Quote Of The Day

What about life expectancy statistics — a favorite of the critics, since Americans don’t score very high? It turns out that when you remove outcomes doctors have almost no impact on — death from fatal injuries (car accidents, violent crime, etc.) — U.S. life expectancy jumps from 19th in the world to number one!John Goodman, answering the question, Do We Really Spend More and Get Less with regard to Healthcare?

20 Responses to “Quote Of The Day”


  • I don’t see this claim justified in your source. For instance look at slide 16. Future years of life expected for those that have reached age 60 is greatest in Japan. Switzerland, Sweden, Italy, France, Denmark. Actually they are all beating us except the UK, which is tied with us. Are the elderly dying from car accidents and violent crime?

  • Btw, that was more in jest…I still need to look more into the study.

  • Jon – When you say slide 16, are you looking at table 1-1? Because that table shows that UK, Germany, and Canada are tied with the US (at least for males). And when you say “other countries are beating us”, the table shows that they have an extra 1 or 2 years after the age of 60. It would not surprise me if this is due to non-medical issues, such as car accidents.

  • Yes, table 1-1. The claim is that the US has the highest life expectancy in the world. If male life expectancy for Canadians is tied with US males, but female life expectancy for Canadians exceeds US females, then overall Canadian life expectancy exceeds US life expectancy and the claim in this post is false.

    Like I said, the UK is tied with us. Like I also said, maybe elderly Americans are dying in violent crime or car accidents. I looked at life expectancy at 60 because I thought it was the closest thing in the slides that corrected for car accidents and violent crime. Violent crime and auto accidents effect youth more I assume.

    Notice the hotlink is to “U.S. life expectancy jumps from 19th in the world to number 1!” Is that actually in the slides? I didn’t see it.

  • I took the point about accidents and age this way: There are the same number of accidents (and violent crimes, etc) for the young and old, possibly even more for the young than for the old; but chances of recovery for the old is lower.

  • I’ll tell you one thing. Using a Powerpoint presentation for a link doesn’t work for me. There’s no text, very hard to interpret, it just leaves everyone with a lot of guesswork.

  • I wouldn’t totally be surprised if the US did well by some measures. We spend so much you’d think we’d be on top in some ways. But it seems there’s a lot of ground to make up on the Japanese in elderly violent death and car accidents. Seems implausible, but maybe.

    Life expectancy for Cubans isn’t bad. Quite close to the US. Looks like they’ve beaten us in recent years, though we just jumped ahead of them barely more recently. They spend something like $250/capita. We spend over $7K.

  • Call me a contrarian, but I think alot of it has to do with this. We give healthcare WAY TOO much credit. When at best, it helps at the margins – extra year here, extra month there.

    The real gains are in life style choices. Cuba, for example, has comparable results mainly because they are poor: they have to bike to work, walk to work, do their own house work, cook at home, etc.

    In a way, yes, wealth makes us sedentary, and that makes us unhealthier. And healthcare can only reverse so much.

  • Take a look at Russia and how it fared when the state run health services collapsed and market reforms were imposed following the collapse of the Berlin Wall. A huge immediate drop in life expectancy. They were dying by the millions. This is a huge factor.

    Haiti also has all the walking, biking, and home cooking. But unlike Cuba there’s no universal health care.

    Remember, when your goal is profits, not health, you aren’t going to put as much emphasis on cheap preventative behavior. Why? There’s no money in it. Maybe Cuba, since they lack money, focuses on less profitable preventative measures. Less chemotherapy, insulin, and statins (extremely profitable). More nutrition (not as profitable).

  • Can you provide your sources on Russia? What makes you think it was the collapse of the state run health services, instead of say, crime, or other variables?

    With that said, I am not making the claim that healthcare is completely worthless. Certainly I would expect, say, infant mortality to significantly worsen if tomorrow all OBGYN’s quit. My point is that it is largely a waste. The link in my previous post makes the claim that roughly 50% of it is a waste. Read the link. I’d be interested to hear your well thought out response.

    Regarding Haiti, there it is basic nutrition and health. Again, I am not making an extreme argument here. I’m saying once you have the basics covered, healthcare matters alot alot less.

    Oh and, WikiLeaks, showed what Cuba healthcare is really like (click here).

  • Russia is just a test case where we can compare the non free market and then free market methods. See here:

    http://www.newint.org/features/2004/04/01/facts/

    There were other factors that effected health as you can see at the link, so it’s not all universal coverage.

    Our medical expenditures are certainly wasteful and could be cut in half. The goal is profit, not health. So medicines over preventative measures, as stated at your Cato piece.

    Truthfully nothing too surprising at the Wikileaks disclosures on Cuba. It’s a very poor country of course. It is amazing what they are able to accomplish with so little. Also they have to endure a lot of terrorism as you know.

  • Jon,

    Your link basically states: • Male life expectancy went from 64.2 years in 1989 to 59.8 in 1999. The drop in female life expectancy was less severe from 74.5 to 72.8 years.3

    Okay – but how does this relate to the coverage??? I could just as easily cite that as evidence for the rise in crime, etc.

    You made a stronger claim than simply life expectancy dropped – you linked it to the collapse of the state run health services. Do you have more proof than merely conjecture?

    I didn’t click through all the links…so if there is something I missed, please point me towards it.

  • No, No, No, In Cuba it’s worse then any of you think.

    In many hospitals you have to bring in your own medicines’, bed sheets etc etc etc.

    Please!!! There is NO comparison. Just don’t go there, you don’t know.
    One of my Family members IS a Doctor there.

    You can’t even get the basics “Over counter medicines” unless you go into the black market.

  • I think your question well illustrates the difference between you and me. I’m more scientific minded. You are theoretical. You think health care plays little role and you offer no tests. That would be scientific. It makes sense to you. That’s the main thing. Not true for me. I want to look at how things play out when universal health care is brought on line or removed. The Soviet Union is a case in point. We could also look at the effects of the embrace of public universal care wherever that has been tried and I suspect we’d see good things.

    To ask as you do how this proves that health care was the cause is to misunderstand the nature of science. Precisely the same thing could be said of smoking and lung cancer. You can’t prove that smoking causes lung cancer. What you do is you look to correlations. What effect on lung cancer was observed when usage rates declined?

    That doesn’t prove anything, says RJ Reynolds. Sure. But for a scientific minded person that matters. Same with regulations on lead in gasoline. You can’t prove that lead caused brain defects. In fact you can’t prove gravitation. What you do is you observe what happens when you drop a ball and draw an inference.

    The Soviet Union is one data point (or you could say it is several because several states were involved) and I’m not saying it’s conclusive. But I’m just bringing data into the debate. Given that the only data we have shows a negative correlation I think that’s the most plausible conclusion, but without additional data (which I think can be produced) my confidence level would have to remain low. For me though your conclusion, which comes with no data of any kind, seems even less plausible.

  • Let me ask again: You made a stronger claim than simply life expectancy dropped – you linked it to the collapse of the state run health services. Do you have more proof than merely conjecture?

    I know you like making conjectures Jon, and are trying hard to avoid having to prove your claims – but I am not going to let you. Do you have stronger proof than merely conjecture?

    If the answer is no, say so – don’t hide it behind some “I am more scientific than you are” copout because conjectures, my dear friend, are not scientific it’s speculation. I think it’s more scientific to substantiate claims before you make them – but that’s just me.

  • The link between smoking and lung cancer is in a sense conjecture. You can’t actually prove the causal link. But I say conjecture, which is a conclusion based on incomplete information, is better than a conclusion based on zero information. That’s how science works. You can never have complete information. We don’t have complete information on gravitation. But so what?

    In science you don’t ask if a conclusion can be drawn with mathematical certainty. It never can. What you ask is, which conclusion is more plausible? We have your claim that the issue is that in Cuba they do their own house cleaning and bike to work. That’s fine. That’s a data point. But I point to Haiti, which has precisely the same conditions. No apparent health benefit for them.

    I take the Soviet Union as a data point. We have a case where health services collapsed and also death occurred on the scale of Stalin’s purges. It wasn’t bombs falling on them. Something else was killing them. Life expectancy collapsed as a result of so many people dying. So we at least have a test case for a state that had health services and then lost them.

    So the question is, which conclusion is more plausible? Health services are unrelated to health and it’s more about house cleaning and biking to work? Or the reverse? We have the Soviet states as a data point supporting my hypothesis. We have nothing as a data point supporting your hypothesis.

    Well, that’s conjecture you say. Is that all I have? Conjecture? That’s all any scientific claim has. Smoking and lung cancer or greenhouse gases and global warming. It’s conjecture. If you don’t understand that this is part and parcel to science then apparently you don’t understand science.

  • I want you (and the readers) to notice the difference between what we each consider “proof” and even “conjecture”.

    I argued, above: “We give healthcare WAY TOO much credit. When at best, it helps at the margins – extra year here, extra month there”. The justification for my claim is a link here.

    If you click on the link, you will notice careful extrapolation of data. Peer reviewed links. It is also an argument made from someone who is considered knowledgeable in health economics. Studies are provided. Experiments are done. Control groups are included. And careful conclusions are drawn.

    Notice my argument is not that healthcare completely doesn’t matter, or that basic healthcare is useless. So the Haiti rebuttal doesn’t address my argument. My argument is that after some basic level, the marginal difference has more to do with lifestyle choices than medical care.

    Jon, on the other hand, first doesn’t address my point. After correction, he provides what he considers proof for his side. Link here. If you look at the link, the only thing remotely related to his point is this claim: Male life expectancy went from 64.2 years in 1989 to 59.8 in 1999. The drop in female life expectancy was less severe from 74.5 to 72.8 years.

    That’s basically it. One data point. One data point in a time where many many variables were changing. One data point in a 10 year span! This is the time, let’s remember, that Russia was going through “shock therapy” – one of the most dramatic changes in it’s history. But this doesn’t matter to Jon. It’s all about “correlation”. Was this change in life expectancy due to crime rates? Jon doesn’t know. Was it due to demographic changes? No answer. For all we know, this could have been due to simply those affected by Chernobyl getting older.

    Nevermind the fact that even his claim, one could argue, actually points to the same conclusion as my argument. Remember, this is a time of DRASTIC change in Russia. Institutions were overturned. And, according to Jon, the state run health services collapsed – and what was the result of this? Life expectancy for males dropped by ~4.5 years and for females even less, 1.7 years – NOT EVEN a 2 year life expectancy drop over a 10 year period! One could argue, based on Jon’s data point that maybe even basic healthcare services doesn’t matter all that much???

    Regardless, Jon’s one data point is conjecture at best though really more like mere speculation.

    Yet with this difference in mind, Jon, strong with confirmation bias concludes our differences as: I think your question well illustrates the difference between you and me. I’m more scientific minded. You are theoretical.

    Wow, is all I have to say. Kinda reminds me of this discussion.

  • I think that’s a fair response. In other words, yes, you should reply to me and say “Here’s data on my side.” But look at the data you offer? What does it say? It says this is merely correlation, not causation. So you can’t prove something like this conclusively. You are stuck with conjecture. But you reply like these kinds of things are unacceptable. The very scientific method used in your source you object to when I do the same. We must look to correlations. We must live with the fact that we have incomplete information. That’s the nature of science.

    When the state run health services in the Soviet Union collapsed health indicators collapsed on virtually every measure:

    http://en.wikipedia.org/wiki/Healthcare_in_Russia#Reform_in_1991-1993

    According to published studies the cause is related to multiple factors, including the collapse in health care services:

    http://www.ncbi.nlm.nih.gov/pubmed/9508159

    Like I said above, no argument from me that health care expenditures are wasteful. CATO sees little correlation between expenditures and health. Expenditures and health are one thing. But universal care and health are another. Expenditures are driven by the for profit systems (extremely expensive in the US) and the public systems (driven by the desires of the population rather than investors, hence much cheaper). I’d be interested to see correlations in health by those dominated by for profit and those dominated by public. For profit of course will dominate in the traditional neoliberal zones. Haiti, Latin America, Africa. We are much more socialized here (public expenditure is still half of our health care expenses).

  • We obviously have a very different definition of “conjecture” and “correlation”. Looking at data the way you do, you would conclude that taking Tylenol must GIVE YOU headaches since an overwhelming amount of people who take Tylenol have headaches.

    Regardless, I encourage readers to read the link I provided and contrast that to what Jon provides. This asymmetry is a constant in our discussions. Yet I’m sure Jon walks away from every discussion thinking he is the actual scientific minded one.

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