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Why is life expectancy in the US lower than in other rich countries?

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Re: Why is life expectancy in the US lower than in other rich countries?

#61
post #6

There really are two Americas - wealthy america and the rest of america. I'll bet if you split America into two sets of counties, the graph would be much different -- one would be a super-outlier and the other a super-laggard. I know this personally, as I've spent 21yrs of my life in one half, and another 20 in the other half. I've also lived overseas for several years, and they also have stratas, but much less prono…

Which half made you happier?

Due to work, I spent:

- 3 months in Japan - 3 Months in Germany - 3 months in the US - 3 months in India

The transition was alarming. I see bits of both Germany and India in the US. Unfortunately (having grown up in America) I see the trend as towards India. I don't mean this as a cultural slight, but as a cultural observation. I've seen high-trust vs low-trust societies brought up many times on HN. Traffic was most pronounced. In Germany, they obeyed the rules to the extent they wouldn't J-walk even if there was no traffic. In America, you'd look both ways then cross. In India might makes right, big cars get the right of way, pedestrians have to be aggressive and just make their way, eyeballing cars down with a death stare of determination.

Anyway all this is to say, it seems like there are two types of wealth:

- In India, you can found a startup, make money, buy a Ferrari, but that would be a terrible move because if you drive it anywhere on public roads you will go max 30kph, and it will get destroyed on the roads - In Germany, you can have a modest Skoda and still hit 200 kph on their impeccable freeways with confidence that the person in the right lane will never, ever change lanes without a signal and mirror check

So, my personal take, and I realize that this is highly reductionist, but I hope, relevant is that there are two types of wealth:

1. a type where society is wealthy, and that translates into well being for the individual and the whole 2. a type where wealth is relative, and the wealthy take joy not in having an absolute sense of wealth (as in compared to a German), but as in "my neighbor lives in a shack and I live in a gated tower high rise"

I fear America is at a cross roads and will make a choice that makes us poor in a global sense.

Re: Why is life expectancy in the US lower than in other rich countries?

#62
post #7

We spend double, as a percentage of GDP, what any other rich country spends on health care, so that's not it.

A random blogger who no one's ever heard of explains this in excruciating detail and very persuasively:

https://randomcriticalanalysis.com/why-conventional-wisdom-o...

He agrees with the linked article that lifestyle factors are what drives the worse health outcomes in the US relative to other wealthy countries. They're not primarily driven by differences in access to or effectiveness in health care. He also makes the case for a few other very unintuitive points:

* Health care spending is a direct function of national wealth. If a country gets richer it spends more on health care, and every country at every time in modern history spends about the same amount on health care as a function of its wealth.

* The US looks like an outlier in health care spending because GDP is not a perfect measure of wealth. Actual Individual Consumption is a less well-known but much more relevant measure of national wealth. AIC shows the US is more of an outlier in wealth, which makes its high health care spending less remarkable.

* There's no magic bullet. Single payer nations pay less than the US mostly because they are less wealthy and health care spending is a function of wealth. Other countries have better health outcomes mostly because of demographics and culture, which can't be fixed by the health care system. And even though finding obvious waste and inefficiency in the US health care system is easy, at a macro level it doesn't look like the US is remarkably less efficient than other rich countries, and most spending goes towards things that patients want.

Re: Why is life expectancy in the US lower than in other rich countries?

#63

Earlier quoted context omitted.

Are other races somehow not American? I never understood this argument. "If it weren't for all those black people and immigrants we'd actually be really good! Those other countries are just too 'homogenous'. " And then somehow this fact apparently dismisses other countries efforts at providing universal/preventative healthcare and initiatives that the US simply does not.

Genetics are about 2/3s of life expectancy. If you wish to compare ethnically inhomogeneous populations versus those that are homogenous, your comparison is not useful for anything. Urbanized (or rural) Asians in the US live longer than Asians elsewhere. The same is true for Blacks.

That doesn't hold up. A lot of the countries compared aren't that ethnically homogeneous either. In fact, Australia, New Zealand, Spain, Switzerland, Canada, and Sweden all have a higher ratio of migrants per 100k population than the US...

Re: Why is life expectancy in the US lower than in other rich countries?

#64
post #16

Earlier quoted context omitted.

I don't think its so geographically aligned like that. Plenty of rich areas in Chicago, Houston, Dallas, Phoenix etc.

Data is 5 to 6 years old: County level: https://www.worldlifeexpectancy.com/usa/life-expectancy-by-c... State and county level: https://www.cdc.gov/nchs/data-visualization/life-expectancy/...

At the county level I dont think it neatly lines up to coasts vs interior. There's definitely a serious problem of the interior southeast though

Re: Why is life expectancy in the US lower than in other rich countries?

#65

Comparing ethnically homogenous countries to the US is meaningless and downright deliberately misleading at best. There is significant variation in every state by race. https://en.wikipedia.org/wiki/List_of_U.S._states_and_territ...

Having a look at how people with various ethnic background fare is interesting and can be essential to optimise the effectiveness of health policies by targetting the right groups.

However, they are still all US Citizen, there is nothing misleading about the article or their analysis unless you want them to start splitting the stats by 'race', which would be a strange starting point (why would ethnic background be a better way to group people than socio-economic brackets anyway?).

Re: Why is life expectancy in the US lower than in other rich countries?

#66
post #30

Wow, the difference between the US and Canada is a surprise, in particular the opioid overdoses and road accidents. I am a US->Canada transplant, and the cultural and economic differences here just don’t seem that stark. Yes, there is universal health care, obviously…but there is definitely not an abundance of easily available mental health care here, especially outside the major metro areas. And the health care in t…

There are dramatically more high density, high risk driving environments in the US versus Canada. I could also make some questionable generalizations about Canadian drivers versus US drivers.

And Torontonians could make questionable generalizations about Brampton drivers.

Though, now that I think about it, residential street speed limits are way lower here.

Re: Why is life expectancy in the US lower than in other rich countries?

#67
Just like @TuringNYC,I spent the early part of my life in the lower half of socio-economic ladder. With a bit of luck (and yes, work), I extracted myself from this group. I'm not rich, but I have zero debt. I own a house, multiple vehicles, and an 4 season expedition camper - free and clear. I have a rewarding and unusual career.

By contrast, the entirety of my close and extended family lives in poverty. Bankruptcy, car repos, eviction, and mortgage default are almost a game. MY father died at the age of 40. My grandfather: 36. My brother died at 42 (after a lethal encounter with police after speeding).

I'm 56 (The oldest of any male in two generations). I have multiple retirement accounts. First class healthcare. I take care of my Mom. I can't predict the future, but I suspect my economic success will allow me a longer, more fulfilling life.

I'm convinced that access to healthcare, decent work, and basic housing would have allowed my short lived male family members to live longer with a better quality of life.

Re: Why is life expectancy in the US lower than in other rich countries?

#68
post #57
post #46

Earlier quoted context omitted.

I think you have to go even finer grained than that. Chicago, for example. My old stomping grounds. The inequality within that city is stark. Glaring. The South and West sides are a world apart from the North side.

One side of the street is Little Italy, the other side is not someplace to hang out after dark.

That Andersonville to Uptown transition can be a shock.

Re: Why is life expectancy in the US lower than in other rich countries?

#69
post #12

Comparing ethnically homogenous countries to the US is meaningless and downright deliberately misleading at best. There is significant variation in every state by race. https://en.wikipedia.org/wiki/List_of_U.S._states_and_territ...

West Virginia is 92% non-Hispanic white (2018) and has the lowest life expectancy of any US state (74.8). Which clearly disproves that common hypothesis. https://en.wikipedia.org/wiki/List_of_U.S._states_and_territ... Life expectancy and overall heath in the US is strongly correlated to wealth. It’s a feedback loop, being poor directly results in worse access to healthcare etc, but also because it’s much harder for s…

[deleted]

Re: Why is life expectancy in the US lower than in other rich countries?

#70

"It's a poor nation with rich people in it."

Yet the median disposable income per person, after adjustments for government provided healthcare and education is enormously higher than any other nation, according to the OECD. https://data.oecd.org/hha/household-disposable-income.htm

Yes, hence the quip about "rich people in it".

A more serious way of putting it might be that the US is in raw dollar terms one of the richest countries in the world (certainly by far the richest large one), yet in many ways (infrastructure, quality of administration, political culture, etc.) it feels more similar to a middle-income one.

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