What’s Not to Like?

Matt Yglesias quotes a commenter at Marginal Revolution.

At birth, someone living in the Netherlands can expect to live 2.35 years longer than someone born in the US, but at age 65, the difference is reversed, and someone living in the US can expect to live 0.4 years longer than someone living in the Netherlands. This difference can be explained by assuming that semi-socialized health care is better for young and worse for old people, or, at least as likely, different policies are not the main cause of the difference.

Sources: CDC national vital statistics 2004, www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_09.pdf and RIVM 2007 levensverwachting, www.rivm.nl/vtv/object_document/o2309n18838.html (in Dutch).

Matt jumps in and points out what was invisible to the commenter — after 65, Americans get health care through Medicare.

Americans over the age of 65 participate in a Canadian-style national health insurance scheme known as Medicare. The data, if we want to take it seriously, indicates that the Dutch system is better than private sector medicine but worse than Medicare and tends to support a “Medicare for all” approach.

In a recent post I cited an article in Roll Call that said states whose citizens have the least access to health care also have the highest Medicare costs, per person. The authors speculate that the bump in Medicare costs reflects lifetimes of health care neglect.

Put another way, if you want Medicare costs to go down, give people better health care in the first 65 years of their lives.

Regarding Medicare costs, Paul Krugman wrote recently,

Here’s the raw fact, from the National Health Expenditure data: since 1970 Medicare costs per beneficiary have risen at an annual rate of 8.8% — but insurance premiums have risen at an annual rate of 9.9%. The rise in Medicare costs is just part of the overall rise in health care spending. And in fact Medicare spending has lagged private spending: if insurance premiums had risen “only” as much as Medicare spending, they’d be 1/3 lower than they are.

How do these numbers not show us that Americans are getting substandard medical care? But as Jonathan Alter says, our current system is great! What’s not to like? (Read Alter before commenting.)

6 thoughts on “What’s Not to Like?

  1. The problem with Alter is that righties don’t get irony. Just wait – somebody is going to hold this one up as proof that lefties agree with them.

  2. I read the article by Alter yesterday. When I saw the title, I almost wanted to pass out. Alter, I thought! Didn’t he have a highly publicized bout with cancer recently? Then I read it – it almost made me want to laugh through my tears. He made a lot of great points.
    And Dave S., yeah, you’re right, they don’t get irony. Like empathy, it’s not in their genes or in their psychological makeup.

  3. The other factor in this is how each culture deals with end of life issues. Assuming that the Netherlands provides something like MediCare to their 65 and up population (a big assumption, I simply don’t know what they do), each culture could have different approaches to the end of life. What I’ve observed in the US, is that we tend to go to heroic, sometimes absurd extremes to prolong life. The multitude of pills, procedures, etc that the elderly endure here are a gigantic source of income to the medical industrial complex. The mere fact that doctor assisted suicide is a crime in most states says a lot.

  4. Could be any number of factors. e.g. The Dutch are taller than the Americans. (The Dutch are the tallest in the world). And taller people don’t suffer while young but have shorter lives finally due to the extra blood pressure required to pump up the extra few inches. Also weather can be a factor. The Netherlands is on average colder for much more of the year (it’s lucky to get 5 days over 25c) and much, much wetter on average than the USA (it rains ALL the frikkin’ time in The Netherlands). Which will contribute to killing older people susceptible to disease. There could be a hundred factors. I think comparing a tiny country like The Netherlands is fallacious. You’d need to compare Europe and the USA.

  5. Moonbat I think you’re right about the amount we pay for the final three months of a person’s life. I don’t have the number in front of me so won’t speculate, but have read it is a huge chunk of overall medical spending. The Europeans have a very different approach to LIFE that may not show up in the statistics, of which available health care is just a part. An overall more healthy lifestyle that would include; less food and more exercise; more days off, vacations and leisure time to deal with stress; more available doctors; fewer guns and violent tendencies.

  6. I have a strong hunch the statistics given by Matt are related to race as well as income. There’s a growing understanding that among minorities who have to struggle against racism, there’s a negative relationship between racism and physical health; living with racism produces stress, stress produces high cortisol levels and those levels damage health. Secondly, poverty, which can include all races, is deeper in the US than Holland and again it has an adverse impact on health. Consequently, those who survive to age 65 are not the same as the overall population; those over 65 will include a higher percentage of Americans not physically stressed by race (usually white) and a higher percentage of nonpoor than the average population. To put it another way, many poor people and many members of minorities die before age 65. Hence the skewed numbers compared to Holland.

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