Don't blame health care for poor longevity

In the Great Health Care Debate, much has been ballyhooed about the United States' low life expectancy when compared to other first-world countries. Our life expectancy at age 50 ranks 29th in the world -- 3.3 years behind Japan (the leader) and also behind Canada, France, Iceland and Spain, among others. In contrast, the U.S. spends 16% of its GDP on health care -- more than any other country.

Of course, the big question: Is the poor ranking because our health care system is broken or because of some other factor, such as irresponsible behavior outside the system (smoking) or genetic predispositions?

An as-yet unpublished study by a couple of researchers at the University of Pennsylvania's Population Studies Center concludes that the current system actually does a very good job at discovering and treating fatal diseases when compared to other countries. The authors looked at U.S. practices in finding and treating prostate cancer and breast cancer and found that the U.S. screens more extensively and treats more aggressively than European countries. (Some lively debates on the study's merits have taken place on the blog of University of Chicago professor Gary Becker and judge/lecturer Richard Posner and Tyler Cowen's blog.)

The study points out some fascinating comparisons between the performance of the U.S. health care system and those of other developed nations when it comes to treating serious medical conditions. Since the mid-1990s, age-standardized death rates for prostate cancer have fallen well below those of other countries; age-standardized death rates for breast cancer, while declining rapidly in the 1990s, merely caught up to the lower death rates in other countries.

So what's behind the lower life expectancy for 50-year-olds in the US? While the researchers don't draw any solid conclusions, they point to a history of heavy smoking and high obesity rates as factors. They also make clear that they are studying what happens after a disease has developed. "It is possible," they write, "that the US health care system performs poorly in preventing disease in the first place."

Samuel Preston and Jessica Ho, the study's authors, say that there might still be inefficiencies or unfairness in the system, and they acknowledge that they aren't measuring the overall well-being of cancer survivors. "The question that we have posed is much simpler," they write, "Does a poor performance by the US health care system account for the low international ranking of longevity in the US? Our answer is, 'no'."