Thursday, November 7, 2013

Universal Health Care and Life Expectancy

It is very hard to come by good measures to compare health care systems. We can compare costs fairly easily, but it is much more difficult to compare the actual quality of health care offered. Instead of acknowledging this reality or trying to find better measures, commentators oftentimes use measures that tell us very little about the actual quality of a nation's health care.

The classic example of this is the oft repeated claim that "other countries with nationalized health care have lower prices and higher life expectancy than the USA". This is an entirely true statement, but the implication is that nationalized health care (or other forms of universal health care) is the cause of lower prices and higher life expectancy. 

The relative prices of different health care systems is a point I'll get to in a later post as it is quite complex. However, the claim that these systems increase life expectancy is an example of intellectual laziness. Life expectancy is impacted by many factors that have little to nothing to do with a nation's health care system. This is a point that Avik Roy made in a recent post, drawing on research from Robert Ohsfeldt and John Schneider. After controlling for international differences in car accidents and homicides, they found that the USA actually has the highest life expectancy even among developed nations.

Aaron Carroll also comments with a contrary view. Carroll points out, accurately, that people in the USA still lag in life expectancy after age 65. This metric should be less influenced by premature deaths from homicide and car accidents. However, as Carroll points out, people older than 65 in the USA are on a single payer system: Medicare. Some are also on Medicaid. So, the USA lagging in life expectancy above 65 is not exactly a point in nationalized health care's favor, as this is a group that is on a form of nationalized health care.

I found this old post from Tino Sanandaji comparing Sweden's life expectancy over time with the USA to be quite interesting as well. Here's an excerpt:

"Medicare was introduced 1965 in the US. Public health coverage for the elderly existed by 1950 in Sweden, but full universal coverage dates to 1955 in Sweden (a public health insurance was founded in 1891, and public municipal public health existed for even longer).

In 1950, before Medicare, and before Universal coverage in Sweden the difference was +2.6 at birth and +0.3 at 65. In 2001-2005 the difference between the Sweden and US was +2.7 at birth and +0.3years at 65. Identical!

First, regarding the life expectancy at birth we can note that 50 years of different health policy, labor mark policy, welfare state coverage seems to have had zero effect on total outcome.

Second the pattern of large differences at birth but small differences at 65 existed well before the introduction of Medicare in the U.S, refuting Yglesias and Krugmans automatic attribution of differences in outcomes to the differences to policy.

It suggests a shallow understanding of the world to attribute every national difference to policy. Reality is more complex than that. Health outcomes in Europe and the U.S differ for other reasons, especially having to do with lifestyle, including auto accidents, the murder rate, smoking, diet, and demographic differences."


The key takeaway here is that health policy seems to have very little effect on actual measures of public health. This is similar to the point I was trying to make with regards to the Oregon Medicaid study.

I'm not a supporter of a single payer or nationalized health care system in the USA. One of the main reasons is the lack of evidence that such a system would bring about large benefits. Even the most intelligent supporters of single payer are often guilty of falling back on this very weak argument on life expectancy (or a similarly weak argument on infant mortality), and that does not speak well for single payer.
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