The U.S. National Center for Health Statistics reports that the average U.S. life expectancy in 2016 declined for the second year in a row, down to 78.6 years. Preliminary Centers for Disease Control (CDC) death rates for 2017 reported earlier this year indicate that the full year of 2017 will show yet another decline in American life expectancy, possibly steeper than the past two years.
For the rest of the world it is a far different story. According to the World Health Organization (WHO), in 2016, the average life expectancy of Japanese citizens hit an incredible 84.2 years. Japan already led the world in average life expectancy ten years ago, at about 81 years, but has added more than three more years to its average longevity over a decade. And that is despite spending less than half per person on their medical care compared to Americans, based on their respective cost-of-living. Countries like New Zealand, Australia, Sweden, Norway, Canada, Italy, France, Singapore, Spain and Switzerland, all which already had higher average life expectancies than the U.S., continue to see gains in average life expectancy, while the U.S. falls further behind.
Based on World Health Organization data, in 2016, the U.S. ranked 34th in the world in average life expectancy, down from 30th in 2010, 28th in 2000, and 21st in 1990. Among the 33 countries ranked above the U.S. in 2016, every one showed an improvement in average lifespans from 2010 to 2016 (with the exception of Australia, which had no gain or loss, and which was already ranked 5th in the world in terms of longevity). Collectively, those 33 nations improved their average lifespan by a mean of about 1.25 years compared with 2010, while the average life expectancy in the U.S. fell by .2 years. The U.S. also ranks last among these nations in terms of average lifespan improvement since the year 2000. The majority of developing nations are also continuing to see substantial increases in longevity over the past decade, with many of them now ranking near or ahead of U.S. average longevity.
It's true that life expectancy isn't the only indicator of health (although it is very highly correlated with many other traditional health factors). The WHO publishes an index called the Healthy Life Expectancy (HALE), that measures the average age at which individuals in a country first experience signficant disability or other life impairment. By this measure, the U.S. ranks even lower, at 40th best, lower than countries like Slovenia, Chile, Croatia and China.
What are U.S. citizens getting for their healthcare spending?
It is particularly puzzling that the U.S is such an underperformer, and getting worse than its peers, despite it being far and away the bigger spender on medical care, and increasing its spending every year. The graph below shows medical spending among 35 developed nations, after adjusting for purchasing power parity (PPP), the cost of living for each respective country. After reflecting cost-of-living differences among countries, the U.S. is easily the largest spender on healthcare and medical expenses per person, spending nearly two and a half times that of the average OECD country.
Compared to other countries, the U.S. spends a much larger share of its medical spending on older citizens. For younger adults, average medical spending in the U.S. is comparable to that of other developed nations, but by the time adults get into their 60s, 70s and 80s, average costs for medical care in the U.S. increase sharply. The graph below compares single-age medical spending in the U.S. compared to four other developed nations, each of which exceeds the U.S.' average life expectancy by at least 2.5 years.
Are Opioids to Blame for America's Health Problems?
Commentators like to point to the growing opioid epidemic and its respective death toll, as responsible for the decline in average life expectancies, and it is partly responsible, but it is far from the overall picture. The increase in opioid and other drug death rates alone (now estimated at about 71,000 per year, according to the CDC) can not account for the very large life expectancy differences between the U.S. and other nations. More than half of the 2.7 million yearly deaths in the U.S. are due to cancer or heart disease. The yearly increases in drug deaths (while sad, and incredible), represent less than 1% of those more common causes of death. The death rates of cancer and heart disease has been steadily declining in the U.S. for decades, but while other countries continue to see death rates fall from these diseases, rates in the U.S. are flattening in recent years (see graph below).
Americans aren't spending enough on medical care?
For many, large yearly increases in medical spending in the U.S. are readily accepted as inevitable, at the same time that U.S. citizens, collectively, aren't seeing much benefit, and are falling behind other countries. The U.S. National Institutes of Health, whose mission is to “enhance health, lengthen life, and reduce illness and disability”, spends $37 billion a year on medical research, mostly in the form of grants. That amount alone is more than the total amount of medical and healthcare spending for each of the countries of Portugal, Greece, Chile, Czech Republic, Costa Rica, Finland, and Israel, all of which have a higher average longevity than the U.S. With the more than $200 billion given to the National Institutes of Health since 2010, has this government agency been successful in its core mission of enhancing health, lengthening life and reducing illness and disability?
Such spending, and the enormous amounts the U.S. has spent on healthcare and medical expenses, makes it all the more puzzling to hear the opinion by some commentators that the reason for Americans' flattening longevity and increasing health challenges is because the U.S. isn't spending enough on medical spending. Yet we see dozens of countries that spend a fraction of what the U.S. does per person, yet live longer and have better overall health indicators. How is it that developing nations like Chile and Costa Rica have longer average life expectancies than the U.S., but spend less than a fifth as much per person on healthcare spending? A Vietnamese woman has the same life expectancy as an American woman, despite spending nearly nothing on medical spending, less than a twentieth of her U.S. counterpart (and after adjusting for their respective cost-of-living differences). A seventy-year-old man in the developing nations of either Dominican Republic or Nicaragua will live about as long, on average, as a 70-year-old man in the U.S., despite spending less than a tenth as much on yearly medical spending (and again adjusted for their respective cost-of-living).
So much of what is spent in the U.S. on medical expenses and “healthcare” isn't doing anything for Americans' health. For sure, the more than $500 billion spent yearly on administration costs add little to the health of Americans, though those same costs enrich the pockets of many. The CMS estimated back in 2012 that 10% of healthcare spending was lost to fraud in the healthcare industry. That's the equivalent of almost $400 billion a year today. Others, such as the Institute of Medicine, put that yearly fraud loss at more than $750 billion way back in 2009. The nearly $500 billion of yearly drug sales in the U.S. also does not appear to be the key to health. The U.S. leads the world by far in pharmaceutical sales, spending five times as much as the next largest consumer (Japan) and purchasing about 45% of the world's total drug supply.
Nutrition is a critical issue for health, yet most doctors don't spend much time talking about it with their patients, less than 10% of the time, when obesity is not an issue (see graph below).
All of these countries spend far less than the U.S., compared to the size of their respective economies. Perhaps the difference is that in those other countries, the true goal of their medical spending is so their citizens can be productive citizens. In the U.S., government agencies, corporations and insurance companies see massive medical spending as the avenue to large corporate profits, rising employment to offset economic weakness, an inflated Gross Domestic Product, and more government involvement in healthcare. Ordinary Americans see rapidly rising medical costs without benefits.