Recent data from the University of California Santa Cruz show that although the United States spends far more on health per capita than any other nation, the average life expectancy of its citizens ranks only 28th in the world.
To support this, the website displays the following graph. It depicts life expectancy as bars and the purple line denotes health care expenditures per capita.
Can you see any problems with the data or the way the data are displayed?
I can. Let’s look at the countries ranked ahead of the US. Of the 27 countries ranking higher than the US, 16 have populations of under 11M with 6 of those having populations under 513K [Luxembourg 512K, Iceland 318K, Malta 418K, Andorra 85K, Monaco 35K, San Marino 32K]. At 312M, the US is by far the largest country in the top 30. Japan is second with 128M people.
The US has a much more heterogeneous population than any other country on the list. The per capita expenditures do not take social factors into account. For example, when anyone twists a knee in the US, an expensive MRI is likely to be ordered, not because it’s necessary, but because it’s expected by the patient. There are issues of non-compliance with medications and self-abuse with drugs, alcohol and tobacco. We also expend a lot of money on futile end-of-life interventions.
The bar graph itself is deceptive in that the scale range is from 74 to 82 years old. This makes the difference between the US and Japan seem much larger than the four years it actually is. This is a chart showing the actual difference on a scale of 1 to 85.
Now scroll down the page on the UCSC website and find this:
Although Cuba has limited resources and many economic problems, it has made health care a priority. It is not alone. Sri Lanka, China and the Indian State of Kerala are considered "low-income, high well-being" countries, which have adopted policies that not only reduce inequality but also increase overall health and well-being. The results of these policy priorities are significant, and can be measured in survival indicators, such as average life expectancy.
Now go back and look at the figure. You will not find Sri Lanka, China or the Indian State of Kerala in the list of the top 30 countries in life expectancy.
I am not saying we should not try to do better with our health care dollars. But I think the discussion should not be distorted by those with agendas. The behavior and expectations of our citizens will have to undergo a real sea change before anything meaningful will happen.