Life Expectancy And Quality of Health Care

Often, proponents of nationalized health care will cite statistics indicating that the US lags with respect to life expectancy as compared with other industrialized nations that have some form of nationalized health care. Such comparisons are largely meaningless; life expectancy is not a meaningful metric of the quality of health care in a given country. As this white paper points out, in order to provide meaningful statistical analysis, a given metric must meet three criteria:

Any statistic that accurately measures health-care systems across nations must satisfy three criteria.  First, the statistic must assume actual interaction with the health care system.  Second, it must measure a phenomenon that the health care system can actually affect.  Finally, the statistic must be collected consistently across nations.

To summarize, a meaningful statistic must:

1. Assume actual interaction with the health care system
2. Measure a phenomenon that the health care system can actually affect
3. Be collected consistently across nations

Life expectancy statistics do not satisfy this three-pronged requirement; in fact, it fails at least two out of three.

Assume Actual Interaction With the Health Care System

Life expectancy cannot be assumed to have actual interaction with the health care system.

Consider the 15 leading causes of death in the US (note: the order changes slightly from year-to-year, especially after the top 5 or so; however, the composition remains essentially the same):

1. Heart Disease
2. Cancer
3. Stroke
4. Chronic Lower Respiratory Disease
5. Accidents
6. Diabetes
7. Alzheimer's Disease
8. Influenza/Pneumonia
9. Kidney Disease
10. Septicemia
11. Suicide
12. Chronic Liver Disease/Cirrhosis
13. Hypertension
14. Parkinson's Disease
15. Homicide

Note that Accidents (including motor vehicle accidents), Suicide, and Homicide cannot be assumed to have actual interaction with the health care system (with suicide being a possible exception). In fact, when adjusting for such non-health-related fatal injuries, the US ranks #1 in the world in Life Expectancy - indicating that, for those causes of death that can be assumed to have actual interaction with the health care system, the US health care system is the best in the world.

Measure a Phenomenon that the Health Care System Can Actually Affect

Given the leading causes of death, life expectancy does not measure phenomena that the US health care system can actually affect.

Consider the three leading causes of death: Heart Disease (30%), Cancer (23%), and Stroke (7%) cause 60% of all deaths in the US. These diseases are almost entirely caused by behavioral/lifestyle choices (diet, exercise, smoking, etc.). Including Chronic Lower Respiratory Disease (4%), which is caused almost entirely by smoking, and Diabetes (3%), which is caused almost entirely by diet, and fully 2/3 of all deaths in the US are caused by lifestyle and behavior choices over which the US health care system has no control or impact. Also including accidents (5%), the US health care system has no control over or impact on more than 70% of all deaths in the US.

And what impact do these behavioral/lifestyle choices have on life expectancy? According to one study, the listed criteria have the following (negative) impact on life expectancy:

1. Smoking, Hypertension, High Cholesterol: 10 years
2. Smoking: 6.3 years
3. Employment Grade: 5.4 years
4. Diabetes: 3.6 years
5. Cholesterol: 1.9 years

Other studies have concluded that eradicating cancer deaths would increase life expectancy by 2.7 years, and eradicating risks from heart disease, stroke, and diabetes would increase life expectancy by 14 years.

Efficacy of US Health Care System: Cancer Survival

Further, to the extent that the US health care system may impact the leading causes of death, the US health care system proves its efficacy. Consider cancer: the US dominates Europe with respect to 5-year survival rates for overall cancer, as well as for specific cancers:
And apparently, the Europeans didn't include cancers discovered only upon death - which further skews the disparity. Clearly, to the extent that the health care system has an impact on diagnosis and treatment of cancer, the US health care system far surpasses the health care systems in Europe - and Canada, too, for that matter.

5-year Cancer Survival Rates, US vs. Europe

Recall, the argument in question here is whether or not life expectancy is a meaningful measurement of quality of health care. To preempt some arguments:

1. It is a matter of efficacy, not of efficiency; thus, health care spending per capita or as a percentage of GDP is irrelevant. The point is that the US health care system is more efficacious with respect to diagnosis and treatment of cancer - a result that provides one argument to refute the assertion that life expectancy is a valid metric of quality of health care.
2. Presumably, some of that increased spending in the US health care system goes to earlier and more frequent testing, which leads to commensurately earlier and more frequent diagnosis. Thus, the argument that the increased efficacy merely represents increased diagnosis rather than a quantifiable difference in quality of health care is tautological; as an argument, it is specious. With respect to cancer, timing of diagnosis is critical to successful treatment.

Meaningful Metrics of Life Expectancy

As has already been demonstrated, behavioral/lifestyle choices such as diet, exercise, and smoking are the primary contributors to the leading causes of death in the US. Other studies show a correlation between life expectancy and sanitation, clean water, income, and literacy rate. The CDC indicates that improvement in life expectancy in the 20th century can be partially attributed to vaccination, motor vehicle safety, safer workplaces, control of infectious diseases, decline in CHD deaths, safer/healthier foods, healthier mothers/pre-natal care, family planning, fluoridation of drinking water, reduction of tobacco. Yet other studies have identified marriage, religious involvement, optimism, and cleaner air as having positive impact on life expectancy.

Conclusion

Life expectancy is not a meaningful metric of quality of health care.

The health care system cannot be assumed to have an actual interaction with several of the leading causes of death in the US. More than 70% of the deaths in the US result from causes stemming from behavioral and lifestyle choices over which the health care system has no control or impact. For those causes of death upon which the health care system has some impact, the US health care system proves to be far more efficacious than the nationalized health care systems with which it is compared.

As my mother has always said: if it ain't broke, don't fix it - especially when the "fix" is government-controlled health care.