The Myth about Life Expectancy

Posted by Stephen Weinberg, MD FACC FACP
Much has been made of the fact that the life expectancy in the US is lower than other industrialized nations. This fact has been touted over and over again as proof that the healthcare system in the US is inferior to other countries. But merely saying this, does not make it true. It is important to explore the issues a bit more to understand the data.
It is true that we, as a society, have a lower life expectancy. Information from the OECD ( Organization for Economic Co-operation and Development) indicates that for 2011 (the last year compiled) the best life expectancy was in Switzerland at 82.8 yrs. The average of the 34 reporting countries in the OECD was 80.0 and we were 78.7. We were 26th out of the 34. Not a particularly good showing.
Anyway, let's look at these numbers. Why are we so low? Research has shown that patients on Medicaid (the health program for the poor) have a life expectancy 10 years less than people with standard insurance. Furthermore, people who are uninsured also have a decreased life expectancy which is about the same as the Medicaid population. There are 50M people on Medicaid and 50M uninsured in the country. Let's assume that the people with standard insurance have the same life expectancy as Switzerland (82.8 years) and the others have 72.8 years (10 years less). The people with the lower expectancy make up 33% of the population of 300M. Taking a simple weighted average of both populations yields a predicted average life expectancy in the US of 78.6 years which is almost precisely what was found in the OECD data. So, this indicates that those of us who have had a lifetime of standard health coverage have the same life expectancy as the best country in the world. Unfortunately, the other 33% of us have a value lower than Slovenia (80.1 years).
So why do we have this huge disparity despite spending all this money?
The answer is complex and that is where the pundits and legislators fail to truly address the situation.
We have one of the highest rates of traumatic deaths in the world, including vehicular, murder, suicide, accidents. Our death rates from HIV/AIDS, mental illness, Alzheimers are also one of the highest in the industrialized world.These illnesses do not lend themselves well to preventive medical care. On the other hand, cancer and hardening of the arteries, (ischemic diseases) have death rates much below average. These illnesses are cared for and prevented by good medical programs.
We don't have the benefit of a relatively homogeneous genetic pool, like most countries, where certain diseases are much less common. An example is Japan where ischemic heart disease is fairly uncommon.
We have great societal differences as it relates to obesity, which leads to diabetes, compared to other countries.
Additionally, we have a significant population in the US (100M people or 1/3 of our population) that has not had comprehensive health insurance coverage and access to care so they are, in general, less compliant with taking medication, obtaining timely medical care, eating properly, and having checkups, and taking care of themselves. As a result, they develop serious illnesses at a young age that then require emergency care at great expense and die prematurely.
"So what", you say. "All of this is just a bunch of numbers that really don't have any meaning for me". Well, not so fast. One of the major arguments set forth to justify radical changes in our healthcare delivery system is that our life expectancy is lower than it should be compared to other industrialized countries. (The other issue is cost which will be addressed in a future post.) That is true for the 1/3 of our population without private health insurance, but it is not true for the 2/3 of us that have such coverage. With changes designed to affect everyone, without good scientific evidence that they will be effective, it may mean that the vast majority of us living full lives may suffer as a result. Money may be diverted, physicians and hospitals may be incentivized to ration care. We certainly need to develop programs that will improve the health of those disadvantaged, but not harm others.
It is vital that all of these discussions and issues are transparent and that major changes to our system are not made in the absence of convincing evidence they will work and not cause unanticipated problems.