Health outcome statistics are notably hard to parse, given all the factors that go into the health profile of a population or country. But they often can be boiled down to one convenient metric for how well a country serves the health needs of its people: life expectancy.
By that measure, the United States stinks, and according to a new projection of global longevity, by comparison with other developed and even some less-developed countries, over the next decade or so it’s going to get drastically worse.
The projection, from the Institute for Health Metrics and Evaluation at the University of Washington, was published last week in the Lancet, a leading British medical journal. It was based on data from the Global Burden of Disease research project overseen by the World Health Organization, which tries to identify the most important diseases affecting health worldwide and project their course into the future.
The projection underscores a shocking near-term statistic on life expectancy — the U.S. is on pace for its third annual decline in longevity. Such a three-year trend hasn’t occurred for 100 years, or since 1916-18, during a global flu pandemic.
America’s rankings in these data should cause nationwide shame. The nation’s 2016 average life expectancy from birth of 78.7 years placed the U.S. at 43rd among the 196 countries in the data set. That was easily the worst among highly industrialized countries, trailing Denmark (80.7 years) by 15 places. Japan, a long-term leader in life expectancy, came in first, at 83.7, followed by Switzerland and Singapore (both 83.3).
More shocking is the projection for 2040. That year, the researchers say, the U.S. will fall to 64th place, based on a projected average longevity of 79.8. Although life expectancy will increase by 1.1 years, that will be outpaced by greater improvements in other countries. The projected 2040 leader will be Spain, by virtue of it improving its life expectancy to 85.8 years from 82.9 in 2016. (Japan will fall to second place because its life expectancy will improve only to 85.7.)
Changes in life expectancies over the next decade and a half won’t exactly place the U.S. at Third World levels, but it will bring it uncomfortably close. The study projects that Bangladesh will pull to within six months of the U.S. average by 2040 and several other less-developed countries, including Syria, will be within a year or two further behind.
As science commentator Tom Levenson observes, there are obvious limitations to these projections, because they’re based on models that can certainly be confounded by external events such as war and internal politics. But since the same limitations affect all the country-level projections, he says, it’s proper to focus on the relative performance of the U.S., which is dismal by any measure.
It’s also true that the health of different regions is subject to different influences. Among the conditions projected to cause the largest number of years lost to disease by 2040, HIV, pneumonia, malaria and diarrhoeal diseases rank highest in parts of sub-Saharan Africa. In Western Europe, Canada and the U.S., heart disease is the No. 1 killer, followed by Alzheimer’s and a host of cancers. In “high-income North America,” meaning Canada and (mostly) the U.S., drug use disorders rank fourth — undoubtedly a reflection of our inability to get our arms around the opioid epidemic.
Yet those variances don’t explain why the U.S. should be projected to do so much worse in managing its health profile than other industrialized countries with the same challenges, or why other developed countries are outpacing the U.S. by increasingly large margins. In 2040, the report says, “Japan, Singapore, Spain and Switzerland [have] a forecasted life expectancy exceeding 85 years for both sexes, and 59 countries including China were projected to surpass a life expectancy of 80 years.”
What’s especially disconcerting — or amusing if political schadenfreude is your thing — is that these projections make a hash of the Trump administration’s recent brief against “socialism.” Issued this week by the Council of Economic Advisers, which plainly needs some grown-up tasks to keep its idle hands busy, the report tried to illustrate the “opportunity costs of socialism” by comparing a few U.S. healthcare metrics against those of countries with purportedly socialistic healthcare policies such as single-payer or universal health coverage.
These metrics include post-diagnosis cancer survival rates and waiting times for appointments with specialists. The accuracy of some of these CEA statistics already has been questioned — the specialist waiting times for seniors in the U.S., which is purportedly so much lower than for single-payer systems elsewhere, are based on Medicare, which is, yes, a single-payer system.
More to the point, almost every country cited as falling behind the U.S. in some healthcare metric had a higher life expectancy than the U.S. in 2016. The one exception, Slovakia, which is among the European Union countries with shorter post-diagnosis cancer survival, ranked 60th in life expectancy compared to the U.S. ranking of 43rd in 2016 — but is projected to be ahead of the U.S. in 2040 — ranking 47th vs the U.S. at 64th — with average life expectancy of 80.9 vs the U.S. average then of 79.8.
Then there’s China, which still seems to qualify by the administration’s reckoning as a socialist country, albeit one making the transition to capitalism (the report keeps referring to “Maoist China”). China will leapfrog the U.S. by moving from 68th in 2016 to 39th in 2040. Cuba, by the way, will move further ahead of the U.S.; in 2016 it was ahead of the U.S. by 0.1 of a year and two rankings, but by 2040 it will be 1.2 years better in life expectancy and 19 ranks ahead.
Since the health conditions in the U.S. aren’t much different from its competitors in the developed world, we have to look elsewhere for explanations of America’s awful performance. The proper focus is on policy.
Cost long has been the chief obstacle to accessing healthcare for millions of Americans. That’s what the Affordable Care Act was designed to address, and it’s the focus of initiatives like Bernie Sanders’ “Medicare for all” single-payer proposal. The administration's “socialism” paper, by the way, labels Sanders’ plan “socialized medicine.”
Republican policy since the ACA’s enactment in 2010 has been aimed at stripping away the cost protections and access the law provided. Fourteen states, all Republican, continue to reject Medicaid expansion under the ACA; 20 red states, abetted by the Trump administration, have moved in federal court to get the ACA declared unconstitutional.
Trump on Wednesday signed a bill with modest provisions to address the opioid crisis, including stricter enforcement against illicit drug importation and improvements in Medicaid and Medicare coverage for opioid addiction. But in every other respect the administration is making things much worse. It’s encouraging states to impose work requirements and premiums for Medicaid, which plainly will narrow access to coverage for the most needful population, and it’s promoting junk health insurance plans that will be allowed to exclude people with pre-existing conditions, like opioid addiction.
Medicaid has been attacked by Republicans for causing the opioid crisis; that’s utterly untrue, but what is true is that it’s a key to solving the crisis — if it’s properly funded.
Republicans in Congress have had no answers for the maladies that afflict the U.S. healthcare system except various ideas for making it less serviceable. The harvest is visible in the decline in longevity seen over the last two or three years, and beckons us from over the horizon and into 2040.