“Don’t talk to me about people who are nice,

I’ve spent my whole life in ruins

Because of people who are nice”

                        Steven Patrick Morrissey 

 

 

 

          In a USC OT Leadership class in January 2011, as part of a presentation by students, we were shown a video of a speaker from Lobby Day, which was an event sponsored by the California Health Professional Student Alliance that took students to Sacramento to promote a government-run single payer health care system. The speaker in the Lobby Day video told the audience that America’s health care system was ranked 37th in the world. The speaker used this statistic as a springboard to rail against what he considered the injustices of an American system that he claimed compared poorly to all other industrialized countries on various measures of health. Unfortunately, the video only presents information that makes students think positively about the policies promoted by USC OT and uses false and misleading information to do so.

       The ranking cited by the speaker was derived from a WHO report issued ten years ago and can be found at http://www.who.int/whr/2000/en/whr00_en.pdf. It’s a report that has been discredited by its own editor-in-chief, Philip Musgrove. In 2003, Musgrove wrote an article in The Lancet explaining why the rankings were, in his words, “spurious” and “meaningless.”¹ Then in 2009, in an interview with the Wall Street Journal, Musgrove admitted that the figures used were, again in his own words, “so many made up numbers” that it resulted in a “nonsense ranking.”²

       The question arises, why were USC OT students shown a video of a speaker citing America’s allegedly poor ranking compared to other countries if that ranking had been completely repudiated by its editor-in-chief almost a decade ago? The answer: the video was shown because the speaker’s claims aroused people’s emotions and created enthusiasm for the political positions supported by USC OT.

      The video was shown with the department’s expert in health care policy in the room. This expert is also a militant supporter of Single Payer health care and she shepherded USC OT students through the Lobby Day event. The speaker in the video was railing against the U.S. system precisely because he was promoting the Single Payer initiative in California. Thus you can see why USC OT’s expert was biased against exposing any misinformation spread by the speakers at the rally.

       Regrettably for students, many in academia do not know how to separate their identities as individuals and activists from their role as educators and expository speakers. If the students who used the video for their presentation had been inspired by USC OT to engage in fact-based inquiry and reflection, rather than manipulated for political purposes, they would not have presented a video with a speaker using old and discredited information. But when political advocacy is the main concern, opportunities for learning are lost and students are exposed to only a limited set of perspectives.

       So how does America’s health care system stack up against that of other countries? Let’s look at some data. In 2007 Lancet Oncology published a study comparing the cancer survival rates for the U.S. with 18 European countries and these are the results:

    • For surviving prostate cancer: U.S. #1
    • For surviving colorectal cancer: U.S. #1
    • For surviving skin cancer: U.S. #2
    • For surviving breast cancer: U.S. #2
    • For surviving thyroid cancer: U.S. #2
    • For surviving lung cancer: U.S. #3
    • For surviving soft tissue cancer: U.S #3.³

       The U.S. ranked #4 in survival rates for corpus uteri cancer, performing better than Switzerland, the Netherlands, Belgium, and Great Britain. It also ranked #4 in survival rates for non-Hodgkin lymphoma, beating Sweden, Norway, and Great Britain. It ranked 7th best for kidney cancer, beating Sweden, Norway, and Great Britain, and also ranked 7th best for stomach cancer, performing better than Sweden, France and Great Britain. And when you combine the survival rates for all cancers, the U.S. ranks first, thus beating everybody.⁴ A country that beats every other country when combining survival rates for all cancers is a far cry from the claim by the speaker on Lobby Day alleging a 37th ranking based on repudiated data. When data from a prestigious medical journal are used to understand an issue, rather than inflammatory rhetoric at a political rally, we get an entirely different picture of a topic.

       And cancer treatment isn’t the only health measure in which the U.S. outperforms most other advanced countries. An OECD study comparing stroke outcomes also shows that the U.S. performs better than most other rich countries. This study presented data of people admitted to a hospital after a stroke using day 7 and day 30 in the hospital as cut-off points to determine the survival rate.⁵ Here are some results:

    • 30-day survival rate for men over 75: U.S. #1
    • 30-day survival rate for women over 75: U.S. #2
    • 30-day survival rate for men 65-74: U.S. #2
    • 30-day survival rates for women 65-74: U.S. #2
    • 7-day survival rate for men over 75: U.S. #2
    • 7-day survival rate for women over 75: U.S. #2
    • 7-day survival rate for men 65-74: U.S. #3
    • 7-day survival rate for women 65-74: U.S. #3.

       A country that ranks 1, 2, or 3 in several categories for surviving stroke can’t be said to be failing in comparison to other countries. In fact, the question should be, Why are so many countries with universal health insurance coverage performing worse than the U.S.? But if you’re goal is to promote your politics rather than engage in fact-based inquiry, then fact-based questions are not going to be part of your reasoning process.

       The U.S. also ranked first in the world in providing coronary angioplasties.⁶ The U.S. is also superior to every Western European country and Canada in providing dialysis.⁷ Furthermore, in a comparison of wait-times for elective surgery among English-speaking countries, the U.S. ranked first.⁸ But it’s not just that it ranked first – it blew the competition away: the U.S. was five times better than Australia, the country that ranked second in this study. Additionally, the U.S. outranked all other English-speaking countries in the percentage of patients who spent more than 20 minutes with their doctor.⁹ So again, the U.S. ranked first.

       In one study of hypertension in seven developed countries, the U.S. ranked first in providing patients with antihypertensive medication.¹⁰ In another study of deaths from influenza among 16 developed nations, the U.S. ranked 6th, outperforming France, Canada, and Sweden.¹¹ Is a health care system that regularly outperforms all of the English-speaking countries in the world and most of Western Europe in many health care measures as awful a system as was portrayed in the Lobby Day video?

       One of the statistics cited by the speaker in the Lobby Day video was America’s life expectancy. But life expectancy is not an appropriate measure of a health care system because that number is affected by things that have nothing to do with what doctors, hospitals or insurance companies do. Homicide, death by car accidents, and personal and cultural habits are things that can lower life expectancy. But these things are not related to the health care system. Your insurance company is not responsible if you overeat and don’t exercise, nor can you blame your doctor if you get shot. America’s life expectancy is shorter than most other developed countries but that has nothing to do with the quality of our health care system.¹² The most likely reason for our lower survival rates has to do with smoking, obesity, our sedentary lifestyle and the fact that we have more stressful working lives than most other industrialized countries.

      America had the highest per capita consumption of cigarettes of all industrialized countries for the 50-year period ending in the mid 1980s.¹³ The effects of cigarette smoking on one’s health do not appear until decades later so we can expect to see lower life expectancies in the U.S. than what would be otherwise based on that alone. This means that death rates in the 1990s and 2000s will include the consequences of individual reckless behavior in the 70s, and 80s. How would America compare if we calculated life expectancy by looking only at deaths not related to smoking? One recent study estimated that America’s life expectancy among OECD countries would go from 14th to 9th for men and from 18th to 7th for women if deaths caused by smoking were eliminated.¹⁴

       America is also the fattest country in the world, and we are much fatter by a whole lot of fat.¹⁵ America has about eight times the number of obese people than does Japan, the leader in life expectancy.¹⁶ Moderate obesity has been found to reduce life expectancy by three years and severe obesity reduces it by about 10 years.¹⁷ It’s also important to note that the sharp increase in childhood obesity, both in terms of the percentage of the population and in terms of how much fatter individuals are becoming, means that a growing number of Americans are unlikely to have longer lives than their parents regardless of the quality of the health care they receive. This will depress America’s average life expectancy, but the personal choice to be fat or stay fat is not an issue that reflects on the quality of a health care system.

       Even though obesity and smoking cut down America’s life expectancy, America is not that far behind Japan, the best country in this category. The CIA World Factbook lists Japan’s life expectancy as 82.25 compared to 78.37 for the U.S. In other words, America’s life expectancy is 95.3% of the ideal. Since when do people complain about achieving over 95% of an ideal?

       When broken down by sex, a CNN report shows that American women’s life expectancy is 97.4% of Sweden’s and American men have a life expectancy that is 97.7% of French men.¹⁸ How could you call an over 97% similarity to the liberal ideals of France and Sweden a broken system?

       Although you often hear the U.S. is ranked very low for life expectancy, most countries are bunched within a couple of years of each other so there is very little separating them. According to the CIA World Factbook, for example, America’s life expectancy is only three months lower than Denmark’s. Have you ever heard someone denouncing Denmark’s universal health care system for resulting in practically the same life expectancy as America’s? In fact, America’s life expectancy is within two years of 12 western European countries and within three years of all of them but Italy.¹⁹

       Furthermore, when you look inside the numbers, you also learn things that those who share USC OT’s political goals won’t tell you. For example, American men who reach the age of 80 have a longer life expectancy than men from Sweden, France, and England.²⁰ And American women who reach the age of 80 can expect to live longer than women in Sweden, Denmark, and England.²¹

       Surprisingly, American Hispanics, one of the groups most likely to NOT have health insurance, live longer than blacks and whites in America. According to the Center for Disease Control, American Hispanics born in 2006 have a life expectancy of 80.6 years,²² which means that their life expectancy is longer than that of Norwegians, New Zealanders, Austrians, Germans, the Dutch, the Irish and the British, all from countries that have universal health insurance.²³ And the French and Swedish have a life expectancy that’s only about a couple of months higher than American Hispanics. So even though life expectancy is not a relevant measure when comparing health care systems, even when using such a measure as was done by the speaker on Lobby Day, several European countries have lower or equivalent life expectancies to that of an allegedly oppressed and disproportionately uninsured minority group in America.

       I haven’t researched the effects of stress, but I imagine that it must also play some role in reducing life expectancy, which would also play a role in increasing the differences between the U.S. and other countries since Americans work more hours per week, take less vacation, and have a later retirement age than most if not all other industrialized countries.

       I don’t think these differences are worth much mulling over. Although they are certainly fascinating research issues, using the differences in life expectancy as a basis to argue in favor of one system over another is not scientifically warranted. These life expectancy comparisons are skewed against America because of smoking and obesity and who knows what else. These things are not within the control of the health care system, and yet America’s life expectancy when compared to most western European countries is still close to a 100% similar. Such minor differences are not much to make hay out of for purposes of deciding how health care should be run.

       So what precisely was the goal of USC OT in showing a video that used false and misleading information to give us a stark picture of America’s health care system? Because they want to make it seem like America is in extreme crisis in order to manipulate students to support radical change in our health care system. And why do they want to do that? Please see my speech – “The Horror of Modern-Day Benevolence” regarding the moral philosophy of altruism and the outsourcing of one’s benevolence.

(special thanks to M. Lovey for sharing her editorial eye)

1. Philip Musgrove, “Judging health systems: reflections on WHOs methods,” The Lancet, vol. 361, issue 9371, pages 1817-1820 (May 24, 2003) doi:10.1016/S0140-6736(03)13408-3.
2. The Numbers Guy, “Ill-conceived Rankings Make for Unhealthy Debate” The Wall Street Journal Oct 21, 2009 http://online.wsj.com/article/SB125608054324397621.html
3. Arduino Verdecchia, “Recent cancer survival in Europe: a 2000-02 period analysis of EUROCARE-4 data,” Lancet Oncology (Sept. 2007) vol. 8 pages 784-96.
4. See note iii.
5. Moon, Lynelle et al. “Stroke Care in 17 OECD Countries” found at http://www.oecd.org/dataoecd/10/46/2957752.pdf . pages 61-72
6. Gerard Anderson et al. “It’s the Prices Stupid.” Health Affairs, 22, no.23 (2003):89-105
7. See Anderson “It’s the Prices Stupid.”
8. Cathy Schoen, “Comparison of Health Care System Views and Experiences in Five Nations, 2001” Commonwealth Fund, Issue Brief, May 2002.
9. Karen Donelan, “The Cost of Health System Change: Public Discontent in Five Nations,” Health Affairs, May/June 1999.
10. Preston and Ho, “Low Life Expectancy in the United States” page 6, citing Wolf-Maier (2004).
11. Preson and Ho, “Low Life Expectancy in the United States” page 43 Figure 1.                        12. See “Low Life Expectancy in the United States: Is the Health Care System at Fault?” by Samuel Preston and Jessica Ho.
13. See Preston and Ho page 1 citing Forey et al. (2002).
14. See Preston and Ho pages 1-2.
15. David Cutler et al., “Why have Americans become more obese?” Journal of Economic Perspectives vol 17, No. 3 Summer2003 pages 93-118.
16. See http://www.noo.org.uk/uploads/doc799_2_International_Comparisons_Obesity_Prevalence2.pdf
17. See Science Daily: “Moderate Obesity Takes Years off Life Expectancy.” http://www.sciencedaily.com/releases/2009/03/090319224823.htm
18. “Why Americans Aren’t Living Longer,” http://pagingdrgupta.blogs.cnn.com/2011/01/27/why-americans-aren%E2%80%99t-living-longer/ 
19. I include in this comparison only the 17 major western European countries listed and exclude small ones such as Monaco, Andorra and San Marino as these tiny countries are not useful for making comparisons.
20. Eileen Crimmins, "Explaining Divergent Levels of Longevity in High-Income Countries," page I-22 Table 1-1 column for 2007.
21. See Eileen Crimmins above
22. See Media Advisory: First Report on Hispanic Life Expectancy Released by CDC October 2010. http://www.cdc.gov/media/pressrel/2010/a101013.html
23. Gerard Anderson, “Multinational Comparisons of Health Systems Data, 2008,” November 2008.

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