While the U.S. celebrates longer life expectancy for citizens than before, U.S. citizens realize less life expectancy than citizens of other nations and the U.S. ranks only 37^th in the world in quality health care - yet nationally America spends 82% more per person on health care than others - even U.S. federal and state government spends more on health care than other governments.

We Celebrate improved LIFE EXPECTANCY
52-year period, 1950-2002

This is a happy chart, showing improvements in life expectancy for both males and females:

This chart is repeated from the author's Generational Celebration Report, the creation of which was recommended by Nobel laureate Milton Friedman. (That report covered 3 areas to celebrate over recent generations, including life-expectancy.) Before reviewing this chart, let's consider: Achieved live expectancy is a very important measure of over-all health care quality - nationally and individually. We should know how we are achieving in this regard compared to our past AND compared to that now achieved in other developed nations. And, we want to know our efficiency - - whether we are spending more or less of our economy on health care than other nations for quality achieved. A life expectancy gap plus over-spending is indicated, compared to other nations. Since a picture is worth a thousand words, this issue is presented in 7 pictures that follow.

The black curve in the chart above represents the overall increase in life expectancy at birth for both sexes in the past 52 years - - growing from 68.2 years in 1950 to 77.3 years in 2002 - - an improvement of 9 years from 1950 to 2002. That performance is something to celebrate.

The overall increase (black curve) in the 30-year period between 1950 and 1980 was 5.5 years (66 months) - or about 2.2 months per year. In the 22-year period from 1980 to 2002, a 3.6 year (43 months) increase occurred, although at a slower rate of 1.95 months per year. However, the difference in the past 22 years between males and females has been dramatic.

The green curve on the chart represents female life expectancy from birth and the pink curve represents life expectancy growth for males - both have increased. In the period 1950-80 female life expectancy increased 75.6 months, 43% faster than the 52.8 months for males. Thereafter male life expectancy increased 80% faster than females 1980-2002 as if 'magically' trying to narrow the gap.

In the more recent period, 1990-2002, male life expectancy increased 145% faster than female life expectancy - as male life expectancy increased 32.4 months in this 12 year period from 71.8 to 74.5 years, while females increased 13 months from 78.8 to 79.9 years.

Considering that in the past much early female mortality was due to childbirth and considering the supposed improvement in prenatal healthcare and education during the past several decades, as well as recognizing that today's young women are having fewer children, it is surprising that life-expectancy for women is slowing down compared to the past - - as shown by the chart.

While we celebrate increases for both sexes and that males are growing faster than in the past, it is unknown to the author if this faster improvement since 1975 for males relative to females (and more pronounced after 1989) is a data problem or is indicative of other causes.

The Family Income Report shows the life expectancy slowdown period for females was the same 2 ½ decade period when real median family incomes stopped growing and stagnated, as many woman left their children for daycare by others in order to enter the workforce to help keep family incomes from falling. That report contains a long-term graphic showing 64% of all married women with children below 6 years old are in the labor force - - a 6 times higher ratio than in the 1950s - - and 76% with children age 6-17. Is it possible life-style changes for woman, as more must now be both breadwinner and homemaker compared to pre-1970s, influence such data? Perhaps those with more knowledge will contact me with other reasons potentially 'behind the data'.

Comments by Nobel laureate Milton Friedman: After reviewing this chart in the Celebration Report chapter of the Grandfather Economic Report series, a letter to the author from Dr. Friedman on February 24, 1998 contained: "Improved life expectancy is most surely the most important single improvement in decades, but it's interesting to note from your chart that there has been a distinct slowdown in the rate of increase and the slowdown comes shortly after enactment of Medicare and Medicaid. I do not believe that is an accident." In July 1998 I wrote back and asked: "when you have a chance I would appreciate learning what you mean by the impact on these curves of Medicare and Medicaid." On September 4, 1998 Dr. Friedman replied with the following:

"With respect to my comment about Medicare and Medicaid, what I had in mind was that their passage marked the beginning of a far greater involvement of government in the whole area of medical care. The effect is to decrease the efficiency with which the resources employed in medical care are used. We do have continued discoveries and findings but probably at a slower pace. I do not know any other explanation as to why there should have been a slowdown in the rate of increase of the length of life since the 1970s as shown clearly in your diagram. It would be interesting to have another figure, showing what has happened to remaining life expectancy of individuals aged, say 40 or 50 (or 65 - author's). The figures showing length of life are strongly affected, particularly in the early decades of the 20th century, by infant and mother mortality. The improvement in length of life is much less striking if taken even from age 5 on than from birth. I certainly commend you for the Grandfather Reports you have produced and for the imaginative way in which you have displayed data highly relevant to very important issues. Keep up the good work." (see A Tribute to Milton Friedman).

Based on that input, the author was able to add the following for seniors and will add for ages 40 and 50 when available.

LIFE EXPECTANCY OF SENIORS

While the preceding chart shows life expectancy trends from birth for all citizens, the left chart shows life expectancy of seniors when reaching age 65 at different periods.

The data shows in 1960 women (pink curve) at age 65 were expected to live an additional 16 years (to age 81), which in another year (2000) will have increased to 19 years (to age 84), and is expected to add another year (20 years) for those reaching 65 in 2010.

The data shows men (black curve) reaching age 65 in 1960 were expected to live another 13 years (to age 78), whereas by 2000 will rise to 16 years (to age 81).

This chart also shows a steeper curve for men than for women after 1970.

(Data Source: Nations Business, October 1998, page 76 - Source: 1998 Report Board of Trustees Old Age & Survivors Insurance & Disability Insurance Trust.)

A 2004 update for 2001 shows females at 19.4 additional years to age 84 (about the same as per this chart), but it shows a dramatic increase in additional years for men at 16.4 years to age 81 for 2001. (National Vital Statistics Report Vol 51 March 2003 at http://www.cdc.gov/nchs/fastats/lifexpec.htm). So, life expectancy for men at age 65 is increasing even faster than the 2x rate over women.

For those interested in data for life expectancy from age 75 as of 2001 - - for men it was an additional 10.2 years (to age 85), up from 8.8 years as of 1980. For women it was an additional 12.4 years (to age 87), up from 11.5 years in 1980.

We know there is an Approaching Time-Bomb (see graphic in the Social Security Report) of the rising trend line starting 2005 of those age 65 and over ('baby boomers') increasing in numbers from 12% of the population to a 20% share over the following 20 years. This 67% increase in the senior-citizen proportion of the population, together with the increased life expectancy trends shown in the above chart, will place a major challenge on health care.

The above charts show our improvement in life expectancy, compared to our own past.

But - - how are we doing relative to other nations? See the next picture chart.

OTHER NATIONS HAVE LONGER LIFE EXPECTANCY THAN THE U.S.

Despite past life-expectancy growth within the U.S. as shown in the first chart, the left chart shows life-expectancy in the USA is less than most other advanced nations. Data source: 1997 statistical abstract, table # 1336 Although we can be proud today's generation can celebrate the advancement in life expectancy for both sexes, compared to the past - Citizens of other nations are living longer than Americans. Let us call this a U.S. Health Care Gap.

Is this health care 'gap' caused by too little health care spending relative to other nations?
Answer: certainly not as shown by following pictures.

THE U.S. RANKS ONLY 37th IN QUALITY HEALTH CARE

"The United States spends more per person on health care than any other country, yet in overall quality, its care ranks 37^th in the world," says a World Health Organization analysis. It concluded that France provides the globe's best health care, with Italy ranked 2^nd. Japan won the distinction as having the world's healthiest people. 'While good at expensive, heroic care, Americans are poor at the low-cost preventive care that keeps Europeans healthy,' said Princeton University health economist Uwe Reinhardt. Measuring how long people live in good health - - not just how long they live - - the Japanese beat Americans by 4 ½ years - - yet Japan spends just $1,750 per person on health and France $2,100, compared to the stunning $3,724 spent by the U.S. The report said it doesn't endorse government-run insurance only, as countries with good mixes of private and public programs due well.

Of the 191-country ranking, here are the top 50:

• Top 10 quality care nations: France, Italy, San Marino, Andorra, Malta, Singapore, Spain, Oman, Austria, Japan.
• 2^nd 10: Norway, Portugal, Monaco, Greece, Iceland, Luxembourg, Netherlands, England, Ireland, Switzerland.
• 3^rd 10: Belgium, Columbia, Sweden, Cyprus, German, Saudi Arabia, United Arab Emirates, Israel, Morocco, Canada.
• 4^th ten: Finland, Australia, Chile, Denmark, Dominica, Costa Rica, United States, Slovenia, Cuba, Brunei.
• 5^th ten: New Zealand, Bahrain, Crotia, Qatar, Kuwait, Barbados, Thailand, Czech Republic, Malaysia, Poland.
  (reported 21 June 2000, Bradenton Herald-Tribune).

DISTURBING 2005 UPDATE

NOTE > to update the above chart and the next chart below, in December 2005 the National Center for Health Statistics reported health care spending in the U.S. in 2003 increased to $1.7 trillion. Health expenditures as a percentage of gross domestic product rose to 15.3 percent in 2003, up from 14.9 percent in 2002. (This shows an 8% increase in the share of the U.S. economy consumed by health care spending in 2003, compared to the 14.2% ratio just a few years earlier).

Additionally, the 2005 report states,

"the march of medical progress in the USA has taken a worrisome turn: Half of Americans in the 55-to-64 age group - including the oldest of the baby boomers - have high blood pressure, and two in five are obese. That means they are in worse shape in some respects than Americans born a decade earlier were when they were that age.

The health of this large group of the near-elderly is of major concern to American taxpayers, because they are now becoming eligible for Medicare and Social Security. 'What happens to this group is very important because it's going to affect every other group," said Amy Bernstein of the National Center for Health Statistics.'" Source: Reuters, AP writer Mike Stobbe 12/8/05'.

For another view of international comparison, the left chart shows total health care spending by various nations. Note the U.S. spent 14.2% of its economy on healthcare at the date of this chart. The above update reports 2003 spending significantly higher at 15.3% of GDP. ...Spending much more than nations covering all citizens via national health insurance. (Data Source: OECD data published The Economist magazine 10/24/98)

GOVERNMENT VS. PRIVATE SECTOR HEALTH CARE SPENDING

Truly a remarkable chart.

NOTE: In addition to the U.S. government spending (the blue bars) more on health care than many other nations, which have better life expectancy, the U.S. private sector (brown bar) spends an additional 7.5% of the U.S. economy on health care. It was that 7.5% of the economy spent by the private sector, which was potentially a target for government take-over with the failed 1993 National Health Care Plan proposed by the Clinton administration. Had same been approved by the Congress, then the brown bar (private spending) may have dropped toward zero as the U.S. blue bar (government spending/control) could have zoomed to as much as 14.2% of the economy compared to 5.8% for other nations. - - with a possible result that U.S. government health care spending/control might then consume 145% more of its economy than other governments. Some might say this data suggests that had that 'plan' been implemented, the U.S. life expectancy gap vs. other nations might have increased. This data adds credence to some who have suggested the ill-fated national plan was partly motivated by other than health enhancement.

This chart breaks out the data for several nations in the foregoing chart - of government vs. private sector health care spending..

The blue bars represent the share of each economy consumed by government spending on healthcare.

Note from this chart that U.S. government spending is higher than most, yet U.S. government spending includes a much smaller share of its citizens than others.

Certainly said charts do not suggest a need for more government spending on health care in the U.S., but perhaps less - - with significantly more efficiency.

More specialists = more cost without better quality in USA -

States in America that spend more on Medicare don't necessarily have better health care, according to a study being published. In fact, health care in those states may be less effective and lower in quality. The study found that New Hampshire, which had the highest overall quality ranking in America, spent the least at $4,863 per beneficiary, while Louisiana, which spent the most at $8,238 per beneficiary, had the lowest quality ranking. The pattern is likely due to state medical practice patterns, such as the use of intensive surgical procedures instead of drug treatments where both could be considered viable options, rather than the relative cost of medical treatments in a given state, said Katherine Baicker, lead author of the report in the peer-reviewed policy journal Health Affairs and assistant professor of economics at Dartmouth College in New Hampshire. The mix of specialists vs. general practitioners in a state had a direct link to cost and quality of care, the report said. Each additional general practitioner per 10,000 people increased the state's quality ranking and lowered spending by $684 per beneficiary. Each additional specialist per 10,000 people lowered a state's ranking and increased spending by $526 per beneficiary. Larry Lipman, Atlanta Journal-Constitution, 04/06/04

U.S. Spends 2x per person More on Health care than Other Nations
Above is our data for U.S. health care spending % GDP vs. other nations. Below regards comparison on a per capita basis.

April 15, 2005 – The New York Times (Paul Krugman): 

“In 2002, the latest year for which comparable data are available, the United States spent $5,267 on health care for each man, woman and child in the population. Of this, $2,364, or 45 percent, was government spending, mainly on Medicare and Medicaid. Canada spent $2,931 per person, of which $2,048 came from the government. France spent $2,736 per person, of which $2,080 was government spending.  Amazing, isn’t it? U.S. health care is so expensive that our government spends more on health care than the governments of other advanced countries, even though the private sector pays a far higher share of the bills than anywhere else.”

• Looking forward, all nations are faced with a crisis in their government-operated social security and health care programs - as seniors make up a larger and larger share of the population.
• The above data give the appearance that other nations may be in a better position concerning health care delivery and efficiency to meet that challenge.
• The above data also suggest the lack of efficiency of U.S. government spending for health care itself may be driving increased costs to the private sector's health care spending.
• It is a wish for the generation of my grandchildren that not only will their life-expectancy far exceed mine, but that it shall exceed that of all other developed nations and that the quality or our health care will quickly improve from its low #37 rank to consistently become rank #1 in the world.
• It is my additional wish that such performance will be a lower cost per person (more efficient) than other nations.

For related reports, see the Government Size Report showing how government has grown faster than the economy during my generation, the Social Security Report for long term graphics and the ticking time bomb, and the chart comparing other nations in the International Spending Report.