Nicholas Kristof, writing in the New York Times, provides a veritable assault of statistics designed to show the weakness of the U.S. healthcare system and the strengths of a single-payer approach. The United States has higher infant mortality than countries with universal healthcare, he says. American life expectancy is 37th in the world, tied with Kuwait and Chile. The U.S. health system ranks last in terms of “preventable deaths.” All of this is arguable, as we’ll see, but let’s assume for a moment that Kristof is correct.
Kristof then goes on to say:
There is one American health statistic that is strikingly above average: life expectancy for Americans who have already reached the age of 65. At that point, they can expect to live longer than the average in industrialized countries. That’s because Americans above age 65 actually have universal healthcare coverage: Medicare. Suddenly, a diverse population with pockets of poverty is no longer such a drawback.
Is America’s better life expectancy at 65 necessarily because retirees have universal coverage through Medicare? Or might it be—again assuming all of Kristof’s horrific health statistics are meaningful—that only the very healthiest Americans survive to 65 after running the gauntlet of our survival-of-the-fittest healthcare system? This is survivorship bias in its most literal sense. Kristof here makes an elementary error of logic.
Moreover, we do know, for instance, that infant mortality has a lot more to do with social factors such as low birth weight than it does with healthcare systems. We also know that life expectancies are affected by eating and smoking habits, violent crime, automobile deaths, and other factors besides healthcare. Robert Ohsfeldt and John Schneider adjusted life expectancy statistics to account for deaths relating to these kinds of factors, finding that, instead of the middling ranking Kristof reports, the United States has the highest life expectancy in the world. Likewise, economists June and Dave O’Neill of Baruch College, in a comparison of the U.S. and Canadian health systems, concluded that “that the efficacy of healthcare systems cannot be usefully evaluated by comparisons of infant mortality and life expectancy.”
The University of Pennsylvania’s Samuel Preston and Jessica Ho also looked at these issues, finding:
Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. Its low ranking is often blamed on a poor performance by the healthcare system rather than on behavioral or social factors. This paper presents evidence on the relative performance of the U.S. healthcare system using death avoidance as the sole criterion. We find that, by standards of OECD countries, the U.S. does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and where behavioral factors do not play a dominant role. We show that the U.S. has had significantly faster declines in mortality from these two diseases than comparison countries. We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning healthcare system.
Others at the American Enterprise Institute and elsewhere are better qualified than I to assess all of Kristof’s claims on the quality of U.S. healthcare. But given the errors of logic and statistics so far, I wouldn’t take his column all that seriously.