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The Doctor Is In: National Health Insurance = Longer Life?
Many people in countries with socialized medicine outlive Americans. But is access to health care the reason?
The impact of obesity on health includes an increase in the following:
- High blood pressure
- Elevated cholesterol and triglycerides
- Arthritis and back pain
- Diabetes and insulin resistance
- Stroke and heart disease, including heart attacks
- Gallbladder disease
- Breathing problems, including sleep apnea
- Breast, Colon and Uterine cancer rates
- Incontinence, infertility and complications of pregnancy
Obesity is the second most preventable cause of premature deaths in the United States, accounting for 300,000 lives per year.
Although access to treatment for the complications of obesity may be linked to health insurance, there is no evidence that insurance — or even healthcare — impacts the prevalence of obesity. Body weight is influenced far more by behavior, genetic factors, environment, cultural norms, and socioeconomic status.
Good Health — Up in Smoke
Tobacco use is the number one cause of preventable mortality in the United States, linked to one in every five deaths. Tobacco use is associated with more deaths than AIDS, alcohol and illegal drug use, motor vehicle crashes, suicides, and homicides combined.
While a case may be made for decreasing tobacco use as a public health issue, smoking and the use of tobacco products are behaviors learned outside of the healthcare delivery system. Smoking prevention and cessation programs can be provided within communities successfully and cost-effectively, as demonstrated by the American Cancer Society and local demonstration projects across the country.
While access to treatment for tobacco-related illness is associated with health coverage, the decision to smoke or quit is related more closely to environmental and social factors than to health insurance or medical care. [Author's note: As doctors caring for patients who smoke, my colleagues and I profoundly regret this. Far more patients ignore our advice to quit than follow it, regardless of time spent counseling, warning, or cajoling. In four years of caring for women with breast cancer, I can recall only one patient who quit smoking on my recommendation. After her mastectomy, she wanted to have a complex type of breast reconstruction that was risky in smokers. She quit two days after I told her this.]
Violent crime
Among industrialized nations, the United States has the highest rates of childhood homicide. In the 1990s, among children ages 5-14, murder was the third leading cause of death. Overall, U.S. homicide victims are most likely to range in age from 18-34.
The American population most likely to be healthy is also the group most likely to die violently.
Washington, D.C. ranks highest among U.S. cities for murders per 100,000 people: 69.3 during the 1990s. New York City seems comparatively low at 16.8.
But the rate of murders per 100,000 citizens of Canada is 1.73. For Belfast, Ireland it is 4.4. In fact, figures for Sweden, Switzerland, Germany, France, and Denmark are all below 5 per 100,000.
Thirty-seven U.S. states rank higher than these North American and European countries for the number of citizens murdered each year.
The impact of violent crime on the life expectancy of U.S. citizens far outstrips that of European nations. The social and cultural implications of violent crime, important as they are, will not be addressed by health insurance. Access to healthcare is not the same as access to a safe, crime-free environment.
As you can see, comparing life expectancy in countries where government foots the insurance bill to our system here is like equating apples and oranges. Conditions relating to obesity, tobacco use, alcohol, and violencemake America unique. Adopting a national health insurance model will not necessarily lead to a longer life.
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Dr. Linda Halderman was a Breast Cancer Surgeon in rural central California until unsustainable Medicaid payment practices contributed to her practice's closure. She now serves as a policy advisor in the California State Senate.
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31 Comments
1. Smarty:You failed to do basic research on this. It is well documented that we record all premies as live births, most other countries don’t. Babies born under one pound are called live births here, in Europe and Cuba, forget it. This skews the numbers.
Jul 22, 2008 - 4:07 am 2. Joanie:Can’t believe the statement on smoking–especially compared to alcohol. If you’ve ever been a smoker and pass away — it’s automatically a “smoke related death.” Do you actually see more mortality in your patients who smoke — percentagewise?
Jul 22, 2008 - 4:31 am 3. Novathecat:In 2005 the CDC had to reduce the estimated deaths by obesity from 300,000 to around 26,000, based on a study by K Flegal of the NCHS. Please use current statistics when trying to prove a point.
Jul 22, 2008 - 4:49 am 4. Wildmonk:I agree with you wholeheartedly that it is differences in health behavior, crime, and the way that we count live births (thanks Smarty) that accounts for the difference in life expectancy. However, you won’t convince those already predisposed to Socialized health care if you make unfair comparisons like the murder rate in major cities with the overall murder rate in other countries (e.g. Washington DC or New York versus Canada). The people in this debate are pretty highly tuned to deconstruct arguments and this article – despite having the essential kernel of truth in it – will simply be too easy for partisans to deconstruct and thus ignore.
Jul 22, 2008 - 5:20 am 5. WJ:Not a fan of socialized medicine, but this is a poorly written article. The author writes mostly about US statistics in isolation with little comparison to other countries. This doesn’t make any sense to me as how can the reader judge whether the factors the author brings up are causing life expectancy figures to be lower in the U.S.
For example, the section on trauma. What are the comparable trauma statistics in Western Europe or the UK alone? I’m pretty sure that Europeans have car accidents as well.
Same arguement on the smoking section. Having lived in Europe, I can definitely state that I have seen a European smoke a cigarette. Therefore, I would assume that Europeans have had some adverse health effects from smoking as well.
Jul 22, 2008 - 5:54 am 6. reb shlomo:most other civilized countries, including Cuba, have universal health care. This has nothing to do with politics, socialism, or the insurance industry. Only the U.S. has overmedication for the rich & nothing for the disadvantaged. REB SHLOMO
Jul 22, 2008 - 5:58 am 7. goy:Was “longevity” ever a factor in the arguments for or against health care socialism? I don’t claim to have read everything on the subject, but this is the first time I’ve seen this tack and, IMHO, it’s a non-starter.
The main reason to resist health care socialism is that – at least as proposed here in the U.S. so far – it does nothing but multiply the influence of the one factor that has allowed health care costs to skyrocket. That one factor is employer-provided, comprehensive health care insurance.
What’s worse, any national plan to implement health care socialism places administration of the plan into the hands of those most likely to completely screw it up and least likely to be held accountable for the outcome: politicians and federal bureaucrats. Even Linda’s plan fails to recognize this.
IMHO, any “reform” that brings health care costs down and leads us away from health care socialism will need to include something along the following lines:
* Eliminate so-called “comprehensive” commodity health insurance plans entirely. We can legislate these away over a period of years IF we are willing to recognize that these plans are directly responsible for the dynamics that have caused skyrocketing costs. Keep only catastrophic plans for those who feel the need for them, and administer those as group plans through local municipalities, instead of through employers.
* Revert 95% of all monies that were paid by employers to health insurance companies back to employees. Everyone enrolled in a health care plan at work gets an instant annual raise of from $4,000 to $16,000 per employee / family, or more, depending on the cost of the plan they’re in.
* Direct the remaining 5% into a state (not federal) level fund that’s distributed to health care providers to recoup costs of providing care to those whom they’re required to treat but who are unable to pay, based on the facility’s need and inversely proportional to the tax breaks they may already be getting in their municipality (freeloaders like Yale-New Haven Hospital spring to mind).
* Let the resulting free market economics of direct-to-consumer commodity goods and services force the cost of day-to-day health care, equipment and pharmaceuticals back to a more reasonable equilibrium through profit reduction, cost cutting, salary reduction and efficiency improvements.
Consumers have been trained for decades to believe they can’t live without comp. health insurance. This was achieved as a kind of self-fulfilling prophecy driven entirely by major health insurers. A national, statutory requirement for health insurance will only make this problem worse.
Jul 22, 2008 - 6:26 am 8. Smarty:“Nothing for the disadvantaged”???
Well, I guess Medicare and Medicaid and the laws that require emergency medical treatment for all (including illegal aliens) are all in our imaginations.
Reb Shlomo, just change your name to “typical dishonest liberal jew”, a little truth in advertising to counter the lies when you type.
Jul 22, 2008 - 6:44 am 9. Jill:I began to read “Pajamas Media” to get away from the statistic spouting main line Media; who generally feels that using numbers to win an argument, even if the statistics are wrong, is ok. I am happy to see that the readership challenges (if they feel there is a discrepancy)the statistics of anyone they see using them to “prove” their point. Thank you.
Jul 22, 2008 - 7:11 am 10. David:Let me give you a good picture of what “socialized” medicine will be like. Go to http://www.lsu-unofficial.com. I am in the process of laying out what occured in my 6 years at LSU in Shreveport. Why is this somehting that you should see? It is because the LSU system is the first socialized medicine scheme in our country. It will be the model that will be used. Read my accounts and understand that I am telling only a small amount of what I saw and experienced.
Jul 22, 2008 - 7:44 am 11. exDemocrat:I kept waiting for a re-calculated life expectancy age after taking into account these other variables.
So, if we take OUT murders, trauma, etc. what WOULD our average life expectancy be?
Jul 22, 2008 - 7:51 am 12. Talnik:Smarty’s initial comment about premies is correct. The numbers are not comparable, negating this argument (Smarty’s second comment notwithstanding).
Jul 22, 2008 - 8:41 am 13. Pope Linus:Reb Schlomo: “most other civilized countries, including Cuba, have universal health care.”
Civilized countries, like Cuba? You don’t set a very high bar when defining a word like ‘civilized.’ And when Fidel Castro needed his massive stomach surgery a while back, why did he fly in a Spanish surgeon? One would think that the Worker’s Paradise, with it’s phenomenal health care system, could provide one for him.
Jul 22, 2008 - 8:56 am 14. Pope Linus:WJ: “What are the comparable trauma statistics in Western Europe or the UK alone? I’m pretty sure that Europeans have car accidents as well.”
But I think it’s safe to say that the average American drives far more than the average European. More cars owned, more cars driven, more roads, all lead to far higher incidences of vehicular death.
Jul 22, 2008 - 8:58 am 15. Dani:Besides the documentation problem mentioned by Smarty, the US has a preterm birth rate almost twice that of Europe- 12.7% and climbing. Most of the increase is due to multiple gestation (twins on up) and possibly advanced maternal age- things that are a result of advanced reproductive technology. American women want children and are willing to pay for it- but the technology isn’t sufficiently refined to prevent all multiple gestations. Comparing preterm birth and infant mortality rates in the US with any other country is truly apples and oranges, and of course, nothing skews longevity statistics like infant death.
I don’t really think we can or want to change this. Europe may have healthy individuals, but due to their declining birth rate, they have a dying culture. We may not live sensibly- we may eat too much, drive too fast and have too many kids, but at least there’s a good chance our culture, such as it is, will live to see the 22nd century.
Jul 22, 2008 - 10:16 am 16. pch1013:Smoking rates are about 30% higher in Europe than in the U.S., so mentioning smoking in any discussion of why “socialized” medicine doesn’t work is not only futile, but counterproductive.
Jul 22, 2008 - 11:15 am 17. cedarford:Smarty:
You failed to do basic research on this. It is well documented that we record all premies as live births, most other countries don’t. Babies born under one pound are called live births here, in Europe and Cuba, forget it. This skews the numbers.
Correcting for infant mortality, people in Europe and advanced Asian countries with various systems of universal health care still outlive Americans. And pay 20-50% less per capita in national healthcare expenses – less overhead.
No medical bankruptcies vs. the million a year in the US. No situation where their working poor natives get no health care coverage while their criminals and illegals get free care. No people subject to a lifetime ban from getting insurance by pre-existing conditions.
Nor are all systems beset with the problems of the UK system, which is a post-Stalinist scocialist model. In Japan, 5 keiretsus offer insurance for all, and Nipponese can pick the insurer, pick their health care provider, and free market forces continue to compete & work robustly. Singapore has a great system. So do France and Germany.
And employers are now near-unanimous that they cannot compete globally as well with the employer-provided healthcare system – and they are all working to cut benefits, coverage as much as possible.
Poor workers and part-time workers in America are also disincentivized from savings and investment. With all their money spent, they understand that the next major illness or injury will not wipe out what they sacrificed and tried to save for the future from hospital bill collectors and lawyers. They will still get health care, WalMart avoids health care coverage overhead for all it’s “part-time”, “subcontracted”, and “temp workers” – and local taxpayers or those with remaining employer health plans or expensive private insurance pick up the tab.
Jul 22, 2008 - 11:25 am 18. HeatherRadish:We just worked out with lawyers how to protect an Aunt’s assets from medical bill collectors after she lost her job in China outsourcing. And no private insurer would cover her despite her having the money to pay for it because she has a genetic spinal disorder.
“Do you actually see more mortality in your patients who smoke — percentagewise?”
I’m guessing it’s 100%, same as patients who don’t smoke.
Jul 22, 2008 - 11:27 am 19. goy:cedarford, contrary to what you may have been led to believe, in the U.S. comp. health insurance is a benefit which – much like the actual employment itself (in most states) – is at will. That is: at the will of the employer. Your comments indicate a deep misconception that health insurance is, or should be, an entitlement. What’s next? A food expense entitlement? Utility bill entitlement? Shouldn’t Wal-Mart part-timers have those entitlements too? And if not, why not?
With respect to the skyrocketing cost of health care, the notion that it’s somehow an employer’s responsibility to provide a health insurance benefit is one of the most economically destructive misconceptions in the U.S. at this point. The notion is anti-business and, ultimately, anti-consumer (see links in my post above for details). Employers are absolutely right to force the issue by cutting benefits and/or eliminating them altogether. And it has nothing to do with competing globally. On the contrary, forcing the issue will help shed light on how completely broken the comprehensive health insurance system has become and, ultimately, why it is both the enabler and the root cause of high costs.
On your apples-to-oranges comparisons of U.S. and other countries, I’d first submit that if Japan has the same sort of comprehensive health insurance arrangement as we have here, then “free market forces” are not what are keeping the costs down. When you find a way to legally apply price controls to health care goods and services, you’ll be able to implement a plan in the U.S. like those in the countries you’ve listed. Right now, that’s not feasible here.
Jul 22, 2008 - 1:24 pm 20. Health News » The Doctor Is In: Does National Health Insurance = Longer Life?:[...] cybilb wrote an interesting post today onHere’s a quick excerptMany people in countries with socialized medicine outlive Americans. But is access to health care the reason? [...]
Jul 22, 2008 - 1:25 pm 21. tanstaafl:But is life expectancy primarily dependent on having health insurance? Is access to healthcare services the main determinant of longevity?
I recollect reading a few years back of comparative statistics of older, well-insured people living in (say for purposes of argument, south Florida) to older less well insured people living in (again, for purposes of argument, south Missouri) and numbers of hospitalizations, procedures, tests performed…the gamut modern medicine has become.
You can guess which group had received orders of magnitude (I exaggerate) more treatment.
But statistics for longevity were not substantially different between the two groups.
I concluded at the time that we’re an over-treated, over-tested, over-hospitalized lot without it making a whole heck of a lot of difference.
I think more important than “access to healthcare services” is taking care of your own health, a novel idea in these strange times when, for example, your “obesity” is the fault of the fast food joint down the street. (you’re never at fault or responsible for your own circumstances, thank you liberals)
The “healthcare” obsession and the emphasis by politicians is what is so wrong with plans like Hillarycare, where she would require you to see a doctor regularly, ASIF, that alone would get you to stop eating all those burgers or get up off that large fanny and take a walk.
I recently saw a special on a Japanese guy in his 90’s with a very active brain as measured by scans. BDNF (brain derived neurotropic factor) is produced in walking & exercise. Good stuff for the ole white (and gray) matter. And myriad other advantages.
Jul 23, 2008 - 8:49 am 22. tanstaafl:…most other civilized countries, including Cuba, have universal health care. This has nothing to do with politics…
Always interesting to compare, for example, Castro’s “healthcare” (an entire wing of a hospital just to treat the old boy and a special treating physician imported from Spain during his gastrointestinal crisis)with that “healthcare” the average Cuban might receive.
I’d be hard pressed to believe that politics doesn’t play a role in treatment/medical options in any country, regardless of universality of healthcare.
I’d be hard pressed to believe that in the US Ted Kennedy (for his own condition and the medical trials of 2 of his children) doesn’t have access to options largely unavailable to most citizens.
I don’t think the “universality” of healthcare would affect these sorts of imbalances in any country.
Anyway, Canada and Great Britain are currently wheeling under the weight of the bureaucracy and costs of their longstanding systems.
When I was young, we (not a wealthy family) could pay for routine healthcare. Insurance was for catastrophic illness and was rarely used.
Now, even a routine 5 min. with a doctor costs an insurer something like $80, up from the $40 basic office visit of just a few decades ago.
So out of whack, everything is.
Jul 23, 2008 - 9:14 am 23. goy:“When I was young, we (not a wealthy family) could pay for routine healthcare. Insurance was for catastrophic illness and was rarely used.”
Same here. Same with everyone I know who’s even close to my age.
But then catastrophic coverage morphed into comprehensive coverage. And our skyrocketing health costs woes began as a direct result.
$80 sound low to me. Most people have no idea how much a visit to their doctor actually costs. The only thing that registers is the “co-pay”.
Jul 23, 2008 - 9:59 am 24. Sharonsj:If you think you get free health care in an emergency room, you’re nuts. If you needed life-saving care you might get it, along with a humongous bill that if you couldn’t pay would result in being sued. Last time I went to the emergency room with a broken arm I got a sling, aspirin, and a bill for an X-ray–and nothing else. What you call socialized medicine I would call finally getting treatment. I can’t afford any medical insurance, and although I would qualify as disabled, I can’t afford any of the tests to prove it, so I can’t get any help, not from the government, not from any organization. Finally a clinic treated me at a lower cost, but I still have to find the money for the pills myself. I have to get one of the drugs from outside the U.S. even though our wonderful legislature made that illegal. Medical assistance in this country is nearly non-existent and I’m just waiting for the rest of the fools on this blog to come down with a disease they can’t afford to treat.
Jul 23, 2008 - 11:18 am 25. AgingMom:(1) For years I have been seeing “human interest” stories of people from all over the world coming to the USA, legally or otherwise, to get medical treatment for all sorts of problems. We already know that illegal aliens use the emergency room as the source of much of their free medical care, including the birth of their anchor babies. If we make health care “free” everybody in the world with cancer, etc., will make a beeline for the USA. And we will be “too compassionate” to tell them to get lost. There is truly no upper limit on how much socialized medicine could cost in the USA.
(2) The system in Japan may work because it only treats Japanese people, who tend to take pretty good care of themselves and who are smart enough to read and understand the directions on the medications that they are given. Recent studies have shown that a significant portion of America’s underclass is UNABLE to read, understand, and follow the directions for their medications.
(3) German doctors often fly to England for the weekend to make extra money by working shifts in English hospitals because they are underpaid in Germany. Which means that they are exhausted whichever country they are working in.
(4) Today’s Telegraph or BBC online (can’t remember) had an article stating that most of this year’s crop of graduating doctors in Britain do NOT have jobs lined up even though the country desperately needs additional doctors. Apparently, the older doctors who have their own practices are afraid to hire any additional help because the government is opening new “polyclinics” and it is not known how much “business” the polyclinics will take away from the established medical practices. In Britain, the government is always setting “targets” for the health service to meet that lead to adverse outcomes. Example: The government told the hospitals that they had to treat everyone coming into the emergency room within a certain amount of time. Result: The hospitals ONLY unload ambulances when they are certain that they will be able to provide treatment immediately. In some cases, the ambulances are lined up outside the hospital for hours, unable to leave and provide ambulance service for others because they can’t unload the patient they already have. If you need an ambulance, there aren’t any available, they are all parked in front of an emergency room somewhere.
(5) Canada’s system only works because they have the hospitals of the Northern USA to provide neurosurgery and high-risk obstetrical care when their own overburdened system blows a gasket, and because wealthier Canadians often purchase U.S. medical services out of their own pockets. If the USA adopts socialized medicine, what country will handle OUR shortages of care? Mexico?
(6) I have had retired relatives on Medicare who had oodles of leisure time, and made all sorts of medical appointments for VERY minor medical problems. If you have “high” co-pays, people are going to complain that the poor are shut out of the system. If you have “low” co-pays, or no co-pay at all, I guarantee you that many of the elderly people in my neighborhood will visit at least one or two doctors each and every week. Lonely people LOVE to go to the doctor, and if it is free, they will abuse the system. Offer them free ambulance rides, and emergency room visits, and they will take lots of free ambulance rides and go to the emergency room on a regular basis. Showing up in the emergency room is often a way for them to get a visit from their children and grandchildren and to be the center of attention.
(7) I have no medical insurance myself, and I have had some serious problems. I think that the government should do something about the fact that the pharmaceutical companies seem to sell affordable drugs everywhere in the world except the USA, but having the government provide “free” medical benefits in our country, with its open borders, will be nothing short of a disaster.
Jul 23, 2008 - 10:28 pm 26. Akatsukami:“If you think you get free health care in an emergency room, you’re nuts. If you needed life-saving care you might get it, along with a humongous bill that if you couldn’t pay would result in being sued.”
So, then, you should countersue for the EMTALA violation, yes?
Jul 24, 2008 - 4:16 am 27. tanstaafl:Good points, AgingMom.
Also, goy, in your link, especially on the shift from medical insurance as catastrophic to medical insurance as comprehensive. And the AMA’s encouragement of same.
Which has impacted the plethora of tests, see esp. scans, and how medical facilities pay for all the new high tech equipment.
Naturally, your average patient wouldn’t be able to effectively handle those kinds of costs out of (personal) pocket. But the deep pockets of government and insurance quickly “shell out” for tests that doctors have managed to get onto “approved” lists.
Jul 24, 2008 - 9:52 am 28. Northern Light:The way I see this is that Dr. Haldeman believes that America’s lower life expectancy isn’t due to the lack of universal health coverage, it’s because Americans are fat, drunken, homicidal maniacs. I guess the Americans who visit Canada are exceptional. Most of the ones I’ve met were very nice and no fatter or drunker than the average Canadian.
Would the high homicide rate be due to the accessibility of guns in the USA? Oh, it can’t be. Americans just like to murder each other. Guns aren’t to blame.
Jul 24, 2008 - 2:46 pm 29. cas:Oh Lord, where to start with this subject?
Jul 25, 2008 - 7:51 am 30. Nancy Reyes:I have been trying for some time to find the “right to free lifetime medical care” in the US Constitution, which is STILL the overriding law in the US…nothing yet, but who knows what new “progressive” Supreme Court justices may find there…
I do not have the statistics to prove it, but my “guesstimate” is that a LARGE portion of the rise in Health Care costs is due to procedures / care / drugs that were simply not available before. These treatments have extended life expectancy worldwide beyond any expectation; simply compare the statistics from 1908 and 2008, for any country, and when analyzing the underlying causes, be sure to include the increase in the emphasis on PUBLIC health / hygiene (sanitation, disease epidemic prevention, immunization, etc.)
I believe that for the first time in the history of mankind, preventable disease is among the leading causes of death, as opposed to war, famine, trauma, etc. Why is this a bad thing? Just ask yourself; how prevalent was cancer before these radical changes took place?
Those commenters that attribute the rise in “childhood” death to murder, need to break those figures out by specific age group. I think they will find that “juvenile” offenders (i.e, teenage felons) contribute to those statistics overwhelmingly.
I agree with majority of the comments that the key to longer life expectancy / lower health care costs is PREVENTION; i.e., quit smoking, eat better, exercise more, get checkups more often (to detect conditions that are treatable early such colon or breast cancer). But Americans CANNOT be FORCED to take this advice, so why should taxpayers be FORCED to PAY for Health care for those who ignore this advice?
If socialized medicine would make Americans live longer, then the longest lived people would live on Indian Reservations, since all Native Americans with proper papers can get free medical care in the clinics, and there is an extensive outreach for social services, dietary instructions, help with transportation to specialists etc.
A similar outreach to poor rural and inner city folks by subsidizing Migrant clinics and other clinics has been less successful, and many inner city blacks distrust the medical system because of the Tuskeegee experiment (not to mention the snobbish superiority of a lot of docs, both domestic yuppies and foreigners).
Want to help people get healthy? Import IHS type people with cross cultural sensitivity to work in problem neighborhoods.
As for rural people, I quit rural private practice when my malpractice became higher than my take home pay. Again, subsidizing salaries and “respite” coverage would help docs settle in isolated towns…
As for obesity etc… there is an obesity epidemic here in Asia. Other countries are merely behind the curve…
Jul 25, 2008 - 6:26 pm 31. Smarty:We need to shoot the lawyers first, then compare health care costs. Risk avoidance procedures and practices are costing us a fortune.
Jul 25, 2008 - 7:16 pm