Life expectancy can vary widely in the United States, depending on where you live. That's the finding of a study published in the Journal of the American Medical Association.
The study also shows something else that wasn't necessarily intended by the authors — namely, that all those claims about how the U.S. spends more money on health care and gets worse outcomes than any other industrialized nation are nonsense.
Overall, the life expectancy at birth in the U.S. is 79.1 years (76.7 for men and 81.5 years for women), the JAMA study says.
That's the number that countless reports about the quality of U.S. health care rely on. They all note that while the U.S. spends a far greater share of its GDP on health care, it has worse health outcomes, one measure of which always cited is longevity.
"At 17.1% of GDP, the U.S. devotes at least 50% more of its economy to health care than do other countries," notes a typical report, this one from the Commonwealth Fund.
Yet despite all this money, "on several measures of population health, Americans had worse outcomes than their international peers. The U.S. had the lowest life expectancy at birth of the countries studied, at 78.8 years in 2013, compared with the OECD median of 81.2 years."
Statements like this are almost always used in support of government-run health care. All those other countries, after all, have single-payer systems, or something akin to it. Only the U.S. relies largely on the private sector to deliver health care and fails to provide universal health insurance. Look at the debate over ObamaCare and you see this claim made constantly.
But as the JAMA findings make clear, comparing overall longevity numbers in the U.S. with those of other countries is highly misleading. And blaming the difference on health care is even worse.
The JAMA study found that life expectancy rates by county vary by a full 20 years. A county in Colorado has a life expectancy at birth of 87 years, while a county in North Dakota is 66 years.
Even within a state, there can be a wide range in longevity. In Texas, the life expectancy in Fort Bend County — southwest of Houston — is in the 80s, while in Polk County — which lies northeast of Houston — it is in the 70s.
The JAMA article also shows that these wide variations are not due to differences in the quality of health care — insurance coverage, number of doctors or the like — but to behavioral and socioeconomic factors.
Looked at individually, behavioral factors — things like obesity, inactivity, smoking, hypertension, diabetes — accounted for 74% of the variation. Socioeconomic factors — poverty, education, unemployment, racial composition — accounted for slightly less at 60%. But health care? It accounted for just 27% of the differences in life expectancy from county to county.
The study also noted that, when the three factors are combined, they account for 74% of the variation in life expectancy, and the contribution of socioeconomic factors and health care both shrink.
In other words, health care plays a minor role in explaining the differences in longevity within the U.S., while behavioral factors explain almost all of it. Presumably that's the case internationally as well. And wouldn't you know it, the U.S. has higher rates of obesity, heart disease, and other such ailments that result from behavior than other countries. The U.S. also has higher rates of drug abuse, homicide, auto fatalities, and other things that cut lives short.
Yet these crucially important contributors to life expectancy are never brought up, or fully explained, by people making these international comparisons. Instead, it's assumed that differences in longevity are a reliable proxy for differences in the quality of health care.
The other common measure of "health quality" — infant mortality — suffers similar problems when it comes to making international comparisons.
Meanwhile, when looking at health outcomes that are the direct result of medical interventions — say, cancer survival rates — the U.S. does better than other industrialized nations.
Does the U.S. spend "too much" on health care? You could ask whether we spend too much on vacations, or cellphones, or cars, or clothes. Who is to say?
Are we getting worse care than other countries? Only if you use misleading statistics like longevity.