Life expectancy in the United States for someone born in 2018 is 78.7 years, up one-tenth of a year from 2017 but still below the peak in 2014 at 78.9 years. The rankings of leading causes of death remained the same but with deaths decreasing or staying the same in every category except influenza/pneumonia and suicide, where deaths increased. Health Care News discussed the report with Robert Moffit, PhD., senior fellow in Domestic Policy Studies, The Heritage Foundation and expert on Medicare.
Health Care News: The United States spends $3.5 billion on health care each year, more than any other country. However, life expectancy is nearly five years lower than some countries, such as Japan. What are we to make of this from a public policy standpoint?
Moffit: It is commonly argued that America spends more on health care and has the lowest life expectancy at birth (78.8 years) compared to Japan, for example, with the highest level of life expectancy (83.9 years). There is no simple relationship between health spending and life expectancy. Health spending on medical technologies, treatments and procedures to combat cancer, especially breast and prostate cancer, heart disease and stroke have had a positive impact on life expectancy, particularly among Americans over the age of 65. Based on the professional literature, the evidence there is strong. Spending to battle these major killers has been a sound investment, and a great return on investment. Concerning life expectancy in general and the current state of our “health care system,” there is a lot to unpack.
Health Care News: So, let’s break it down. The United States has somewhat of a quasi-private health care system where nearly 40 percent of Americans are in public coverage programs such as Medicare or Medicaid, and the rest pay for health care privately. It would seem like that would cover it all for helping Americans live longer.
Moffit: The United States, unlike, say Britain or Canada, does not have anything vaguely resembling a “system.” Rather, American health care is financed and delivered through large third- party payment systems, with different rules of eligibility and different streams of public and private funding. That is why international comparisons of the performance of the American “system” are often flawed. A person on a government program like Medicaid, for example, is likely to face steeper problems getting access to physicians and medical specialists and positive medical outcomes compared to, say, a person enrolled in an employer-sponsored health plan. Geography and demographics also play a major role; some states have higher rates of mortality while others are relatively low.
Health Care News: Are you saying money is not always a factor?
Moffit: Beyond standard systemic health care financing and delivery factors, and their impact on cost, quality and coverage, there are behavioral and other risk factors, which have little if anything to do with whether or not health care dollars pass through public or private accounts. American overconsumption of refined carbohydrates, among other factors, contributes to American obesity rates that are the highest in the world- and thus direct contributor to the high rates of chronic disease, particularly diabetes. And about three-quarters of all health spending is focused on treating or mediating the consequences of chronic disease. Indeed, a major 2017 study (Dwyer-Lingren, et. al) in the Journal of the American Medical Association, estimated that almost three-quarters of the variation in life expectancy in the United States was attributable to behavioral and metabolic risk factors.
In 2019, the Organization for Economic Cooperation and Development (OECD), which rated the United States as having the highest in rates of obesity, also recorded that the U.S. was followed in this category by Australia, Britain and Canada – in that order. The one thing that all three of these countries have in common- outside of the English language- is government-financed national health insurance.
Health Care News: It sounds like you’re suggesting that national health insurance is no guarantee of prolonged life, or any particular system for that matter, including one more free market, like the United States.
Moffit: Right, health coverage is no guarantee. Few economically advanced countries record America’s high level of traffic fatalities or have the homicide and suicide rates of the United States. And, then there is drug abuse and the opioid crisis. Of all the OECD member nations, the U.S. had the highest number of opioid-related deaths at 130 per million, followed by “single payer” Canada with 120 deaths per million. In answer to your specific question, it is hard to see how any of this is somehow related to “the free market”.
Health Care News: Life expectancy at birth peaked in the United States in 2014, right before Obamacare went into full effect. Obamacare, if anything, increased administrative costs. Do you think that explains the decline in life expectancy since then?
Moffit: I have seen no evidence that would lead me to believe that Obamacare has impeded progress in American life expectancy. Yes, we are spending far too much on administration, and not just because of the administrative costs of private insurance, but also because the burdensome transactional and compliance costs of the most highly regulated sector of the American economy; and the failure of administration manifest in Medicare and Medicaid fraud and waste (in the tens of billions of dollars annually) is compounding these high administrative costs.
America is an economically advanced country, and its health care arrangements are very different from other economically advanced countries. There are multiple variables affecting health and life expectancy. The bottom line is this: life expectancy as a metric by itself does not, in any dispositive way, prove the superiority or inferiority of any particular organization or financing of health care. There are so many other external variables.