Poor healthcare may shorten American lives: study

[ray245]

(Reuters) - Americans die sooner than citizens of a dozen other developed nations and the usual suspects -- obesity, traffic accidents and a high murder rate -- are not to blame, researchers reported on Thursday.

Instead, poor healthcare may be to blame, the team at Columbia University in New York reported.

They found that 15-year survival rates for men and women aged 45 to 65 have fallen in the United States relative to the other 12 countries over the past 30 years.

Such figures are frequently cited by supporters of healthcare reform, and critics often point out that the United States also has higher rates of obesity, more traffic fatalities and more murders than these countries.

Columbia's Peter Muennig, who led the study published in the journal Health Affairs, said his team accounted for these factors this time.

"But what really surprised us was that all of the usual suspects -- smoking, obesity, traffic accidents, and homicides -- are not the culprits," Meunnig said in a statement.

"The U.S. doesn't stand out as doing any worse in these areas than any of the other countries we studied, leading us to believe that failings in the U.S. health care system, such as costly specialized and fragmented care, are likely playing a large role in this relatively poor performance on improvements in life expectancy."

In June, the Commonwealth Fund, which advocates on and does research focusing on healthcare reform, reported that Americans spend twice as much on healthcare as residents of other developed countries -- $7,290 per person -- but get lower quality and less efficiency.

Muennig and Sherry Glied compared the United States to Australia, Austria, Belgium, Britain, Canada, France, Germany, Italy, Japan, the Netherlands, Sweden and Switzerland.

All these countries provide universal health insurance, in contrast to the United States, where 15 percent of the population lacks health insurance, although healthcare reform passed in March is designed to lower that disparity.

Republicans have promised to derail the legislation if they gain power in Congress in next month's elections.

COSTS GO UP

Between 1975 and 2005, medical costs went up in all the countries, as did life expectancy.

But costs went up far more in the United States and life expectancy increased to a far lower degree.

Glied and Meunnig do not believe obesity accounts for the differences. While more Americans are obese, overall the populations in all the nations have been getting fatter, they said.

"For obesity to explain the decline in U.S. life expectancy or the increase in health spending relative to the 12 comparison countries, Americans would have to be becoming obese at a faster rate than people in the comparison nations over time," they wrote. But this has not been happening.

Americans are less likely to smoke, and while Americans are more likely to die in car crashes or be murdered, again these rates do not explain the lower life expectancy, the Columbia team said.

"The findings undercut critics who might argue that the U.S. health care system is not in need of major changes," they wrote.

They noted that the United States has been dropping in life expectancy tables for decades.

"In 1950, the United States was fifth among the leading industrialized nations with respect to female life expectancy at birth, surpassed only by Sweden, Norway, Australia, and the Netherlands," they wrote. At last count, the United States was 46th in female life expectancy; 49th for both sexes.

http://www.reuters.com/article/idUSTRE6 ... geNumber=2


Nothing new to us, but it's good to have a study that confirms the view that poor healthcare is the main reason for the poor longevity of Americans.

[Master_Baerne]

What a surprise - it turns out that countries where preventable deaths are prevented have less people die preventably than ones that don't. Surely, no one could have forseen this? Good to have extra proof, I suppose, but this smells of false controversy to me: Every rational person I've spoken to agrees that the US healthcare system is broken (this includes many members of the US healthcare system; nurses, doctors, etc.), while the irrational ones won't pay any attention to scientific evidence anyway.

[PainRack]

What a surprise - it turns out that countries where preventable deaths are prevented have less people die preventably than ones that don't. Surely, no one could have forseen this? Good to have extra proof, I suppose, but this smells of false controversy to me: Every rational person I've spoken to agrees that the US healthcare system is broken (this includes many members of the US healthcare system; nurses, doctors, etc.), while the irrational ones won't pay any attention to scientific evidence anyway.

Isn't the real problem defining preventable deaths?

Opponenents of healthcare reform argue that increasing access to healthcare won't help reduce the mortality rate of Americans as it isn't the lack of access that's killing people, its "structural" problems.

[montypython]

What a surprise - it turns out that countries where preventable deaths are prevented have less people die preventably than ones that don't. Surely, no one could have forseen this? Good to have extra proof, I suppose, but this smells of false controversy to me: Every rational person I've spoken to agrees that the US healthcare system is broken (this includes many members of the US healthcare system; nurses, doctors, etc.), while the irrational ones won't pay any attention to scientific evidence anyway.

Isn't the real problem defining preventable deaths?

Opponenents of healthcare reform argue that increasing access to healthcare won't help reduce the mortality rate of Americans as it isn't the lack of access that's killing people, its "structural" problems.

Thing is though that places like Cuba with better preventative access have better health outcomes relative to expenditures than the US, so the critics of healthcare reform are barking up the wrong tree.

[PainRack]

Thing is though that places like Cuba with better preventative access have better health outcomes relative to expenditures than the US, so the critics of healthcare reform are barking up the wrong tree.

To be honest though, I personally believe environmental and public health has a better impact on general health outcome than access and usuage of primary/secondary healthcare facillities.

Or to illustrate this using an example, starting a person on anti-hypertensive in their 40s loses out to starting a public campaign on exercise, diet and reducing air pollution.

[Master_Baerne]

What a surprise - it turns out that countries where preventable deaths are prevented have less people die preventably than ones that don't. Surely, no one could have forseen this? Good to have extra proof, I suppose, but this smells of false controversy to me: Every rational person I've spoken to agrees that the US healthcare system is broken (this includes many members of the US healthcare system; nurses, doctors, etc.), while the irrational ones won't pay any attention to scientific evidence anyway.

Isn't the real problem defining preventable deaths?

Opponenents of healthcare reform argue that increasing access to healthcare won't help reduce the mortality rate of Americans as it isn't the lack of access that's killing people, its "structural" problems.

While it is true that "structural" problems, specifically related to the immoral, moneygrubbing insurance companies who control access to healthcare, at least good and consistent healthcare, are responsible for large parts of the twisted, bureaucratic nonsense that makes up the American healthcare system, I am baffled by the suggestion that increasing access to healthcare wouldn't save lives. Firstly because that's the result of the structural problems; insurance agencies don't grant coverage to people who need it as a matter of business, and secondly because that's the point of healthcare: to save lives. We, as a species, have gotten damned good at saving lives recently, and seeing more hospital TV shows than actual hospitals bothers me for reasons both ethical and related to national pride. We can do better than this preposterous hypercapitalist abortion of a system we've got now, but we don't, for no adequate reason.

[K. A. Pital]

Thing is though that places like Cuba with better preventative access have better health outcomes relative to expenditures than the US, so the critics of healthcare reform are barking up the wrong tree.

To be honest though, I personally believe environmental and public health has a better impact on general health outcome than access and usuage of primary/secondary healthcare facillities.

Or to illustrate this using an example, starting a person on anti-hypertensive in their 40s loses out to starting a public campaign on exercise, diet and reducing air pollution.

Are you serious? *shakes head* Access to healthcare facilities is fundamental in maintaining the health of the population. And how exactly can one achieve good public health indicators without having access to healthcare facilities? That means people don't go to the doctor and for the most part remain in the dark about healthcare and their own health until it becomes really unbearable (say, they get pneumonia or something). Not to mention that the prospects of spending money for healthcare tends to keep people, especially poorer people, at home until the situation is dire as a rule of thumb. How can this NOT produce an adverse effect?

[PainRack]

Are you serious? *shakes head* Access to healthcare facilities is fundamental in maintaining the health of the population.

I said environmental and public health has a LARGER impact on health outcomes than access to intervention.

And how exactly can one achieve good public health indicators without having access to healthcare facilities? That means people don't go to the doctor and for the most part remain in the dark about healthcare and their own health until it becomes really unbearable (say, they get pneumonia or something). Not to mention that the prospects of spending money for healthcare tends to keep people, especially poorer people, at home until the situation is dire as a rule of thumb. How can this NOT produce an adverse effect?

Ok. I think I need to make something clear.
1. My earlier post was with regards entirely to the critics of healthcare reform stance on the subject of preventable death.

2. My second post is an entirely different topic altogether, because other than a few libertarians on this board who are now silent, nobody is going to comment on the OT other than me-too posts.


So, the fact is that routine checkups hasn't been shown to actually increase life expectancy apart from some studies dating from the 1920s.

The change in disease pattern, from infectious disease and accidents to chronic lifestyle disease makes environmental and lifestyle choices increasingly important with regards to health. Smoking cessation, an active lifestyle(simple intervention from building park connectors or signs with a picture of an africian american woman climbing the stairs on the stairwell), controlling air pollution for asthma are probably more significant than access to drugs and etc is right now.


And of course, the fact also remains that the swing from infectious diseases/accident to lifestyle disease iself was enacted by public health engineering. From vaccination, to sanitation and regulation regarding workplace safety and etc, all of this were more important than having clinics and free healthcare.

[Thirdfain]

This article is a total crock of shit. Why? Because the US life expectancy is barely different from that of other industrial countries. Most Europeans only live only two years longer on average than Americans; Germany, Belgium, the Netherlands, the United Kingdom, and Finland all fit in that area. Simply put, the life expectancy difference is negligible.

Whatever systemic problems there are in US healthcare- which I readily acknowledge, being someone with no insurance who pays out of pocket for medical needs- it mostly handles our needs. It's not like life in socialized systems is radically better. The numbers prove it- people just don't live substantially longer in other systems.

[K. A. Pital]

I don't know what is more funny - the above chart, or the half-assed attempt to say that despite twice the average per capita spending, the average life expectancy being 2 years lower is normal. Phase one - denial.

[PainRack]

I don't know what is more funny - the above chart, or the half-assed attempt to say that despite twice the average per capita spending, the average life expectancy being 2 years lower is normal. Phase one - denial.

Because not all spending is effective at life extension.

here's a funny thing. For the British NHS, they placed extremely strong emphasis on public health and such. This isn't actually characterised by the general populace going into clinics for routine health check-up and then being given health advice, which is what comes to most people mind when they talk about preventive medicine.

Its about natal care given to pregnant women. A good portion of this isn't clinic visits and screening, but rather, workshops and other information(granted, started at the clinic) for such women.

Its about smoking cessation. Initated at schools and other vulnerable population, smokers are entered into workshops to encourage them to stop smoking.

One can easily argue that the US fee for service model, which IMO is still there despite the restructuring into PPO and HMO crowds out such a model on health and the fragmented nature of federal/state governmetns make any national effort difficult.

But that's an entirely layman opinion.

[Master_Baerne]

I believe that was the point - that the vast amount Americans spend per year on expensive medical procedures is less effective than the relative pittance preventative measures cost.

The interesting thing about the US system is that hospitals actually have no fiscal incentive to instigate preventative measures; they are paid, in many cases, per procedure, and preventative healthcare, being preventative rather than last-minute, makes these unneccesary. And because the payments frequently come from insurance, which is largely not available to people with chronic conditions, there's even less reason for hospitals to move away from invasive procedures and towards preventative measures, so as those mentioned by Painrack.

[PainRack]

I believe that was the point - that the vast amount Americans spend per year on expensive medical procedures is less effective than the relative pittance preventative measures cost.

The interesting thing about the US system is that hospitals actually have no fiscal incentive to instigate preventative measures; they are paid, in many cases, per procedure, and preventative healthcare, being preventative rather than last-minute, makes these unneccesary. And because the payments frequently come from insurance, which is largely not available to people with chronic conditions, there's even less reason for hospitals to move away from invasive procedures and towards preventative measures, so as those mentioned by Painrack.

I won't argue that hospitals have no fiscal incentive. The whole HMO and PPO had a very short lived effect on arresting medical inflation in the nineties.

Preventive healthcare however is generally practised at the community level and isn't linked to a service for fee model. Sure, you can have more personal trainers and the like, but the general health advice of moderate exercise 30min 3 times a week for cardio health or light exercise an hour a day for weight control and general benefit is a strange interplay between community and individuality. That's why there are multiple theories on health behaviour such as Theory of Reasoned action. Indeed, some motivational theories are said to work better on chronic conditions, some for preventive and so forth.
Getting the information out there or even motivating people is only step one. Reducing barriers, oppurtinity cost and actually allowing people to engage in health behaviours is just a big a problem.

A personal example would be my attempt to actually eat 5 plant serving a day and reduce fat/sodium intake. Its virtually impossible since I rely too much on eating out and for some odd reason, outside food in Singapore balances the edge between vices. A vegetarian meal has too much oil and usually salt. Noodles based are usually too salty. Rice based usually don't have enough veggies or have too much calories.

It goes on and on. Suburban sprawl in America discourage cycling and other forms of physical activity to get to where you want to go. The opposite itself doesn't actually encourage physical activity either, a common complaint here is a mere 400m walk is considered "too far" away...... How come that never comes up when it comes to shopping?!?!?!