlier is highly significant.
Consider a previous study (in the 1980's I believe). It showed that Electronic Engineers in the US were far more likely than others to die in their 40's of exposure to PCBs. This lead to panic about Poly Chlorinated Biphenys, which are used in transformers.
Once the panic settled down, it was discovered that polychlorinated biphenyls are only used in power distribution transformers (ie in substations), whihc most EEs are never exposed to at all. However, almost all EEs were exposed to Printed Circuit Boards. Statistical analyists were not exposed to neither, and could not the difference between a liquid and a solid. The reason for the discrepancy in the death rate was that EEs lived much longer than their peers because they were not sent to Vietnam, and were much more likely to die of health problems in the 40's because their peers died of gunshot wounds at the atge of ne-ne-ne--nineteen.
Moral: Trust statistics only after you personally have discovered how far you can throw them. (Chucking them into a WPB is a well proven strategy).
Sent from my ASR33 using ASCII
From TFA:
"The study also investigated the relationship between the financial resources of individuals in both countries and how soon they would they would die in the future.
"While poorer people are more likely to die sooner than their more well-off counterparts, researchers say their finding supports the view that the primary pathway between health and wealth is that poor health leads to a depletion of household wealth, rather than being poor causes one's health to decline. Researchers found that the substantial changes in wealth that occurred in the years 1992 and 2002 in the United States through increases in stock prices and housing prices did not alter the probability of subsequent death."
Also this interesting conclusion:
"The United States' health problem is not fundamentally a health care or insurance problem, at least at older ages," Banks said. "It is a problem of excess illness and the solution to that problem may lie outside the health care delivery system. The solution may be to alter lifestyles or other behaviors."
Also, the British thinktank who instituted this are a right-wing one, no doubt plotting to destroy the NHS alongside the Tory allies. So they publish a non-peer reviewed piece of 'research' designed to conclude what they want it to conclude. Bullshit.
The Tories recently gutted NICE, the body that evaluates the cost effectiveness of drugs to see if they should be made available on the NHS. They were doing a fine job, but got nothing but shit because they prevented pharmaceutical companies gouging into the state healthcare providers ample budget. When retards in the US talk about 'death panels' they are usually referring to these guys, and they don't get much of a good press in the UK either.
Basically, they talked to terminal patients to find out how much of their life they would be willing to give up to remain in good health for the rest of their life, and used this to calibrate a 'quality adjusted life year' which represented the value of a drug. Thus they could reject a hugely overpriced drug that added 2 weeks to the life of a late-stage cancer patient and spend the money saved on a drug that might allow a very sick child to reach adulthood. That second part *never* got a mention by the rightwing critics. When opportunity costs are being used to make the state healthcare system more efficient whilst forcing drug companies to charge realistic prices based on what their products can actually do, the right suddenly decides to reject economic language and talk shit about 'death panels' and NICE 'killing patients'.
Yes, we ration healthcare in this country - but up until now it has been based on how much extra life (across the whole population) that healthcare can give. The US rations healthcare too - based on how rich or poor you are. Our system is, frankly, better.
If we can put a man on the moon, why can't we shoot people for Apollo-related non-sequiturs?
Actually, this is quite possible.
You'll note that the "Rand Corporation" only collected data for this study from 2002-2006. That's when the life expectancy trend was really starting to show up.
Second, you'll note that for some reason, they compared the US to Great Britain. If they had used other countries with what you so quaintly call "socialized medicine" the results would show that the US was not doing quite so well in the health and life expectancy olympics.
You are welcome on my lawn.
"While poorer people are more likely to die sooner than their more well-off counterparts, researchers say their finding supports the view that the primary pathway between health and wealth is that poor health leads to a depletion of household wealth, rather than being poor causes one's health to decline. Researchers found that the substantial changes in wealth that occurred in the years 1992 and 2002 in the United States through increases in stock prices and housing prices did not alter the probability of subsequent death."
Yes, that's exactly the part I was eluding to. It doesn't tell us anything about comparative differences between the countries as regards wealth. I.e. are the differences in health care between the two countries constant across different wealth demographics or are they different, e.g. we find the the US is ahead of the UK in heatlh care for the wealthy, but the UK is ahead in health care for the median earners or the poor. That's what would be really interesting to know if we want to start examining the role of health care in more meaningful depth and by the sounds of it, they collected data relevant to this, but it is missing from their conclusions. I find it highly unlikely that the difference in health care is constant across all demographics of society.
Aide-toi, le Ciel t'aidera - Jeanne D'Arc.
Canadian life expectancy = 80.3 years, UK ife expectancy = 78.7 years, and US life expectancy = 78.0 years (in 2007) according to http://www.infoplease.com/ipa/A0004393.html and that's because Canada and the UK have life-long public health care.
But when medicare starts to cover US citizens at age 65, suddenly US citizens have a much better outlook. US citizens lucky enough to survive until age 65 and receive medicare coverage have a longer life expectancy than their British peers.
Actually, if you go back and study the data at http://www.infoplease.com/ipa/A0004393.html and http://www.oecd.org/dataoecd/46/33/38979719.pdf you'll discover that the US has both higher infant mortality and lower life expectancy than Canada and almost every developed European democracy (even Germany who absorbed the disaster known as East Germany a few decades back). For what its worth, the US also pays much more per capita for their lower life expectancies. I wonder if this data would change anyone's mind about the benefits of health care reform...
--- Often in error; never in doubt!
Real ale is fresh living beer that undergoes a natural second fermentation in the cask. Like any natural live product, the beer will mature age and ultimately go off. Real Ale must therefore be drunk within a strict timescale. Real ales requires proper handling on its way to the pub, and care within the pub to bring it to condition for serving. However, real ale can reach its full flavour potential, without chilling, filtration, pasteurisation and added gas.
Keg Beer, mass produced, often pasteurised, dead, with C02 gas added. The reason it is chilled is to inhibit a natural secondary fermentation.
Campaign for Real Ale definition of Real Ale.
Yes, government healthcare is efficient as proven by the countries that pay less for healthcare and whose citizens live longer than the USA. Government healthcare may have many faults, but efficiency certainly isn't one of them.
Yes, government *insurance* is very efficient. See a comparison of Medicare v. Medicare Advantage. Medicare Advantage is one of the most inefficient programs we have. We basically subsidize private insurers to do what Medicare already does more cheaply.
Government health-care? That's a different ball of wax.
The fact is that the US health system costs 10 points of GDP more than socialised systems with better outcomes. So as far as efficiency goes, experience shows public health care is massively more efficient than private one.
And this is obvious: you cannot ask someone to decide objectively how much to spend on their health when their life is on the line. This is exactly equivalent to legal mugging.
Basically, you are arguing that 10% of US GDP (way more than the average deficit even with the Bush madness) is well spent just because instead of staying in the pockets of the people, goes to line the pockets of private companies? For no benefit to the public at all? Because you are not getting better outcomes, you are not getting better innovation, you are not getting more employment. You do get better catering, but if you think hospitals should be run as glorified hotels you need to look up on what is expected of a hospital.
You fail at basic logic and basic knowledge.
Here I am, deluded and home alone in the dark. I've never considered the death rate before. Too me the death rate for all mortals is 100%. Apparently I am misinformed.
But USA health care is profit oriented, and there is more profit to be made in selling snake oil than there is in treating diseases.
There, fixed that for you. Seriously. I talked to a guy with high blood pressure recently. his doctor wants to put him on drugs, but he's not so sure.
I commented that well over 1/2 of the population doesn't get even the RDA of magnesium in their diet. high blood pressure is usually related to stress, and how can one relax if they don't have enough of the relaxation mineral in their diet?
I did some more reading, and the "life extension" people (Pearson & Shaw) say that potassium bicarbonate can help with blood pressure too.
A little Mg, KHCO3, and daily total-body relaxation will deprive the pharmaceutical complex of years of income for treating the symptom of high blood pressure. I guess I don't get why doctors refuse to treat a symptom by addressing the causes.
Allopathic health care treats symptoms, and Obamacare continues this fine tradition.
Learn the rules so you know how to break them properly.
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Without specifying what precise ailments she was suffering from, it's impossible to judge whether or not the NHS failed in that situation. The problem is, we never want to let our loved ones go, even when no medical technology can save them.
Last night, I was talking to a nurse who'd spent some time working in Dubai, and who had regularly encountered a particularly common form of cognitive disfunction: the belief that money can solve every problem. He was regularly confronted with people who thought that the reason that their relatives were dying was that they hadn't offered enough money. That there was an infinite sliding scale of increasingly expensive treatments, and somewhere in there there was a magic pill that would save their loved one.
The truth is, medical science has come a long way, but it still can't fix everything. So there's a possibility that she was sent home because there was nothing they could do but prolong the agony.
Rgasuya aata! : I have been coding Perl and cannot tell where my fingers are now!
Is that the same people who will cry that we should question climate change science will rush to accept this study on the face of it.
Of course, that works in reverse. The same people who say we should "trust the experts because we don't have degrees in this", will be first in line to question it.
Ahhh, partisan hypocrisy, may you never die.
It's not that we're better than the brits. They just considering it unethical to prolong death in the ways that we do here in the US. We can keep someone alive an extra 6-18 months with modern medicine. Quality of life during those months ia really crappy, but as long as you have an estate or medicare to draw funds from who cares?
The concern in Europe is about making end of life care as painless and dignified.
It's one of the reasons health care costs less there.
I would assume they used Great Britain because they're culturally more similar. Japan, for example, has a longer life expectancy, but there are enough cultural differences that you can't honestly attribute an increased life expectancy to differences in healthcare systems.
Plus you start needing to account for genetic and pathogen differences. I.e. if you pick a country in Africa with high rates of malaria and sickle cell anemia, they'll have a lower life expectancy regardless of how good their healthcare system is.
Possibly, you say.
In this I see more of the American emphasis on quantity over quality. You know: like their cheese.
What isn't included in this survey, I surmise, is that the sick Americans are kept "alive" longer, by bankrupting them on expensive medical technologies and pharmaceuticals. It is a life-extending technology that only kicks-in, once the damage has been done!
So, those last years are spent in drugged misery, draining the bank accounts and inflating the insurance-rates - leaving another generation with less than the preceding one.
"Flyin' in just a sweet place,
Never been known to fail..."
It's already rationed whether you like it or not. No country has an infinite amount of resources to fund unlimited medical treatment. The question is how to use our limited medical resources to treat people. It's hard to imagine how the US uses our resources more efficiently than other first-world countries (based on cost per person, life expectancy, etc).
Medicare is 'rationed' but is also more popular than any other private insurance program in the US and is one of the most popular government programs.
I've talked to American and British surgeons at lectures and read their articles.
One of the questions they always deal with is whether an operation will do more harm than good. That comes before they even get to the cost calculations.
A lot of major cardiovascular procedures have a surgical death rate of 3% or more. You don't want to take a 1/33 risk of death unless it's going to lower your subsequent risk of dying substantially more than that.
There are lots of people in their 60s who couldn't survive major surgery. They have poor function in their lungs, kidneys, or heart. They have pre-existing conditions, such as diabetes.
The New England Journal of Medicine just had an essay by an oncologist about a patient with untreatable metastatic bladder cancer disseminated to the liver. He said, "I'm not afraid of dying. We all have to go sometime, and I've had a good life." His sister had chemotherapy, and he didn't want to go through that. Then his son showed up at the next visit, insisted on aggressive treatment, and talked his father into it. The father had chemotherapy, declined rapidly, and died painfully in a few days. If his son hadn't insisted on chemotherapy, the father could have spent one more Christmas with his family. Doctors have lots of stories like that.
Surgeons in the U.S. have a financial incentive to operate; they get paid by the operation. Surgeons in the UK (if they work on salary for a government hospital) don't have that incentive. But they do have hospital administrators monitoring their surgery for death rates, appropriateness, etc.
In case you haven't noticed, seniors in the U.S. are on Medicare. Medicare funding decisions are made by expert panels of doctors, who decide whether a treatment is appropriate based on its effectiveness and safety, not cost.
There is a conservative meme, "Please, Senator, keep the government out of my Medicare." Actually, if you look at the facts, federally-run health care is usually pretty good, compared to the private alternatives. The problems come with state-run Medicaid, which many states refuse to fund at efficient levels, because of the anti-tax movement. It's the anti-tax voters who are telling people to curl up and die.
No, it's not.
Unlike "socialized medicine", Medicare does nothing to bring down the overall costs of health care. The government is still unable to negotiate with pharmaceutical customers to get lower prices, as is done in countries with universal coverage.
Plus, Medicare forces people without coverage to wait until they're 65 to get basic health care. By then, diseases which might have been easily prevented at age 45 or 50 have become symptomatic, which means there is less chance of cure and higher associated costs.
You are welcome on my lawn.
I think it's more likely that the metric used to measure health is a poor predictor of life expectancy. In fact, the article actually demonstrates as much. This could be because, say, the ability to run a few miles or the number of days spent with a cold each year might indicate good health, but doesn't mean you won't come down with a bad case of cancer or something else that may actually kill you. I suspect Americans are in worse overall health because they're less active and more overweight, wheras brits consume a whole lot more alcohol.
Even if the metric is a good predictor, the conclusions are still bogus. The medical system is not the "cause of death", so attributing death rates without considering the causes is silly. The UK has 36,700 more deaths in winter than in summer, mostly among the elderly. (Your blood thickens when you are cold and you are more likely to have a heart attack or stroke.) So the most likely cause of the difference in death rates would be that US homes are better insulated, being generally newer, and have better heating. I'd guess social factors also have a big impact. The elderly in the UK probably have less contact with the community than in the US (social breakdown is a bit of a problem in Britain at the moment), with impacts like "you didn't have friends looking in on you every day, so nobody told you you should really see a doctor about that."
Actually, it's more of the dangers of the lifestyle in general. More people are killed from more reckless behavior in the US then in the UK. We do more stupid shit on a regular basis like give some types of guns to anyone over 18 based on nothing more then their desire to have them. We allow juveniles to handle loaded firearms and other weapons (Bow and Arrows) unsupervised for extended lengths of time (while hunting) and so on. We have one of the largest recreational boating populations in the western world, some of the largest lands allotted to motorcycle, quad-atv, and other recreational uses.
But probably the number one risk that would alter the life expectancy quite a bit would be cars. In the US, there is/was about 2.28 cars per household (in 2008) while only about 1.1 cars per household in the UK (at about the time- from 2008 to 2009). This means that more people are driving in the US then in the UK. Gas is also cheaper which generally means that more people are driving for recreational uses verses more restrictive usage like necessities and so on. But something that probably would make this skewed even more would be that in the UK, you typically have to be 17 to get a drivers license and even then, you are restricted to what types of cars you can drive until your 18 or 21. In the US, it differs from state to state, but in most cases, you can start driving at 16 years of age, there is no limits on the types of cars (or non-commercial trucks) and in some areas, with certain hardships you can get a drivers license at age 14 (Ohio is one).
A reflection of this is strongly shown in the UK traffic death statistics in which they listed that in 2006, there were 5.4 road accident deaths per 100,000 population in the UK compared to 14.3 per 100,000 populations in the US. I don't car where you are, if you have almost three times as many people dieing from more or less random occurrences, the life expectancy will be lower and it won't be much on the grounds of health care provided Health care provided is equal in traffic fatalities because it's all either not in the equation (dead on the scene) or life threatening injuries in which not only does car insurance cover, it's illegal in the US for a hospital open to the public to refuse or limit emergency medical treatment based around the ability to pay.
My point is that it is easy to lie with statistics -- or to misapply them.
A common misconception.
Peer-reviewed publications require data to be submitted according to certain rules, because those rules make it difficult to lie with statistics.
The infant mortality statistics have been thoroughly reviewed. Their strengths and weaknesses are well known.
It's also well known that doctors who take the hardest cases have the worst outcomes.
It is true that it's easy to lie and misapply statistics in non-peer-reviewed publications, like the Wall Street Journal editorial page, or in white papers from (mostly) right-wing think tanks, or blogs. That's the kind of thing you get when you do a Google search for "infant mortality". But if you go to the major peer-reviewed journals, statistical weaknesses are acknowledged and actual lies are rare.
>>Yes, government *insurance* is very efficient. See a comparison of Medicare v. Medicare Advantage. Medicare Advantage is one of the most inefficient programs we have. We basically subsidize private insurers to do what Medicare already does more cheaply.
>>Government health-care? That's a different ball of wax.
You got it backwards.
Medicare? Medicaid? Cheaply? Only in the sense they underpay for certain services, which means that hospitals compensate by overusing the services they make a profit on, and fucking the taxpayer in the process. If Medicare worked efficiently, it could run on half the money it does know (and incidentally help balance the budget - crazy notion, I know!) Up to half of this - our biggest federal expenditure - goes to waste and fraud.
To compare with the VA system, Medicare/Medicaid costs about $10k per patient covered, including patient contributions. VA, $2,500 per patient covered, including money from third parties. This it's a perfect comparison for a lot of reasons, but it does help show how badly run Medicare/Medicaid is.
(Medicare Advantage is a whole 'nother issue entirely.)