Thursday, July 9, 2009

Steyn on Life Span and Health Care Systems

I had to pass on this money quotation from Mark Steyn's latest post at NRO.
Life expectancy in the European Union 78.7 years; life expectancy in the United States 78.06 years; life expectancy in Albania 77.6 years; life expectancy in Libya, 76.88 years; life expectancy in Bosnia & Herzegovina, 78.17 years. Once you get on top of childhood mortality and basic hygiene, everything else is peripheral – margin-of-error territory. Maybe we could get another six months by adopting EU-style socialized health care. Or we could get another six weeks by reducing the Lower 48 to rubble in an orgy of bloodletting, which seems to have done wonders for Bosnian longevity... Even within the United States, even within the Medicare system, there are regions that offer twice as much “health care” per patient – twice as many check-ups, pills, tests, operations – for no discernible variation in outcome.
Health care is incredibly complex, but my instincts tell me that the costs of having government run our health care system will greatly overshadow any of the benefits. And the benefits--improved access, lower cost (in theory anyway)--will probably have no discernible effect on big outcomes like life span, cancer rates or obesity rates.


  1. Rob, it is very complicated but you're right!

  2. Anyone who thinks government run health care is the answer needs to spend a couple day at one of the VA's.

    For all the Vets do for our country, they sure do get the short end of the stick when it comes to their access healthcare. The healthcare is there, it's just the hoops you have to jump through to access it.

  3. Here's the thing...

    Anyone who poo-poos socialized medicine should talk to a Canadian. People were shaky in Canada when they passed that law, now it's fairly universally (get it...universally) embraced.

    Now the U.S. is not Canada, but this argument that our life span is the same as people in Bosnia therefore our healthcare is just fine is annoying.

    I also think you're looking at the wrong aspects, life span and obesity are one thing, but what about the thousands of people who have no healthcare? What about the staggering amount you have to pay if your job doesn't provide healthcare? Sure, costs for government healthcare are a factor, but isn't there some responsibility within a country for the health of a country's citizens?

    This argument also suggests that more check-ups apparently have no barring on patients health. Isn't that basically saying that we just don't need doctors, or that they don't do anything for us? It's a similar argument heard in Canada around the time they passed universal health care, that if you let people go the doctor whenever they want, they'll go WHENEVER THEY WANT!!! Like it's a bad thing. Lesley's experiences with universal healthcare in Canada have all been positive. No one she knows abuses the system, and everybody has coverage.

    Universal healthcare in the U.S. may not work well as it does in Canada, but doing nothing, as it seems this article suggests, is just ignoring a horrible healthcare system that ignores many many people in need.

  4. I think Mark Steyn is good at selecting the data that prove his simplistic and outrageous points. Countries DON'T basically have the same lifespan there's quite a big spread. And what good is it to control for infant mortality? Infant mortality is a great indicator of the quality of health care.

    Besides health care is not just about living a long time, it's about being able to enjoy your life, and there are plenty of people in miserable insurmountable situations in this country because of the problems with our health care system.

  5. We had to cancel our health insurance last month because they raised our insurance premiums from $500 a month to $600 a month, and I got a pay cut of $200 a month and my work (as a high school teacher, for crying out loud) doesn't provide health care. So, yeah, I'm nervous. My kids might not die any sooner without it, but if they get a broken arm I'll have to refinance the house or something.

  6. Alright, comments! First, let me solicit some feedback about more political posts of late. Do you guys think political discussion is better left off the blog or is better among friends? I lean to the latter, obviously, but I don't want anyone to think that my opinion of them will change because of their political positions. I think that should be a universal sentiment--but I know political opinions can get emotional (which is okay).

    D'H--I agree that the VA sucks based on accounts I've heard from others. So if government stinks, why do health care costs increase faster than inflation. Taliatha and I were talking about this and I couldn't give her all the answers. Maybe you could write us a post in your copious spare time about factors that drive up medical costs--or someone can just give us a good link. I've read stuff in the past so I will see if I can dig something up.

    Tone--Actually, Steyn is Canadian. How's that for irony. I don't doubt your assertion that Canadians like their system. I'd be interested in some poll numbers. Clearly they must have some complaints--and it is nice having the USA next door in case you need a procedure for which there is a long waiting list. At any rate we do have serious problems that you bring up (costs that limit access--see Brandon's family) and reform is needed. It's just what form the reform takes that is worth debating. My impression is that our current system is not very "capitalist" at all in that there are government policies that reduce competition which will always inflate prices--but don't ask me for too many specifics right now.

    Taliatha--Steyn is bombastic and it does look like he cherry-picked some data. Still, he is right that having a massive universal health care system will probably not affect life span in the US that much. Now that's probably not the right metric--quality of life is more important--but I think his assertion, even if it does seem pointless, stands.

    Brandon-Isn't your school a govt. school? I can see a private school pulling that but I thought teachers got benefits at govt. schools. What's up with that? At any rate if there were actually a competitive marketplace for health insurance you could buy plans from anywhere in the country and probably could come up with something affordable. We're looking at a high deductible/HSA plan for the fam since my work's plan for families isn't that cheap. We think we found a good option.

    I'll end with another simplistic and outrageous quotation from Steyn that addresses a potential unintended consequence of universal healthcare--the loss of liberty.

    "If the government is obligated to cure you of illness, it has an interest in preventing you getting ill in the first place – by regulating what you eat, how you live, the choices you make from the moment you get up in the morning."

    Are we willing to trade liberty for security? Where do we balance the two?

  7. I would suggest you look at
    It is the Human Develop Index - since 1999 Norway has been in the top 2 of this list and the US continues to drop each year - in fact this is the first year that we have seen Japan above the US. It measures more than just life span - the website gives details of all the factors.

    I bring up Norway since I know people that live there. As a citizen the government pays for all health care - most citizens pay about 20-30% in taxes (factor in what you pay for health care, education and this is generally less than what you pay in the US), Also, in Norway you pay significantly less in taxes if you are married and have children. This is a country that I feel we should use as a role model.
    - look at the website, most countries ranked higher than the US have government health care.

    I am in a similar situation to Brandon - my insurance keeps rising and my payrate does not.

    I would trade my choice to eat McDonalds for the ability to get my children the health care they need. However, I don't think that if we have a government insurance plan that all the sudden we would be living in a dictatorship.
    I hate having to gamble that something won't happen to us because I can't afford it. I would like to see the statistics on what kind of health benefits you get for not stressing each day about how to pay the doctor bill.

    I agree with Tony, there is a responsibility for the country to take care of it's citizens - some people just like to use the scare of lose of freedom as a way out of that responsibility.

  8. I'm alright with political posts as long as we all remain friendly, yet express true opinions, which seems to be happening. I also think we should post about other things and not be TOO political.

  9. I wanted to weigh in on this earlier, but I was in Mexico last week (saw me a turquoise-browed motmot, too).

    Tony, I can't speak for Canadians, but my brother in England hasn't had an awesome experience with their health care system. His wife had a growth on her arm that she had her personal care physician look at. He thought it looked bad, but was unable to authorize a biopsy or refer her to a specialist and simply offered to cut it out himself. So they paid to see a private specialist, and he took care of it. This kind of thing happens often enough that there are companies in England that are starting to offer private insurance as a benefit to their employees -- that's on top of whatever they get from the National Health.

    Norway probably couldn't be a model for the U.S. Norway's mean tax rate is almost 40% compared to the US's at 30%. This is because they have a 25% sales tax (14% on food) that generates a lot of their government's revenue. Also, Norway is an oil producing country which adds a lot to their revenue that the U.S. couldn't replicate. Even if we had the oil resource, the U.S. would allow private companies to extract it, rather than creating a national firm.

    Where do I stand on the whole thing? I don't really know. I feel like there needs to be some regulation of the industry to keep costs from rising so quickly (something that would slow the rise of malpractice insurance premiums, for example). If costs were lowered, that would solve some of the problems you guys bring up. The lack of universal coverage is an issue that needs to be addressed, but if rising costs aren't curtailed, universal coverage (by our current definition of coverage) simply won't be possible.

  10. that I read some of the news stories about Obama's position, I find that controlling costs is one of his fundamental concerns. That makes me look like a total tool.

    So, I'm changing my stance: I prefer a mixture of the free-market and governmental system, where a massive bureaucracy creates inefficiencies and rations healthcare that is too expensive for anyone to afford. There, now I don't look like some lame, Obama-loving, ironic facial hair-wearing, hipster.

  11. I've never heard of "ironic facial hair."

  12. Thanks Aaron.

    I wanted to respond to Cathy's comment that the fear of loss of freedom is just a scare tactic. I don't think it is a scare tactic. I think it is a legitimate concern that must be balanced with the goal of folks having access to health care--and I don't trust the federal government to strike the right balance. (Actually I don't trust the federal government to do a good job on just about any social program.) As food for thought I include the link to a post where my favorite libertarian blogger makes the argument better than I could.

  13. I hope you forgive me barging in on your posts here (this is Carrie Russon's husband), but I couldn't resist. First, I think it is great that you guys have this forum on which to talk about this stuff and important issues, like Grizzly Bear and Neil Young.

    I think this issue of loss of freedom is very interesting. We regularly restrict and take away freedoms (smoking in restaurants, drugs, trans fats in certain cities) and these, with the exception of trans fats, are largely embraced and welcomed because of the impact it has on health and society. So, clearly fast food has been identified as negative to your health (a nation chalk full of good old fashioned obesity is one of the proofs to that), so does one restrict or ban fast food? There is no chance of that happening. Yet, it is likely the root of so many chronic diseases (obesity, diabetes, heart disease, certain cancers, etc.). Without checking these types of activities, can you really have a universal health system that works fiscally? Would creating a heavy tax on fast foods, sodas, and candy help alleviate the massive cost of health care, and incentivize people to eat healthier?

    As an employee in the health care industry (I design medical devices), and as someone who really strives to eat healthy by living the Word of Wisdom, these questions fascinate me.

  14. Hey Matthew, I'm your wife's friends' former roommate. I'm glad you brought up the junk food tax

    As an economist with a healthy interest in environmental policy, I'm really interested in a junk food tax.

    Determining an efficient tax level and metric to base the tax on (fat content, cholesterol content, sugar content?) would range from really difficult to impossible. But we could probably settle for a second-best, simplified cost-minimization formulation of the tax and be alright.

    The great thing about the tax is that it would really affect the people who consume too much of the bad stuff the most. If we're talking about an effective rate of $.50 or $1.00 for a Whopper, it's not going to keep me from occasionally indulging -- like I do now. But a person who's at the Burger King every day is likely to be forced to change consumption habits, which is great for me because that person's future (or current, I guess) poor health is going to increase my insurance and/or healthcare costs. So I pay a little more for my once-every-two-months fat fix, but I end up paying less on my health insurance.

    The proceeds from the tax can be used to finance health care (which wouldn't be a great idea, because we're hoping that people consume less junk food in the future, thus generating less tax revenue) or just returned to tax payers as a lump sum, where everyone gets an equal share of the revenue.

    Anyway, it's probably pretty obvious that I'm not libertarian. Taxes can be fun!

    What were we talking about?