Becker writes:
On the one hand, I have a kind of gut-sympathy to Becker's point. It seems overly crude to make sweeping statements based on different countries' lifespans. But is the US system really so effective? Consider this graph, from David Leonhardt of the New York Times:A study published in Lancet Oncology in 2007 calculates cancer survival rates for both men and women in the United States, the United Kingdom, and the European Union as a whole. The study claims that the most important determinants of cancer survival are early diagnosis, early treatment, and access to the best drugs, and that the United States does very well on all three criteria. Early diagnosis helps survival, but it may also distort the comparisons of five or even ten-year survival rates. In any case, the calculated five-year survival rates are much better in the US: they are about 65% for both men and women, while they are much lower in the other countries, especially for men. These apparent advantages in cancer survival rates are large enough to be worth a lot to persons having access to the American health system.
So look, as Ezra Klein notes, this isn't a reason to import Canada's health care system. It's a complicated picture rather than Exhibit A for either side of the debate. We do great, comparatively, with breast cancer, and
not so well with colorectal. The graph does not end discussion on the
issue of health care effectiveness, but it does complicate the
assertion that our cancer survival rate is an argument for the status
quo.
It is incredibly stupid to compare expenditure to outcome, unless you control for genetics, diet, exercise, smoking, risk, murder rate, accidental deaths, ...
The list could go on and on and on.
If you went skiing, fell and hit your head would you want to be in America or Canada?
To call the comparison simplistic is an extreme understatement.
One key reason as to why life expectancy isnt always the best measure is in the spending done in the US that it doesnt take into account spending done that while not prolonging life, does (at least theoretically) improve the quality of life.
Hip and knee replacements have a much higher incidence here in the US vs. the usual suspects of comparator countries. Hip replacement surgery is very expensive relative to the alternative of ibuprofren and a cane (or even a wheelchair).
Of course, this leads to questions on if 75 year olds should be getting hip replacements on the governments dime -- but that is a longer post.
I've read that those life expectancy comparisons start looking a lot better when you take non-healthcare factors into account. For instance we have shorter lifespans because we have way more traffic accidents because we drive way more.
Murder rate too, both take the young predominantly.
What is the life expectancy of a black male in DC, Baltimore or Philadelphia?
That has nothing to do with health care.
The only metric shown where the US is clearly hitting it out of the park, comparatively is in breast cancer. Do the "health care spending" numbers reflect that breast cancer probably has the highest visibility of any disease? After a generation of fundraising by millions upon millions of women - I get requests for donations to the Komen foundation or something similar roughly quarterly, and I donate at least once a year - there is both high visibility and scads of volunteer work and funding for breast cancer. There is some for the others, but not nearly so much. My guess is that the broad public interest and private donation financing has more to do with that number than the "health care system" as it functions without those things. Just something to think about in this equation.
And if my supposition is right, then we're really not getting better life expectancy for the money.
But if the difference in cost goes into QUALITY of life, then I'm all for it. Keep in mind that my grandmother in her 90s is still delivering meals on wheels, so I have high hopes for a long life and I'd rather it be a good one, not decades of agony or boredom.