Tag Archives: Prostate Cancer

American health care: does it cause poor life-expectancy and high infant mortality?

Probably one of the best health care policy experts writing today is Avik Roy, who writes for Forbes magazine.

Here is his latest column, which I think is useful for helping us all get better at debating health care policy. (H/T Matt from Well Spent Journey)

Excerpt:

It’s one of the most oft-repeated justifications for socialized medicine: Americans spend more money than other developed countries on health care, but don’t live as long. If we would just hop on the European health-care bandwagon, we’d live longer and healthier lives. The only problem is it’s not true.

[…]If you really want to measure health outcomes, the best way to do it is at the point of medical intervention. If you have a heart attack, how long do you live in the U.S. vs. another country? If you’re diagnosed with breast cancer? In 2008, a group of investigators conducted a worldwide study of cancer survival rates, called CONCORD. They looked at 5-year survival rates for breast cancer, colon and rectal cancer, and prostate cancer. I compiled their data for the U.S., Canada, Australia, Japan, and western Europe. Guess who came out number one?

Here is the raw data:

Health care outcomes
Health care outcomes by country and type of treatment

Click here to see the larger graph.

So, what explains this?

The article continues:

Another point worth making is that people die for other reasons than health. For example, people die because of car accidents and violent crime. A few years back, Robert Ohsfeldt of Texas A&M and John Schneider of the University of Iowa asked the obvious question: what happens if you remove deaths from fatal injuries from the life expectancy tables? Among the 29 members of the OECD, the U.S. vaults from 19th place to…you guessed it…first. Japan, on the same adjustment, drops from first to ninth.

It’s great that the Japanese eat more sushi than we do, and that they settle their arguments more peaceably. But these things don’t have anything to do with socialized medicine.

Finally, U.S. life-expectancy statistics are skewed by the fact that the U.S. doesn’t have one health-care system, but three: Medicaid, Medicare, and private insurance. (A fourth, the Obamacare exchanges, is supposed to go into effect in 2014.) As I have noted in the past, health outcomes for those on government-sponsored insurance are worse than for those on private insurance.

To my knowledge, no one has attempted to segregate U.S. life-expectancy figures by insurance status. But based on the data we have, it’s highly likely that those on private insurance have the best life expectancy, with Medicare patients in the middle, and the uninsured and Medicaid at the bottom.

I know that my readers who like to dig deep into economics and policy will love the links at the bottom of the article:

For further reading on the topic of life expectancy, here are some recommendations. Harvard economist Greg Mankiw discusses some of the confounding factors with life expectancy statistics, citing this NBER study by June and Dave O’Neill comparing the U.S. and Canada. (Mankiw calls the misuse of U.S. life expectancy stats “schlocky.”) Chicago economist Gary Becker makes note of the CONCORD study in this blog post. In 2009, Sam Preston and Jessica Ho of the University of Pennsylvania published a lengthy analysis of life expectancy statistics, concluding that “the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system.”

The funniest thing I have found when talking to people from countries with socialized health care systems, like Canada and the UK, is that they are woefully uninformed about American health care. They literally do not know about free emergency room care, which is free for anyone regardless of insurance – including illegal aliens. They do not know about our expensive Medicaid program, which helps people who cannot afford health insurance. And our very very expensive Medicare program, which provides health care to the elderly – including prescription drugs. I get the feeling that foreign critics of American health care are getting their views from amateur documentaries produced by uneducated Hollywood propagandists, or maybe from TV shows on the Comedy Channel. They certainly are not getting their information from peer-reviewed studies by credentialed scholars from top universities, like the ones cited above.

I have literally spoken to Canadians who think that people in the USA without insurance do not get treatment and just die in the streets from stab wounds. They don’t know about the emergency room rule, or about charity care, or about Medicaid and Medicare. There is a lot of ignorance up there – wilful ignorance, in some cases. And keep in mind that the average Canadian household is paying over $11,000 a year for this substandard health care! They are paying more for less, and that’s not surprising since a large chunk of the taxes that are collected for health care go to overpaid unionized bureaucrats. Naturally, when their left-wing politicians need treatment, the first place they go is to the United States, where they pay out of pocket for the better health care. But that doesn’t stop them from denouncing American health care when they are talking to voters.

Higher infant mortality rates?

One of the other common arguments you hear from uninformed people outside the USA is the higher infant mortality rates argument.

Here’s an article by Stanford University professor Scott Atlas to explain why the argument fails.

Excerpt:

Virtually every national and international agency involved in statistical assessments of health status, health care, and economic development uses the infant-mortality rate — the number of infants per 1,000 live births who die before reaching the age of one — as a fundamental indicator. America’s high infant-mortality rate has been repeatedly put forth as evidence “proving” the substandard performance of the U.S. health-care system.

[…]n a 2008 study, Joy Lawn estimated that a full three-fourths of the world’s neonatal deaths are counted only through highly unreliable five-yearly retrospective household surveys, instead of being reported at the time by hospitals and health-care professionals, as in the United States. Moreover, the most premature babies — those with the highest likelihood of dying — are the least likely to be recorded in infant and neonatal mortality statistics in other countries. Compounding that difficulty, in other countries the underreporting is greatest for deaths that occur very soon after birth.

[…]The United States strictly adheres to the WHO definition of live birth (any infant “irrespective of the duration of the pregnancy, which . . . breathes or shows any other evidence of life . . . whether or not the umbilical cord has been cut or the placenta is attached”) and uses a strictly implemented linked birth and infant-death data set. On the contrary, many other nations, including highly developed countries in Western Europe, use far less strict definitions, all of which underreport the live births of more fragile infants who soon die. As a consequence, they falsely report more favorable neonatal- and infant-mortality rates.

[…]Neonatal deaths are mainly associated with prematurity and low birth weight. Therefore the fact that the percentage of preterm births in the U.S. is far higher than that in all other OECD countries — 65 percent higher than in Britain, and more than double the rate in Ireland, Finland, and Greece — further undermines the validity of neonatal-mortality comparisons.

You can listen to a podcast with Dr. Atlas here, from the Library of Economics web site.

If you want to read more about how American health care compares with health care in socialized systems, read this article by Stanford University professor of medicine Dr. Scott Atlas. And you can get his book “In Excellent Health: Setting the Record Straight on America’s Health Care” from Amazon.

Obama’s policies ignore the needs and concerns of men

Christina Hoff Sommers
Christina Hoff Sommers

Christina Hoff Sommers re-caps Obama’s history of introducing anti-male policies at the American Enterprise Institute blog.

Excerpt:

The Affordable Care Act mentions “breast” 44 times, “prostate” not once. It also establishes an elaborate and expensive network of special programs to promote women’s health. Programs for men are nowhere to be found. What explains the imbalance?

When President Obama took office, he promised to insulate his administration from organized lobbyists. Yet, from day one, he granted the women’s lobby unprecedented influence. The results should trouble fair-minded feminists.

The 2009 stimulus program set the pattern. The president had originally called for a two-year “shovel-ready” plan to modernize roads, bridges, electrical grids, and dams. Women’s activists were appalled. Op-eds appeared with titles like “Where Are the New Jobs for Women?” and “The Macho Stimulus Plan.” More than 1,000 feminist historians signed an open letter urging Mr. Obama not to favor a “heavily male-dominated field” like construction: “We need to rebuild not only concrete and steel bridges but also human bridges.” Kim Gandy, president of the National Organization for Women (NOW), attacked the “testosterone-laden ‘shovel-ready’ terminology.” Christina Romer, who chaired the President’s Council of Economic Advisers, would later say, “The very first e-mail I got . . . was from a women’s group saying, ‘We don’t want this stimulus package to just create jobs for burly men.’”

The president’s original plan was designed to stop the hemorrhaging in construction and manufacturing while investing in physical infrastructure. It was not a grab bag of gender-correct transfer programs. The whole idea was to get Americans back to work, and it was “burly men” who had lost most of the jobs following the financial collapse of 2008. But as protests mounted, the president’s team reconfigured the bill according to NOW’s specifications. In a column entitled “Economic Recovery: What’s NOW Got to Do with It?” Gandy could hardly contain her elation: “As we looked through the act, over and over we saw reflections of the very specific proposals that we had made, and with big numbers next to them. Numbers that started with a ‘B’ (as in billion).” To read Gandy’s column is to understand why shovels are still standing idle and the stimulus was such a disappointment

A year later, the 2010 Affordable Care Act created an Office of Women’s Health, a National Women’s Health Information Center, a Coordinating Committee on Women’s Health, and more — right down to the mandate that universities pay for students’ birth-control pills.

The average lifespan of American men is five years shorter than women’s, and men contract the big diseases several years earlier. According to the American Cancer Society, men’s lifetime risk of developing cancer is approximately 1 in 2; for women, it is 1 in 3. But the Act is informed by the spirit of NOW and other women’s organizations such as the American Association of University Women. It would never occur to these groups that the health and longevity of men are matters of interest to women. To them, relations between the sexes are a zero-sum game — and their role is to fight for women and against men.

Most striking of all is the Obama administration’s blindness to the growing problem of male academic underachievement. Girls outshine boys by nearly every measure of classroom success. They earn better grades, take more advanced-placement and honors courses in high school, and are far more likely to go to college. Women earn 57 percent of bachelor’s degrees, 63 percent of master’s degrees, and 53 percent of doctoral degrees. According to a recent Harvard study (“Pathways to Prosperity”), the new passport to the American Dream “is education beyond high school.” Today, far more women than men have that passport.

Yet the president persists in acting as if our schools are a hostile learning environment for girls, one that warrants aggressive federal intervention. Pressured by groups like the AAUW and the National Women’s Law Center (NWLC), the White House recently announced that the Department of Education would be adopting a more rigorous application of Title IX to career, technology, and engineering programs in high school and college — to stop the alleged boy-favoritism that is shortchanging girls. To avoid federal investigations that threaten withdrawal of financial support, programs will simply enroll fewer males.

Male readers, did you know about these issues, and the others that Christina brings up in her article? Probably not. It’s a funny thing but sometimes I think that men do need to be a little more vocal about how laws and policies discriminate against us. After all, if we are poor and sick and unemployed, as Obama seems to want, then we cannot do much good for anyone. We need to take care of ourselves even if our ultimate goal is to serve others.

Evaluating common criticisms of American health care

Here is a must-read article from my friend Matt Palumbo at the American Thinker. It’s extremely high quality. (I removed the links in my excerpt – but he linked all the sources in his post)

Excerpt:

The oft-cited “46 million uninsured” is breathtakingly easy to break down to size.  Keep in mind that there is overlap in the following statistics, as many people listed in them belong to multiple categories.  Around 10 million of the uninsured aren’t even citizens.  Another 8 million are aged 18-24, which is the group least prone to medical problems.  The average salary of a person in this age group is $31,790, so affording health care would not be a problem.  Seventeen million of the uninsured make over $50,000 a year, and within that group, 8 million make over $75,000.  These people are usually referred to as the “voluntarily uninsured.”  Another large group of these 46 million are uninsured in name only, as they are eligible for government programs that they haven’t signed up for.  Estimates on how large this group is vary, the range being from 5.4 million as estimated by the Kaiser Family Foundation to as large as one third of all the uninsured, as estimated by BlueCross BlueShield.  The number of people without care because they cannot afford it is around 6 million — still a large number, but a fraction of 46 million, and no reason to restructure the entire health care system.

Then comes the issue of lifespan.  Of all attempts to discredit the American system, lifespan has been the worst.  Although lifespan gives a good indicator of a nation’s health at a glance, it does have its problems under analysis.  We get a strange paradox when examining two statistics: life expectancy and cancer survival rates.  Estimates vary on how we rank exactly; the World Fact Book showing that we rank as poorly as 50th worldwide.  Even the best estimates in our favor place us far behind most developed nations.  Despite this, the United States excels at cancer survival.  Of the 16 most common cancers, the United States has the highest survival rate for 13 of them.  Overall, the five-year cancer survival rate for men in the States is 66.3%, and 47.3% in Europe.  Women have an advantage too, with a survival rate of 62.9% in the States, and 55.8% in Europe.  So that said, how is it that our system takes better care of us, and doesn’t grant added lifespan to boot?  Quite simply, the lifespan measurement commonly cited doesn’t factor in many variables which shorten lifespan, many of which medical care cannot prevent.  Among these factors are murders, suicides, obesity, and accidents.

He looks at the uninsured number, the infant mortality rate, and other interesting things in the article, showing how the statistics that impugn the US health care system have been misused. There are some good articles linked, like this post from Commentary magazine by Scott Atlas, entitled “The Worst Study Ever?”. Atlas is the same guy who listed out how the US health care system compares to others, which I blogged about before.

You can check out Matt’s blog “The Conscience of a Young Conservative“. Not sure how scalable that blog name is. Because of the “young” part, not because of the conscience or conservative part.