Debunking myths about Americans' longevity gains
CHICAGO (Reuters) - Americans are living longer. We hear that claim often from politicians worried about entitlement spending, policymakers urging us to postpone retirement - even insurance companies pitching annuities.
And it's true: Average life expectancy in the United States rose by almost eight years from 1978 to 2011, to 78.7 years, according to a new report by the Organization for Economic Cooperation and Development. But here's something you'll hear less often: Longevity is rising much more slowly in the United States than in other major industrialized nations. In fact, the average life expectancy among member nations of the OECD is now higher, at 80.1 years, than the U.S. average. (The OECD comprises most of the world's major economic powers, including the United States.)
More telling are the gaps in longevity gains from age 65, because they wash out deaths due to infant mortality as well as most violent and accidental deaths. Here, Americans are near the bottom of the ranking of 34 OECD member countries - the only countries with smaller gains in longevity from age 65 over the past 50 years are Iceland, Hungary, Denmark, Greece, Turkey, Mexico and the Slovak Republic.
And the world's leading economies leave us in the dust. Consider just the OECD data on female longevity, since women are the star performers when it comes to longevity. An American woman who turned 65 in 2011 gained 4.6 years of average life expectancy compared with someone who turned 65 in 1960. But if that woman had been Japanese, she would have gained 9.6 years. A French woman gained 8.2 years; for an Italian, it was 7.3 years.
"Usually there is a strong relationship between income levels and life expectancy," says Mark Pearson, head of the OECD's health division. "The U.S. is an outlier - it's very rich, but has lower life expectancy than other countries."
It's no coincidence that all the longevity leaders have universal health insurance coverage - and the United States does not. In fact, almost every OECD member country has universal coverage, and most deliver better primary care to far more of their citizens than the United States. "In other countries, you are getting care at an appropriate level to avoid what are relatively mild conditions turning into something more serious," Pearson says.
In the United States, we're getting worse outcomes for chronic conditions like diabetes, cardiovascular disease and chronic obstructive pulmonary disease than other OECD countries. While these conditions often can be managed effectively on an outpatient basis, they frequently lead to hospitalizations and premature death in the United States.
None of which is to say the U.S. healthcare system doesn't have strengths. "Parts of the U.S. system are the best in the world," Pearson says. "You probably do have the best cancer care - the survival figures always are among the top three or four countries. If I found myself with cancer, I would be very happy to be treated in the U.S. It's just that the important bits of glue that make everything work together aren't functioning well."
Here's the kicker: We're spending far more than any other OECD nation for these inferior outcomes. In 2011, average per capita healthcare spending was $8,508 - more than double the OECD average of $3,322. Japan, the world leader in longevity gains, spent $3,213.
Pearson views universal coverage as a precondition to improved outcomes and longevity. He also notes that many longevity leaders don't have government-run single-payer systems, and have only achieved universality in the recent past.
"Many of these countries - like France and Switzerland - approached the problem with a patchwork approach. They didn't have systems that were very different from the U.S., they made very conscious decisions that no one should be left out."
Even after all the bloodletting from the launch of the Affordable Care Act (ACA) is over, we still won't have universal coverage. The law aims to cover 21 million low-income uninsured Americans through expansion of the federal- and state-sponsored Medicaid program. But when the U.S. Supreme Court ruled on the ACA's constitutionality last year, it gave states the right to opt out of Medicaid expansion - and 26 did so. That means 8 million people who could have been covered are likely to continue getting their care triage-style in emergency rooms. That will be expensive for hospitals, and it means those patients won't be getting the basic follow-up care that can help them recover and stay healthy. That will continue to drag down the U.S. performance on longevity in the years ahead.
Pearson thinks the ACA is a good start. "It's by no means a perfect piece of legislation, but when is health reform ever perfect anywhere? From the outside, it looks like a partial step, but welcome nonetheless."
He's less concerned about the short-term impact from the troubled launch of the ACA than he is about how the difficulties will affect the chances for improvements.
"What worries us about the trauma you're going through is whether we'll see any further reform over the next 20 years. If not, it would be a tragedy - and very different from other countries, where flawed reforms don't lead to an issue falling off the agenda, but rather to doing things better.
It's far too early to predict that the ACA's problems will prevent further progress, but let's hope not. The OECD report makes it clear that even after the ACA rollout is done, our healthcare system will need work, and lots of it.
For more from Mark Miller, see link.reuters.com/qyk97s
(The writer is a Reuters columnist. The opinions expressed are his own.)
(Follow us @ReutersMoney or here. Editing by Douglas Royalty)