Monday, January 14, 2013

U.S. Last in Life Expectancy Among Developed Countries

There was an important story last week by Sabrina Tavernise (who used to report from Iraq during the American occupation) about the results of a study by the Institute of Medicine and the National Research Council which showed that the United States is consistently ranked at the bottom for life expectancy out of 17 developed countries. A lot of this disparity is due to death rates for Americans under the age fifty:
The findings were stark. Deaths before age 50 accounted for about two-thirds of the difference in life expectancy between males in the United States and their counterparts in 16 other developed countries, and about one-third of the difference for females. The countries in the analysis included Canada, Japan, Australia, France, Germany and Spain.
The 378-page study by a panel of experts convened by the Institute of Medicine and the National Research Council is the first to systematically compare death rates and health measures for people of all ages, including American youths. It went further than other studies in documenting the full range of causes of death, from diseases to accidents to violence. It was based on a broad review of mortality and health studies and statistics.
The panel called the pattern of higher rates of disease and shorter lives “the U.S. health disadvantage,” and said it was responsible for dragging the country to the bottom in terms of life expectancy over the past 30 years. American men ranked last in life expectancy among the 17 countries in the study, and American women ranked second to last.
“Something fundamental is going wrong,” said Dr. Steven Woolf, chairman of the Department of Family Medicine at Virginia Commonwealth University, who led the panel. “This is not the product of a particular administration or political party. Something at the core is causing the U.S. to slip behind these other high-income countries. And it’s getting worse.”
Car accidents, gun violence and drug overdoses were major contributors to years of life lost by Americans before age 50.
We have the highest STD rates, the highest teen pregnancy, the highest infant mortality, the highest car-crash deaths; and "Americans lose more years of life before age 50 to alcohol and drug abuse than people in any of the other countries." What explains these appalling results for the "greatest nation on earth"?
The panel sought to explain the poor performance. It noted the United States has a highly fragmented health care system, with limited primary care resources and a large uninsured population. It has the highest rates of poverty among the countries studied. 
The United States is a bigger, more heterogeneous society with greater levels of economic inequality, and comparing its health outcomes to those in countries like Sweden or France may seem lopsided. But the panelists point out that this country spends more on health care than any other in the survey. And as recently as the 1950s, Americans scored better in life expectancy and disease than many of the other countries in the current study.
The money line is that we spend more on health care than any other developed nation yet we have the worst outcomes. This is a definition of complete failure. The Sunday before last there was a frontpage story by Reed Abelson about large health insurers seeking double-digit rate increases in 2013. How much longer can we go on like this? The political system is captured; it's not delivering the change we need. One of the main selling points of Obamacare was its ability to block these huge rate increases by health insurers, but apparently this isn't the case:
Under the health care law, regulators are now required to review any request for a rate increase of 10 percent or more; the requests are posted on a federal Web site,, along with regulators’ evaluations. 
The review process not only reveals the sharp disparity in the rates themselves, it also demonstrates the striking difference between places like New York, one of the 37 states where legislatures have given regulators some authority to deny or roll back rates deemed excessive, and California, which is among the states that do not have that ability. 
New York, for example, recently used its sweeping powers to hold rate increases for 2013 in the individual and small group markets to under 10 percent. California can review rate requests for technical errors but cannot deny rate increases. 
The double-digit requests in some states are being made despite evidence that overall health care costs appear to have slowed in recent years, increasing in the single digits annually as many people put off treatment because of the weak economy. PricewaterhouseCoopers estimates that costs may increase just 7.5 percent next year, well below the rate increases being sought by some insurers. But the companies counter that medical costs for some policy holders are rising much faster than the average, suggesting they are in a sicker population. Federal regulators contend that premiums would be higher still without the law, which also sets limits on profits and administrative costs and provides for rebates if insurers exceed those limits. 
Critics, like Dave Jones, the California insurance commissioner and one of two health plan regulators in that state, said that without a federal provision giving all regulators the ability to deny excessive rate increases, some insurance companies can raise rates as much as they did before the law was enacted. 
“This is business as usual,” Mr. Jones said. “It’s a huge loophole in the Affordable Care Act,” he said.
So once again a legitimate criticism of the Obama administration seems to be the one frequently voiced from the Left -- that it is a wily defense and prolongation of an unjust and corrupt status quo.

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