As we have noted before, a segment of our health intelligentsia loves to berate the US health system for spending more and having worse outcomes than other developed countries. The cost differential has repeatedly been shown to be due almost exclusively to higher unit costs, so anytime our brave leaders want to cut physician pay, hospital reimbursements and drug and medical device prices by a third, we can fix the spending gap. Not exactly sure what overall good that will do our economy. And outcomes comparisons are simplistic as well. One example is use of life expectancy, which is lower in the US. A research letter published in the current Journal of the American Medical Association looks at the relationship between injury rates in various countries and life expectancy. (JAMA Letter) We have a culture in the United States that includes a lot of dangerous activities not found in other nations, and those activities result in a fair number of early deaths. Those activities include being part of heavily armed gangs, high rates of smoking, drug and alcohol use, a lot of reckless driving and so on. The authors of the letter acknowledge that it is hard in all developed countries to track exact causes of death, as the data is collected, kept and coded in different ways, but they looked at three common injury-related causes of death–car accidents, being shot and drug poisonings. They used data from 2012 and compared the US and 12 other developed countries, mostly in Europe and Japan.
People who die from these three causes do so at a relatively young age, and therefore have a significant effect on overall average length of life. The life expectancy gap for men is 2.2 years; for the 12 comparison countries life expectancy is 78.6 years and for the US it is 76.4 years. There is the same gap for women, with the international comparison group averaging 83.4 years and the US women 81.2 years. Just these three injury-related causes of death accounted for 48% of the life expectancy gap among men and 19% of the gap among women. These causes of death have nothing to do with the performance of our health system; in fact it probably prevents many victims of gunshot wounds, overdoses and car accidents from dying. These are serious social and cultural problems, but to use their effect on life expectancy to criticize the quality of health care delivered in this country is total BS. A full and complete understanding of causes of death and their effect on life-expectancy rates would probably remove the gap entirely and I suspect there are subsegments of the US population that have higher life expectancy rates than do similar segments in the comparison countries.