Mexican-Americans, Cuban-Americans and Japanese-Americans live longer than Mexicans, Cubans or Japanese citizens. European-Americans do slightly worse than Europeans, but the gap in life expectancy between North Europeans and Southern Europeans is a similar scale in both continents.
Scots-Irish people have a particular life expectancy problem but they make up a higher percentage of the population in American. West Virginia and Glasgow have much lower life expectancy and higher opiate use than equivalent areas in other regions.
Epidemiology of life expectancy / population health outcomes has been studied for decades and the dominant / most consistent factor is societal inequiality. ie the more unequal a society is the greater the disparity and gradient in health outcomes ( and mortality ). This social gradient was observed and documented by Michael Marmot in the UK in the late 70s. The 2009 book "The Spirit Level" by Wilkinson and Pickett - noted that greater social inequality in countries independently correlated with lower life expectancy in those countries.
My impression is that almost every part of "The Spirit Level" has been completely debunked and is full of embarrassingly bad errors.
"Beware False Prophets re-examines the empirical claims made in The Spirit Level and finds that of the 20 statistical claims made in it, 14 are spurious or invalid and in only one case (the association internationally between infant mortality and income inequality) does the evidence unambiguously support their hypothesis."
Epic fail: the article you have posted is an opinion piece by a Conservative MP (who worked for a “pro market” think tank) that cites a (now removed) article from a right wing (oil company funded) think tank …
It’s also based on several “straw man” arguments that misrepresent claims made in the spirit level on order to discredit them.
I’m not sure what has led you to form that impression. If you did read literature and research publications on social determinants of health and health inequalities you might have a rather different “impression”
Would be good to check this point. When I looked at the data is was only broken down by racial categories rather than country of origin. But it did seem roughly true that Asian-Americans have life expectancies similar to Asian countries, etc.
For what it's worth, I think the comment on MR is about deaths that could be avoided from better healthcare versus deaths from accidents, rather than about age per se.
"The US tends to compare quite well on life-expectancy in later life, which is the point at which quality of health care (rather than e.g. traffic accidents) is a key factor in survival."
It seems they're giving life expectancy at older ages as some circumstantial evidence for that, and it's probably closer to the difference between deaths from diseases versus external causes.
How much does better health care help life expectancy? Like if an American paid for the best health insurance plan on the market, instead of getting something average, how much would that help their life expectancy?
The ability to pay for a high end health program is correlated with other life style benefits. If nothing else, a higher income makes it easier to eat healthier food, avoid physically grinding work situations, and find time for exercise. Getting a higher salary may also have required developing skills useful in advancing one's career as well a maintaining one's health.
Something like 2/3 of older Americans are obese. I think a high fat, processed food diet, sedentary life style, and the resulting isolation must all combine to shorten lives.
Thank science for GLP1 agonists which is now reducing this percentage and will do more so over the next few years as they become cheaper and more widely used.
Only one factor. Australia has high rates of overweight/ obesity but better health outcomes than most other country countries (many with much lower incidence of obesity)
I was wondering this. And what about number of Americans living in poverty, as compared to other wealthy countries -- higher stress, less of a safety net, poor diet?
Lower income Americans have poor diet because of bad food choices, not because they can’t afford nutritious food. And by World Bank measures, the US, similar to Europe, has a lower than 1% poverty rate.
Food is an interrelated factor but not the primary cuase of US's particularly poor health outcomes.
Food / nutrition is a social and commercial "determinant of health" and "invidual choice" is a factor that is interelated with social norms, advertising, educational status and economic factors ( eg subsidisation of unhealthy food)
Epideiological studies show that inequality is a greater factor than poverty (other than extreme poverty). Remeber US is a rich country (!) with poor outcomes - there are examples of poor countries with similar or better health outomes ( Puerto Rico, Cuba, Costa Rica, Lebanon and Panama have similar or better life expectancy that US
It is illegal for US hospitals to turn away emergency patients because of ability to pay. Which means it is expensive for people who do have insurance, since the hospitals spend lots of their own money on providing expensive treatment of poor people going to emergency rooms for common colds, or repeatedly for drug and alcohol use instead of actual emergencies. US emergency care is quite good overall, or the mortality rate for young people with gunshot wounds, car and motorcycle accidents and drug overdoses would be much higher.
On the other hand, going to the emergency room for cancer symptoms has got to have poorer outcomes than having your cancer caught earlier, by regular medical visits.
Here in Canada, at my age, I am entitled to a no-reason medical exam, including bloodwork, annually. My doctor can sense changes between routine exams and take prophylactic action, rather than my feeling bad enough to go to the ER.
Neither is a hospital that is required to "take you in" necessarily going to follow-up on whatever they treat you for.
A hospital emergency room visit is a pretty low bar for "heathcare". Rather, it's self-reported symptom management.
Most Americans also have free yearly medical checkups with bloodwork. I have low tier insurance and I know I have it. Getting people to go in for the appointment, is another issue.
Great work, a fascinating synthesis of data. Apart from the bad health results/costs in the US, it is notable how life expectancy appears (rather) low in Germany, along with many Eastern Europe countries, which lets wondering about possible explanations.
Did DDR have better healthcare outcomes and life expectancy than West Germany (assuming you don’t count the poor brave souls shot to death by the guards as they tried to escape East Berlin)?
Perplexity cites Ärtztezeitung: This assessment was not only observed in the USA. The GDR healthcare system was relatively egalitarian and heavily state-planned in terms of access, but suffered from material shortages and performed increasingly worse than the Federal Republic in terms of life expectancy. During the 1970s and 1980s, it fell behind the West German system, with the result that by the end of the period, medical outcomes were clearly worse than in the Federal Republic.
Germany wasn't unified until the 1990s and old East Germany still lags the west. Germans born after unification are in their 30s now, so those who grew up in East Germany are still dying at rates reflecting East German conditions. Odds are the medical and educational systems were not aligned until late in the decade, so Eastern bloc policies and economics are still driving mortality today.
Yea, at teen abortion rates, among other disreputable health statistics.
With it's patchy and uneven abortion laws between states, it's amazing that in countries where abortion is a right, it is actually much lower than in the US.
Thanks for this synthesis! I was wondering at the difference between the effects on life expectancy of public vs private financing schemes in health expenditure. Any insight on that?
The percentage of Americans without healthcare insurance is now 8% down from 16% in 2013. And Americans over 65 all have government run healthcare insurance.
As a dual citizen with experience in both Canada, and as a US citizen eligible for Medicare, I must note the two are vastly different.
I broke my wrist roller-blading in the US. The ER could not reduce it, and recommended surgery, and gave me several references. This was late on a Friday of a three-day weekend. The first I called at 8AM on Tuesday was able to take me the following day. Excellent!
Fast forward to my final follow-up, about eight weeks later. Soon after, the bills started coming in the mail — sometimes, 3-4 in one day.
Medicare only pays 80% of "usual and customary" medical costs. All told, the sum of nearly two dozen bills was over $80,000, of which, I was on the hook for over $4,000.
Just one example: there was a wrist brace for $185. It was no different than one you'd buy in a pharmacy for $19.95. Medicare covered 80%, and I had to shell out $37 — almost double what I could have bought it for in a pharmacy! (And before you ask, that didn't cover the cost of putting it on me, which was in a *separate* bill!)
When I returned to Canada, I showed my x-rays and the bills to my primary care physician. He was aghast! He said he'd expect that to be a $10k to $15k surgery — $20k tops — in Canada. And that was in Canadian Dollars, which are only about ¾ths of US Dollars. AND I WOULD HAVE PAID ZERO, $0, NADA, NOTHING! Most people are unprepared for a $4,000 medical bill after a sports accident.
If Medicare is your idea of the sort of "government run healthcare insurance" that people in other industrial nations enjoy, you need to get out more.
The overall number of Americans without health insurance dropped by 4.4 million from 2020 to 2024. These findings are included in a new report to be released on Tuesday by CDC's National Center for Health Statistics (NCHS)
Excellent article! Of course healthcare alone isn't the only variable in life expectancy. The US healthcare system is absolutely horrible, but other factors that affect these numbers are cultural and lifestyle. Americans drive more, have cities poorly designed for bikers and pedestrians, have crappy food systems, don't exercise much, are largely obese, and prioritize expedience and comfort over health and longevity. Maybe wealth, prosperity, and "progress" aren't all they're cracked up to be.
I have been wondering lately how much of the difference in healthcare costs are from insurance profits vs things simply costing more here due to our "anything goes" for-profit model.
I simply wonder if insurance companies (although they are clearly involved in inhibiting care though denials and that is a bad thing) are also a reason for high costs? Somehow I think not since they haggle with in-network providers to stay profitable and squeeze money out of them as well. In otherwards we could get rid of insurers and their profits, but the providers would just charge more for a procedure or visit, etc. I'm not sure a lot of savings would result.
So, although it might be good to not have insurance companies for many reasons, somehow I think they squeeze most of their profit when haggling with providers so where are the biggest costs coming from?
I'm not sure axing insurance will solve the expense problem although insurance companies are creating other large issues and deductibles are ridiculous.
Reducing costs seems to be done when government can step in negotiate prices or when a drug can become generic. Patents for new drugs seem to create monopoly environments and high prices here, where elsewhere, prices are negotiated.
Also why is it that Medicaid is so much more cost effective than Medicare?
Is it just the older population? It can't just be just that since lot of older and poorer people are on Medicaid as well as Medicare. Is it because Medicaid is somewhat restrictive? I mean a person on Medicaid is not going to be able to make an appointment at the Mayo Clinic.
I do not know. I do know that regular Medicare is expensive. I am paying 10X more than I was on the ACA exchange since I qualified for a subsidy and I still have extra out of pocket, etc. If I go to the wrong place or get the wrong tests I still pay out of pocket beyond my deductible on top of over 2,400 for regular Medicare and a lot out of pocket on top of that. As an old person, this is a lot. The ACA exchange was better.
The best health insurance I ever had was as a poorer single mom on Medicaid, not Medicare. On Medicaid there is no deductible, and on occasion a small co-py, so one never gets a bill in the mail and the providers are insurance companies, but they seem tightly controlled on what they can and cannot do. Thus, no bankrupts fear if one ends up in the ER and admitted to a hospital.
Now it is also true that AZ has an amazing Medicaid program called AHCCCS and that state had expanded Medicaid long before the ACA (one reason McCain was a thumbs down for the repeal was that his state, AZ already had expanded Medicaid, so the ACA was a boost to state coffers, plus he knew that the people of the state approved of expanding healthcare programs)
So, although we need universal healthcare and to make it so people do not have to worry about bankruptcy (the USA is way to stressful) is Medicare the model or Medicaid? And if it is Medicaid, it does use insurers.
Medicare for all will not save money, "if"one only thinks of money as the issue, and a lot of Medicare is now Medicare Advantage run my insurers (which is proving to be more expensive not less so). That does not mean that Medicare for all is not a good idea, but cost savings should not be why and I doubt that will be the case.
We have to know what the real problems are in order to fix them.
Clearly, the GOP or rather Trump is talking nonsense since we have had the "free market" before and it did not work and we needed the ACA to fix that and giving people some cash is not going to cover them if they get cancer. However, Dems who simply think getting rid of insurance will save a lot of money may not have it right either. Maybe the cost is not what the government should be concerned with, because after all, the money goes right back into the economy and healthcare creates a lot of jobs. Maybe the Healthcare Industrial Complex is an economic boost even when bloat is included. However, people should not have to worry that the treatment their dr says they need won't be covered.
You can see the divergence start when Reagan came into office. I remember a lot of talk about health care costs in the 1980s. $1,000 a year was a real shock when I had to pay for my own policy back then. (Have a good laugh.)
If you have ever been to a hospital, medical office or pharmacy, you would see a big chunk of the problem first hand. Take a look at what so many of the people working there are doing. An outsized number of them are dealing with health insurers. This is one of the things that has driven consolidation in the business, but each billing incident requires approvals which means that there is a person trying to get payment and someone on the other end trying to avoid paying..
If you go to a similar facility under a single payer system, there is still record keeping and often payment involved, but there are a lot fewer people doing this dance. There are people doing record keeping and some dealing with payment but the system is not fundamentally adversarial.
It's also not run for profit. It's either non-profit or regulated much like a utility back when medical costs were less insane. That means no insinuating middlemen like pharmacy benefit managers driving local pharmacies out of business and no need for sales and marketing.
I wouldn't mind as much if we were honest about it and ran it as a jobs program like some third world bureaucracy and regulated where the baksheesh flowed.
A quick look at 2023 mortality info in the US showed cancer, heart disease and accidental as the three highest mortality reasons.
The first two can be deemed lifestyle related for the most part and likely more prevalent at older ages.
So change lifestyle choices for reducing causes up to 65 and maintain access to healthcare for LE to 65 and then LE extension after 65 (Medicare and Medicaid)? But not the RFK way with supplements.
I don't know if the two top mortality reasons are the same for all Westernized societies. If so, general population access to healthcare is the most important - which is more prevalent outside the US - would show the improved mortality in OECD type countries.
One factoid is the US is by far the top meat/sugar consumer in the world but these are not as prevalent in so called Med type countries. Interestingly Asian ethnicity has the lowest mortality rate in the US (eat less meat/sugar in the diet?).
The highest mortality rate in the US is for Native Americans and then African Americans. I would say then that access to health care is the most important mortality reasons for them as it correlates to general income levels and affordability - as health care in the US is all private - compared to most other jurisdictions.
If you don't have a company plan, health care affordability will be your main problem in the US.
This article, while interesting, leaves so much unanswered. I do not believe that the color of your passport has any influence on your longevity. Nor does the amount my neighbor spent on his healthcare.
In addition to this breakdown, I would love to see breakdowns by (for example) national weight / obesity rates. Maybe national miles driven rates, doctors / nurses per capita, number of doctor visits per year, and number of prescriptions might also provide some useful insight. Smoking rates, and fast food establishments per capita might also be fascinating.
League tables--especially for such noisy and heterogeneous "teams" as nations--are not very helpful when looking for root causes and solutions. Indeed I would contend they are harmful because they seem to point at solutions (i.e. "just implement a UK-style NHS everywhere") when that solution could well function negatively in another state.
Thanks for the great article!
There looks to me like a potentially meaningful typo in the section for LE at 65.
'To be clear: healthcare alone determines longevity — social conditions, lifestyle, and prices matter too'.
I'm guessing there should be a 'does not' in the first part of the sentence.
Is this explained by composition effects?
Mexican-Americans, Cuban-Americans and Japanese-Americans live longer than Mexicans, Cubans or Japanese citizens. European-Americans do slightly worse than Europeans, but the gap in life expectancy between North Europeans and Southern Europeans is a similar scale in both continents.
Scots-Irish people have a particular life expectancy problem but they make up a higher percentage of the population in American. West Virginia and Glasgow have much lower life expectancy and higher opiate use than equivalent areas in other regions.
No good evidence for this hypothesis.
Epidemiology of life expectancy / population health outcomes has been studied for decades and the dominant / most consistent factor is societal inequiality. ie the more unequal a society is the greater the disparity and gradient in health outcomes ( and mortality ). This social gradient was observed and documented by Michael Marmot in the UK in the late 70s. The 2009 book "The Spirit Level" by Wilkinson and Pickett - noted that greater social inequality in countries independently correlated with lower life expectancy in those countries.
My impression is that almost every part of "The Spirit Level" has been completely debunked and is full of embarrassingly bad errors.
"Beware False Prophets re-examines the empirical claims made in The Spirit Level and finds that of the 20 statistical claims made in it, 14 are spurious or invalid and in only one case (the association internationally between infant mortality and income inequality) does the evidence unambiguously support their hypothesis."
https://www.theguardian.com/commentisfree/2010/jul/08/spirit-level-book-critique
Epic fail: the article you have posted is an opinion piece by a Conservative MP (who worked for a “pro market” think tank) that cites a (now removed) article from a right wing (oil company funded) think tank …
It’s also based on several “straw man” arguments that misrepresent claims made in the spirit level on order to discredit them.
I’m not sure what has led you to form that impression. If you did read literature and research publications on social determinants of health and health inequalities you might have a rather different “impression”
Would be good to check this point. When I looked at the data is was only broken down by racial categories rather than country of origin. But it did seem roughly true that Asian-Americans have life expectancies similar to Asian countries, etc.
It is interesting because Hispanics have significantly better health outcomes than Whites despite more obesity and poverty.
For what it's worth, I think the comment on MR is about deaths that could be avoided from better healthcare versus deaths from accidents, rather than about age per se.
"The US tends to compare quite well on life-expectancy in later life, which is the point at which quality of health care (rather than e.g. traffic accidents) is a key factor in survival."
It seems they're giving life expectancy at older ages as some circumstantial evidence for that, and it's probably closer to the difference between deaths from diseases versus external causes.
How much does better health care help life expectancy? Like if an American paid for the best health insurance plan on the market, instead of getting something average, how much would that help their life expectancy?
The ability to pay for a high end health program is correlated with other life style benefits. If nothing else, a higher income makes it easier to eat healthier food, avoid physically grinding work situations, and find time for exercise. Getting a higher salary may also have required developing skills useful in advancing one's career as well a maintaining one's health.
Is it diet, maybe?
Something like 2/3 of older Americans are obese. I think a high fat, processed food diet, sedentary life style, and the resulting isolation must all combine to shorten lives.
Thank science for GLP1 agonists which is now reducing this percentage and will do more so over the next few years as they become cheaper and more widely used.
Only one factor. Australia has high rates of overweight/ obesity but better health outcomes than most other country countries (many with much lower incidence of obesity)
I was wondering this. And what about number of Americans living in poverty, as compared to other wealthy countries -- higher stress, less of a safety net, poor diet?
Lower income Americans have poor diet because of bad food choices, not because they can’t afford nutritious food. And by World Bank measures, the US, similar to Europe, has a lower than 1% poverty rate.
Food is an interrelated factor but not the primary cuase of US's particularly poor health outcomes.
Food / nutrition is a social and commercial "determinant of health" and "invidual choice" is a factor that is interelated with social norms, advertising, educational status and economic factors ( eg subsidisation of unhealthy food)
What is your source for this?
Hannah’s own data for the poverty rate: https://ourworldindata.org/grapher/share-of-population-in-extreme-poverty?mapSelect=~USA
Epideiological studies show that inequality is a greater factor than poverty (other than extreme poverty). Remeber US is a rich country (!) with poor outcomes - there are examples of poor countries with similar or better health outomes ( Puerto Rico, Cuba, Costa Rica, Lebanon and Panama have similar or better life expectancy that US
mainly people dont dare to see a doctor of an ER, because it is too expensive. They come too late.
Whilst access to healthcare is a factor in health outcomes, but is not the biggest determinant of life expectancy
It is illegal for US hospitals to turn away emergency patients because of ability to pay. Which means it is expensive for people who do have insurance, since the hospitals spend lots of their own money on providing expensive treatment of poor people going to emergency rooms for common colds, or repeatedly for drug and alcohol use instead of actual emergencies. US emergency care is quite good overall, or the mortality rate for young people with gunshot wounds, car and motorcycle accidents and drug overdoses would be much higher.
On the other hand, going to the emergency room for cancer symptoms has got to have poorer outcomes than having your cancer caught earlier, by regular medical visits.
Here in Canada, at my age, I am entitled to a no-reason medical exam, including bloodwork, annually. My doctor can sense changes between routine exams and take prophylactic action, rather than my feeling bad enough to go to the ER.
Neither is a hospital that is required to "take you in" necessarily going to follow-up on whatever they treat you for.
A hospital emergency room visit is a pretty low bar for "heathcare". Rather, it's self-reported symptom management.
Most Americans also have free yearly medical checkups with bloodwork. I have low tier insurance and I know I have it. Getting people to go in for the appointment, is another issue.
Great work, a fascinating synthesis of data. Apart from the bad health results/costs in the US, it is notable how life expectancy appears (rather) low in Germany, along with many Eastern Europe countries, which lets wondering about possible explanations.
Czechia and Slovakia are more or less on the same level, and pay way less. lts say 2000 or 3000 $ insteadd of 12 000$
Its an outcome of capitalism
Did DDR have better healthcare outcomes and life expectancy than West Germany (assuming you don’t count the poor brave souls shot to death by the guards as they tried to escape East Berlin)?
Perplexity cites Ärtztezeitung: This assessment was not only observed in the USA. The GDR healthcare system was relatively egalitarian and heavily state-planned in terms of access, but suffered from material shortages and performed increasingly worse than the Federal Republic in terms of life expectancy. During the 1970s and 1980s, it fell behind the West German system, with the result that by the end of the period, medical outcomes were clearly worse than in the Federal Republic.
Germany wasn't unified until the 1990s and old East Germany still lags the west. Germans born after unification are in their 30s now, so those who grew up in East Germany are still dying at rates reflecting East German conditions. Odds are the medical and educational systems were not aligned until late in the decade, so Eastern bloc policies and economics are still driving mortality today.
USA! USA!
Hannah, this is a benefit of freeee-dum!
;-)
"WE'RE NUMBER ONE!"
Yea, at teen abortion rates, among other disreputable health statistics.
With it's patchy and uneven abortion laws between states, it's amazing that in countries where abortion is a right, it is actually much lower than in the US.
Maternal mortality, child poverty, etc.
beatiful capitalism
Thanks, Hannah. This should be required reading for all policymakers -- but that presumes that they care at all about Americans' welfare.
Thanks for this synthesis! I was wondering at the difference between the effects on life expectancy of public vs private financing schemes in health expenditure. Any insight on that?
Right! Especially since now, even more Americans will once again be uninsured and not keeping up with basic preventive care.
The percentage of Americans without healthcare insurance is now 8% down from 16% in 2013. And Americans over 65 all have government run healthcare insurance.
As a dual citizen with experience in both Canada, and as a US citizen eligible for Medicare, I must note the two are vastly different.
I broke my wrist roller-blading in the US. The ER could not reduce it, and recommended surgery, and gave me several references. This was late on a Friday of a three-day weekend. The first I called at 8AM on Tuesday was able to take me the following day. Excellent!
Fast forward to my final follow-up, about eight weeks later. Soon after, the bills started coming in the mail — sometimes, 3-4 in one day.
Medicare only pays 80% of "usual and customary" medical costs. All told, the sum of nearly two dozen bills was over $80,000, of which, I was on the hook for over $4,000.
Just one example: there was a wrist brace for $185. It was no different than one you'd buy in a pharmacy for $19.95. Medicare covered 80%, and I had to shell out $37 — almost double what I could have bought it for in a pharmacy! (And before you ask, that didn't cover the cost of putting it on me, which was in a *separate* bill!)
When I returned to Canada, I showed my x-rays and the bills to my primary care physician. He was aghast! He said he'd expect that to be a $10k to $15k surgery — $20k tops — in Canada. And that was in Canadian Dollars, which are only about ¾ths of US Dollars. AND I WOULD HAVE PAID ZERO, $0, NADA, NOTHING! Most people are unprepared for a $4,000 medical bill after a sports accident.
If Medicare is your idea of the sort of "government run healthcare insurance" that people in other industrial nations enjoy, you need to get out more.
Please cite a source for this
https://www.cdc.gov/nchs/pressroom/releases/20250624.html
The overall number of Americans without health insurance dropped by 4.4 million from 2020 to 2024. These findings are included in a new report to be released on Tuesday by CDC's National Center for Health Statistics (NCHS)
Excellent article! Of course healthcare alone isn't the only variable in life expectancy. The US healthcare system is absolutely horrible, but other factors that affect these numbers are cultural and lifestyle. Americans drive more, have cities poorly designed for bikers and pedestrians, have crappy food systems, don't exercise much, are largely obese, and prioritize expedience and comfort over health and longevity. Maybe wealth, prosperity, and "progress" aren't all they're cracked up to be.
Amazing research. Thank you!
I have been wondering lately how much of the difference in healthcare costs are from insurance profits vs things simply costing more here due to our "anything goes" for-profit model.
I simply wonder if insurance companies (although they are clearly involved in inhibiting care though denials and that is a bad thing) are also a reason for high costs? Somehow I think not since they haggle with in-network providers to stay profitable and squeeze money out of them as well. In otherwards we could get rid of insurers and their profits, but the providers would just charge more for a procedure or visit, etc. I'm not sure a lot of savings would result.
So, although it might be good to not have insurance companies for many reasons, somehow I think they squeeze most of their profit when haggling with providers so where are the biggest costs coming from?
I'm not sure axing insurance will solve the expense problem although insurance companies are creating other large issues and deductibles are ridiculous.
Reducing costs seems to be done when government can step in negotiate prices or when a drug can become generic. Patents for new drugs seem to create monopoly environments and high prices here, where elsewhere, prices are negotiated.
Also why is it that Medicaid is so much more cost effective than Medicare?
Is it just the older population? It can't just be just that since lot of older and poorer people are on Medicaid as well as Medicare. Is it because Medicaid is somewhat restrictive? I mean a person on Medicaid is not going to be able to make an appointment at the Mayo Clinic.
I do not know. I do know that regular Medicare is expensive. I am paying 10X more than I was on the ACA exchange since I qualified for a subsidy and I still have extra out of pocket, etc. If I go to the wrong place or get the wrong tests I still pay out of pocket beyond my deductible on top of over 2,400 for regular Medicare and a lot out of pocket on top of that. As an old person, this is a lot. The ACA exchange was better.
The best health insurance I ever had was as a poorer single mom on Medicaid, not Medicare. On Medicaid there is no deductible, and on occasion a small co-py, so one never gets a bill in the mail and the providers are insurance companies, but they seem tightly controlled on what they can and cannot do. Thus, no bankrupts fear if one ends up in the ER and admitted to a hospital.
Now it is also true that AZ has an amazing Medicaid program called AHCCCS and that state had expanded Medicaid long before the ACA (one reason McCain was a thumbs down for the repeal was that his state, AZ already had expanded Medicaid, so the ACA was a boost to state coffers, plus he knew that the people of the state approved of expanding healthcare programs)
So, although we need universal healthcare and to make it so people do not have to worry about bankruptcy (the USA is way to stressful) is Medicare the model or Medicaid? And if it is Medicaid, it does use insurers.
Medicare for all will not save money, "if"one only thinks of money as the issue, and a lot of Medicare is now Medicare Advantage run my insurers (which is proving to be more expensive not less so). That does not mean that Medicare for all is not a good idea, but cost savings should not be why and I doubt that will be the case.
We have to know what the real problems are in order to fix them.
Clearly, the GOP or rather Trump is talking nonsense since we have had the "free market" before and it did not work and we needed the ACA to fix that and giving people some cash is not going to cover them if they get cancer. However, Dems who simply think getting rid of insurance will save a lot of money may not have it right either. Maybe the cost is not what the government should be concerned with, because after all, the money goes right back into the economy and healthcare creates a lot of jobs. Maybe the Healthcare Industrial Complex is an economic boost even when bloat is included. However, people should not have to worry that the treatment their dr says they need won't be covered.
You can see the divergence start when Reagan came into office. I remember a lot of talk about health care costs in the 1980s. $1,000 a year was a real shock when I had to pay for my own policy back then. (Have a good laugh.)
If you have ever been to a hospital, medical office or pharmacy, you would see a big chunk of the problem first hand. Take a look at what so many of the people working there are doing. An outsized number of them are dealing with health insurers. This is one of the things that has driven consolidation in the business, but each billing incident requires approvals which means that there is a person trying to get payment and someone on the other end trying to avoid paying..
If you go to a similar facility under a single payer system, there is still record keeping and often payment involved, but there are a lot fewer people doing this dance. There are people doing record keeping and some dealing with payment but the system is not fundamentally adversarial.
It's also not run for profit. It's either non-profit or regulated much like a utility back when medical costs were less insane. That means no insinuating middlemen like pharmacy benefit managers driving local pharmacies out of business and no need for sales and marketing.
I wouldn't mind as much if we were honest about it and ran it as a jobs program like some third world bureaucracy and regulated where the baksheesh flowed.
A quick look at 2023 mortality info in the US showed cancer, heart disease and accidental as the three highest mortality reasons.
The first two can be deemed lifestyle related for the most part and likely more prevalent at older ages.
So change lifestyle choices for reducing causes up to 65 and maintain access to healthcare for LE to 65 and then LE extension after 65 (Medicare and Medicaid)? But not the RFK way with supplements.
I don't know if the two top mortality reasons are the same for all Westernized societies. If so, general population access to healthcare is the most important - which is more prevalent outside the US - would show the improved mortality in OECD type countries.
One factoid is the US is by far the top meat/sugar consumer in the world but these are not as prevalent in so called Med type countries. Interestingly Asian ethnicity has the lowest mortality rate in the US (eat less meat/sugar in the diet?).
The highest mortality rate in the US is for Native Americans and then African Americans. I would say then that access to health care is the most important mortality reasons for them as it correlates to general income levels and affordability - as health care in the US is all private - compared to most other jurisdictions.
If you don't have a company plan, health care affordability will be your main problem in the US.
this could be the area, where Minister Kennedy could show his competence
We don’t call them Ministers in the USA, we call them crazy vaccine deniers with brain worms.
This article, while interesting, leaves so much unanswered. I do not believe that the color of your passport has any influence on your longevity. Nor does the amount my neighbor spent on his healthcare.
In addition to this breakdown, I would love to see breakdowns by (for example) national weight / obesity rates. Maybe national miles driven rates, doctors / nurses per capita, number of doctor visits per year, and number of prescriptions might also provide some useful insight. Smoking rates, and fast food establishments per capita might also be fascinating.
League tables--especially for such noisy and heterogeneous "teams" as nations--are not very helpful when looking for root causes and solutions. Indeed I would contend they are harmful because they seem to point at solutions (i.e. "just implement a UK-style NHS everywhere") when that solution could well function negatively in another state.
High obesity rates in the US are surely a critical contributor. It'd be interesting to see how obesity correlates with these numbers.