Health care vs health coverage

 By John Jonik

Click to see your premium increase

 By Nick Anderson

How Medicare saves lives

 From a post by Doctor James Gundlach

Here I will start with the conclusion: Here are the numbers:

From 1999 through 2023 age 20-54 deaths = 8,330,842 deaths. If their deaths had changed like the age 65-84 it would have been 6,486,057. That is 1,844,785 [averaging roughly 76,000 per year], or 22.1% fewer.

Medicare is America's public free healthcare, which can be accessed after you turn 65.  This is presumably what Gundlach means by "socialist".   Everybody else has to pay for their healthcare, including any excesses over what the health insurance company will pay.  Most workers get health insurance through their employers, but obviously, their take-home pay is reduced from what it would otherwise be, in effect, a sort of payroll tax.  However, the fact that there are still out-of-pocket expenses makes getting sick horribly expensive in the USA.  The country spends 19% of GDP on healthcare, compared with 9% in Australia, which has a free health system for everybody.  However, the health outcomes in Australia (and other developed countries with free health care) are superior to those in the US. 

In Gundlach's chart, note how both sets of annual death rates rose during Covid, but for those paid for by the government were much lower than those who had to pay for their health care out of their own pockets.

Republican healthcare

 By Sage Stossel 

Uninsured health = much higher death rates

 From Dr James Gundlach

What is up? State middle aged death rates when the percent uninsured goes up. How much? In 2023 I estimate an additional 172,538 age 0-64 deaths and that makes up an estimated 22.1% of all the 2023 middle aged deaths. 🧪💡☠️ #Sociology #Population

Click to enlarge (makes it easier to read)

America's terrible health outcomes

For one of the richest nations on Earth, the US's health outcomes are terrible, even though it spends twice as much (as a percent of GDP) on health care as other wealthy countries.  American exceptionalism indeed.

Red States' death rates

From Dr James H Gundlach 

Each dot shows the percent change in the death rate of people of a single year age in states voting Democratic and Republican [between 1999 and 2023]

Infant deaths in Dem states declined almost twice as much as in Rep states. From age 17 to 30 it was terrible.  The change from age 17 to age 30 amounted to a fair declining in death [rates] to about a 35 percent increase. And there is no real difference between the lines for Democratic and Republican voting states.

Then both lines of dots head down showing less of an increase, until they cross the zero line in the middle to declining. The Democratic states start doing better at age 45 and Republican states take about ten more years to make this shift. From here both lines continue to move into larger declining death rates every year but the Democratic voting state keep going down more. 

Then around age 75 both lines of dots finally begin to look normal, at very old ages the declining death rates decline less each year but the Democratic voting states are experiencing much stronger declines than the Republican voting states. The Democrats max out at a -53% and the Republicans are behind with a -32% at age 76. 

In the United States, we have three major patterns in paying for health care. The young are primarily covered by private insurance, with most of the uninsured covered by state governments. The middle-aged are dominated by capitalist health insurance with large co-pays and a high percent uninsured. The very ill aged 55-64 can move to Medicare early in most states. After age 64 almost all qualify for Medicare and the capitalist clone Medicaid. That final upward slope in both lines shows the normal effect of growing very old, The abnormality here is the line for the elderly in Republican voting is still above the line [i.e., worse]for Democratic voting states. 

The United States pays the most of any country for health care but our CIA World Fact Book ranks us 49th in life expectancy.  Canada spends close to half as much for health care as we do and they are ranked 7th.

[See also: Evangelicals and death rates, and Shit life syndrome]

Dysfunctional US health system

From Eric Topol

An update with latest data available for graph of life expectancy vs health care expenditures per capita for 20 countries and one outlier.

 

And what an outlier!  The US health system is extraordinarily toxic and dysfunctional.  It has nearly the worst life expectancy with by far the most expensive costs.

Canada has a far superior health system to the USA's

 Trump just tells lies.

Why the US economy is worse than it looks

 An intriguing piece from TLDR about why many people don't feel that the economy is going well, despite the statistics.

Some comments:

1.  "Cheapflation", i.e., the phenomenon where the prices of cheap goods consumed by poorer people rise by more than the prices of goods consumed by the richest is new to me, and very interesting.  Its existence explains a lot.
2. I've always though that the huge cost of health care in the USA was an implicit tax, meaning tax rates in the US aren't as low as the Right pretends.  Firms who pay for their employees' health care are in effect paying a social security tax, comparable to the explicit social security taxes which exist in other countries to pay for health, old age pensions, and unemployment benefits.  Social security taxes/company payment for health insurance drive a wedge between what it costs an employer to hire a worker and what the worker receives.  Health insurance paid by your employer is considered part of personal remuneration in the national accounts.   Health insurance excesses paid by you are considered part of your consumption expenditure.  Clearly, both are rising fast.
3. That 40% of the cumulative rise in the CPI has been due to the rising cost of health was a surprise to me.  And the fact that 27%(!) of personal consumption goes on healthcare.  Extraordinary.  No wonder ordinary people feel dudded.  It suggests that the Democrats should push extensive health care reform.  Fat chance.
4. The effect of the growth of healthcare on employment is also most interesting.  I would point out, though, that covid deaths and early retirements due to ill health reduced the labour force, helping reduce the unemployment rate.
5. TLDR says that there seems to be no solution to the US Federal debt dilemma.  This is untrue.  It would be perfectly feasible to increase taxes on the rich and on companies to reduce the deficit.  Of course, what Trump and President Musk want to do is to cut payments to the poor.  Heaven forfend that the very rich should contribute more to society.
6. As for personal debt, their analysis is spoiled by not showing the rise in personal debt per capita.  The per cent of mortgage loans which are delinquent suggests that this is less of a problem than they make out.
7. Recent trend growth in average hourly earnings has been a princely 1.1 percent per annum.   Overall GDP per capita has risen by 1.8% per annum over the same period, which means that the share of worker remuneration in GDP continues to fall.  If you remember that this is the average, i.e., the mean, not the median, the relative decline of the poorest half of American society has been much worse.

The gun problem

 By Dave Whamond

Life expectancy in the US

 This very interesting article from Our World in Data:

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

(Study by Max Roser)

Why do Americans have a lower life expectancy than people in other rich countries, despite paying so much more for health care?

The short summary of what I will discuss below is that Americans suffer higher death rates from smoking, obesity, homicides, opioid overdoses, suicides, road accidents, and infant deaths. In addition to this, deeper poverty and less access to healthcare mean Americans at lower incomes die at a younger age than poor people in other rich countries.

The US clearly stands out as the chart shows: Americans spend far more on health than any other country in the world, yet the life expectancy of the American population is shorter than in other rich countries that spend far less.

The chart here doesn’t just show the latest data points, but how life expectancy and health spending have changed during the last five decades. The arrows start in 1970 and connect the annual data points for both metrics, showing the change over time.

In the 1970s the US didn’t stand out at all, it does so now because life expectancy increased much more slowly than in other countries. At the same time, health spending in the U.S. increased much more rapidly, particularly since the mid-1980s. The consequence of these two exceptional developments is that the US followed the much-flatter trajectory that the chart shows.

The unequal development over recent decades led to an inequality between the US and other rich countries. In the US health spending per capita is up to four times higher, yet life expectancy is lower than in all of these countries.

The US has achieved very substantial progress in health outcomes over the last 140 years: in 1880 the life expectancy of Americans was 39 years, since then it has doubled. But this extremely positive trend has come to an end. While life expectancy for people around the world continued to increase, the life expectancy of Americans has declined since 2014. With the pandemic of 2020 – which already caused more than 225,000 deaths due to COVID-19 and 300,000 excess deaths – it is unfortunately already certain that the decline of life expectancy in the US will continue this year.1

In a word:  the triumph of neo-liberalism.   

Truly, American Exceptionalism is correct.  Just in all the wrong ways.

Shit-life syndrome

Poverty is the 4th cause of death in the US

The great share buyback scam

Not a radical idea

 

Sanctity of life

By Monte Wolverton

 

You shouldn't have to lose your home because your mother got sick

 

The world's healthiest nations

From Bloomberg:

Maybe it’s something in the gazpacho or paella, as Spain just surpassed Italy to become the world’s healthiest country.

That’s according to the 2019 edition of the Bloomberg Healthiest Country Index, which ranks 169 economies according to factors that contribute to overall health. Spain placed sixth in the previous gauge, published in 2017.

Four additional European nations were among the top 10 in 2019: Iceland (third place), Switzerland (fifth), Sweden (sixth) and Norway (ninth). Japan was the healthiest Asian nation, jumping three places from the 2017 survey into fourth and replacing Singapore, which dropped to eighth. Australia and Israel rounded out the top 10 at seventh and 10th place.

Researchers say eating habits may provide clues to health levels enjoyed by Spain and Italy, as a “Mediterranean diet, supplemented with extra-virgin olive oil or nuts, had a lower rate of major cardiovascular events than those assigned to a reduced-fat diet,” according to a study led by the University of Navarra Medical School.

Meanwhile in North America, Canada’s 16th-place ranking far surpassed the U.S. and Mexico, both of which dropped slightly to 35th and 53rd. Life expectancy in the U.S. has been trending lower due to deaths from drug overdoses and suicides.

Cuba placed five spots above the U.S., making it the only nation not classified as "high income" by the World Bank to be ranked that high. One reason for the island nation’s success may be its emphasis on preventative care over the U.S. focus on diagnosing and treating illness, the American Bar Association Health Law Section said in a report last year after vising Cuba.

The article is dancing around the elephant in the room.  One would expect developed countries to have better health than developing countries.  Yet the USA, one of the wealthiest nations on Earth, doesn't rank number 1 on health, but 35th.  The reason isn't just diet (and admittedly, the US diet is terrible).  It's because other developed countries have free public health systems.  Which means they tend to have more preventive health initiatives, such as campaigns to encourage better eating, more exercise, etc.  The USA spends a larger proportion of GDP on health than any other country, with blatantly worse results.  For example, it spends twice as much as Australia, yet we are 7th in the list and the USA is 35th. 

US life expectancy falls again

For the third year in succession, US life expectancy has fallen.

Source: The Economist
Does not include 2017 & 2018 data.

From Science Alert:

The US is the only wealthy country in the world where the life expectancy needle is moving the wrong way.

Between 1959 and 2014, the average length of time that Americans were expected to live was on the rise. Now, for the third year in a row, it's declining, according to a new study published in the Journal of the American Medical Association.

"Americans operate under a lot of misconceptions about how superior we are in many facets of our lives and this is not one of them," the study's lead author Steven Woolf told Business Insider. "We may think we have best medical care in world and highest life expectancy … but that's not the case."

This decline can't be linked to just one ethnicity, gender, or geographic area, either: It originates among an entire age group. People between the ages of 25 and 64 in the US are dying at higher rates, wracked by health problems like opioid addiction, obesity, alcoholic liver disease, and suicide.

Despite having the highest per capita health care spending in the world, Americans are "more likely to die before age 65 than people in other countries," Woolf added. "Their children, too, are less likely to live as long".

Woolf and his co-author Heidi Schoomaker's new study looked at more than 50 years' worth of data on US life expectancy from the US Mortality Database and the US Centres for Disease Control and Prevention's WONDER database.

Results showed that, in the 1970s, the country experienced a rapid and significant jump in life expectancy. But by the 1990s, that increase started to level off.  In 2011, US life expectancy plateaued, and three years later it started to drop.

"We've reached the point where we're going into a free fall," Woolf said.

Medical advances, particularly in the realms of cancer treatment and heart health, prompted an almost 10-year increase in the average American's lifespan. Between 1959 and 2013, life expectancy rose from 69.9 years to 78.9 years. Now, however, that average has dropped to 78.6 years.

The news isn't good if you compare it to other countries, either. In 1960, Americans had the highest life expectancy of any country in the world. But in the past couple of years, the US has plummeted to the bottom of the list of countries with a similar GDP and high average income, according to the Kaiser Family Foundation.

In fact, the US is currently ranked in the mid-40s globally in terms of life expectancy, squished between countries like Lebanon, Cuba, and Chile, which have GDPs that fall far short of our own.

This counterintuitive trend – of an affluent, first-world country that spends billions on privatised healthcare losing swaths of their middle-aged working class – could be traced back to one massive elephant in the room.

"It's a quandary of why this is happening when we spend so much on healthcare," Woolf said, adding: "But my betting money is on the economy."

Upticks in suicides, drug overdoses, and alcohol-related diseases "are all symptoms of people struggling in a poor economy who can't afford housing, find consistent jobs," and despair because of it, according to Woolf.

Drug overdose, alcohol abuse, and suicide – referred to by some as "deaths of despair" – appear to be the primary culprits [of the rising mortality rates].

This age group [25 -64] experienced a nearly four-fold increase in fatal drug overdoses between 1999 and 2017.

Suicide rates went up by nearly 40 percent for people between the ages of 25 and 64, and by 56 percent for people ages 55 to 64 during the same time frame. For Americans between the ages of 25 and 34, the rate of alcohol-related disease deaths spiked almost 160 percent, as well.

Obesity-related mortality rates among this age group also went up by 114 percent, and deaths linked to high blood increased by about 80 percent.

"Working-age Americans are more likely to die in the prime of their lives," Woolf said. Between 2010 and 2017, midlife US adults experienced a 6 percent total increase in mortality rate.

"We are seeing social determinants of health shaping well-being and outcomes," Howard Koh, a professor at the Harvard T.H. Chan School of public health who was not involved in the study, told Business Insider.

"Forces like income inequality and unstable employment cause psychological distress and drive conditions by which diseases and deaths occur," he added.

In countries around the world, research has shown that people with lower incomes die sooner than their wealthier counterparts.  A 2017 study linked low socioeconomic status to significant reductions in life expectancy.

But what makes the US unique, according to Woolf, is that "poor people in other countries live longer than poor people in our country".

[Read more here]


I talked about this before, in my piece Shit-Life Syndrome.  The standard American diet (SAD) is undoubtedly one factor in falling life expectancy, but that doesn't explain suicide, now at the highest rate since the Great Depression, nor rising deaths from alcoholism.  Rising inequality is killing people.  It's time for a change.

Universal healthcare

A twitter thread by Christian Christensen:

He also tweeted this chart, which shows how the number of women dying per 100,000 births:

See also Shit Life Syndrome, where I talk about the USA's declining life expectancy.

Neo-liberalism has failed.