Critiquing U.S. Health Care Critics

Stanford professor Victor Fuchs recently pointed out something that might surprise many critics of the U.S. health care system. There is no positive relationship between per capita health spending and life expectancy. He demonstrates this with data from the two dozen OECD countries having the highest per capita health spending, as well as separate analyses of U.S. states (25 highest- and 25 lowest-income states).

This should not surprise us. In the very first landmark Healthy People report (issued in 1979), it was reported that medical care accounted for only about 10% of total years lost due to premature mortality. The environment (20%), genetics (20%) and especially lifestyle/behavior (50%) were far more important determinants of whether someone died before the age of their life expectancy at birth.

These figures are decades old and the relative contribution of each factor (always imprecise) may have changed a bit since then. For example, some genetic factors are now amenable to medical treatment, so the medical care component may now be slightly higher. But the central truth remains. As Prof. Fuchs points out, there are many non-medical factors leading too many Americans to an early death. Carefully inspect the leading causes of death in this chart, for example:

While the medical care system surely is responsible for factors such as preventable medical errors, by far the heavy hitters on the list are factors that relate to personal responsibility and lifestyle choices. If a shockingly high percentage of Americans are obese--as one illustration--I'm not inclined to point the finger of blame at America's medical care system.

And it's not just obesity. We're known for years that if you remove all deaths due to violent causes--homicides, suicides, automobile accidents and the like, the U.S. moves from being ranked #15 in life expectancy among its OECD peers to ranking #1.

That's a rather sizable shift that dramatically undercuts the conventional wisdom that somehow the U.S. health system lags far behind that of its G-7 counterparts in terms of health system performance. And yet critics of the U.S. health care system don't hesitate to use the highly misleading (arguably meaningless) unadjusted life expectancy figures to score cheap debating points. Don't believe me? Consider just a few:

"The U.S. ranks 26th for life expectancy, right behind Slovenia" (Sarah Kliff, Washington Post, Wonkblog, November 21, 2013).

"U.S. Life Expectancy Ranks 26th In The World, OECD Report Shows" (HuffPost Healthy Living, November 21, 2013).

“U.S. Outcomes Are No Better and Often Worse Than in Other Countries.” (Steven Brill, in Bitter Pill: Why Medical Bills Are Killing Us, Time, April 4, 2013. As I noted in my own critique of Mr. Brill's too-often misleading analysis of the U.S. health care system, the graphics accompanying his piece illustrate that the U.S. ranks lower than many other major countries in the metrics of life expectancy at birth, among others).

"The nation now ranks in the bottom quartile in life expectancy among OECD countries" (Gerard Anderson and David Squires, Commonwealth Fund report, June 2010).

"Americans Face Shorter Life Span Than the Rest of Industrialized World" (AARP Bulletin, March 2013).

Let's be clear. The American health care system has plenty of flaws. Regrettably, Obamacare will do little to correct those ills (and any impact it has on life expectancy will be vanishingly small). Indeed, in many respects this misguided law has simply lengthened the laundry list of problems needing fixing. But we surely cannot find a sensible solution until and unless both sides of the aisle are willing and able to soberly confront the reality of our current system's performance without resorting to statistics that severely bend reality in a favored direction. For unless we can clearly see what our problems are, it is a safe bet we will never find sensible solutions.

READ CHRIS’ BOOK, The American Health Economy Illustrated (AEI Press, 2012), available at Amazon and other major retailers. With generous support from the National Research Initiative at the American Enterprise Institute, an on-line version complete with downloadable Powerpoint slides and companion spreadsheets has been made available through the Medical Industry Leadership Institute's Open Education Hub.  Follow@ConoverChris on Twitter TWTR -0.67%, and The Apothecary on Facebook. Or, sign up to receive a weekly e-mail digest of articles from The Apothecary.