[marinmania]

>The news is perhaps not shocking given the relatively poor quality of health care in the US.

I'm not sure I agree with that? I'd think intuitively the delta between years lived and "health span" would be largest in countries with good health care. The end of the article does allude to this.

>While the US presented the most extreme example, the researchers note that the global trends seem to present a "disease paradox whereby reduced acute mortality exposes survivors to an increased burden of chronic disease."

[LinuxBender]

I am not an expert but I think it may be more nuanced in my opinion. Fast food started in the US in the 70's. Other nations followed after some time and I do recall seeing a funny chart ... not sure if I can find it tonight but it is an overlay of when people started eating fast food and when there was a dramatic increase of type 2 diabetes. One graph followed the other perfectly. There is a time window offset and I think that's why people have a hard time grasping the cause and effect. Other countries have similar graphs and they have the same time window offset but the graphs map onto each other perfectly with that same time windows offset. It's only gotten worse since then. A bored journalist at Ars should try to find those graphs.

[listenallyall]

Lots of people want to vilify fast food and blame it for any unhealthy trends. But the timing of fast food's emergence correlates with all kinds of other possible triggers - massive increase in availability of snack foods (cookies, Domino's, potato chips) in the home, far more sedentary lives and careers, introduction of plastic 2-liter soda bottles, increased use of seed oils, more sugar-based breakfast food, etc. So it is lazy and biased when you look at a few charts and assume it's all McDonald's fault.

[_heimdall]

Once you consider seed oils (many people still vilify saturated fats) the fast food timing gets even murkier. Fast food restaurants originally cooked in beef tallow where as its all seed oils today. If the oil type makes a difference and it wasn't necessarily the design of a fast food restaurant, the clock would have to start when chains got rid of tallow.

[trealira]

Why are seed oils unhealthy, though? I can't find anything that's bad about them in particular. I've only seen people commenting online saying to avoid them.

[_heimdall]

There's too much there for me to give a great answer here, but I can recommend Dr Michael Eades as a starting point. He wrote a couple books over the years on heart health and has been writing a newsletter for the last few years where he discusses various related topics in detail.

At a super high level, it has to do with how seed oils ("vegetable" oils, etc) are produced and how oxidative they are in the body.

[marinmania]

Fast food causing people to eat badly reflects poorly on US society as a whole, but not sure if it reflects badly on the US healthcare system. Especially if the stats show that the US is good at keeping these people alive.

[refurb]

Precisely.

Average lifespan is a terrible metric for quality of healthcare. There are dozens of confounding factors that can reduce lifespan even in the presence of high quality healthcare.

[scary-size]

A recent podcast I listened to highlighted the US‘ child mortality rate as an indicator for the quality of their health care system.

[refurb]

A podcast you say!

Child mortality is even worse. Not all countries count neonatal deaths the same. In many countries premature babies that die are "stillborn" and not counted.

In the US, very, very premature babies are resuscitated and if they pass away, are averaging "zero" into the stats. So in fact, aggressive medical care in neonates can actually make mortality measures worse.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4560894/

The popularity of the infant mortality indicator notwithstanding, international variations in birth registration laws and practices have the potential to bias comparisons of infant mortality. Problems can arise from differential registration of live births and stillbirths, especially births occurring at the borderline of viability (e.g., gestational age <22 weeks or a birth weight <500 grams, who typically do not survive the neonatal period), and/or their classification as stillbirths versus live births

[scary-size]

Thanks for pointers. I was actually curious about this. Didn’t want to imply that child mortality is a better metric.

[rayiner]

It’s like people just say this stuff as a meme. Is healthcare in the U.S. bad? Asian Americans in the U.S. live 84.5 years on average, longer than Singapore, an Asian country with universal healthcare. As far as I can tell Asian Americans have the same healthcare system as at least white Americans. So is the problem the healthcare system?

In Utah, LDS males have a life expectancy of 77.3 versus 70 for non-LDS males. (LDS have higher income but only slightly.) I don’t think there’s any special Mormon healthcare system!

[dangus]

It is objectively bad based on value, and it’s objectively bad on the equality of the care.

US healthcare is great if you’re in the top 50% of earners who have employer-sponsored healthcare and you can keep your job while you go through major care events. People like knowledge workers tend to fit this bill. Doesn’t hurt that they aren’t messing up their back doing construction or something.

Obviously the USA has a ton of excellent care available including some of the top technology, doctors, and hospitals in the world.

It’s not so great if you’re one of the double digit millions of people who have no health insurance at all. It’s not so great if you can’t afford anything except the yearly check-up.

Did you know that over 40% or people who get cancer in America lose their life savings within two years?

[bigfatkitten]

> It’s not so great if you can’t afford anything except the yearly check-up.

The people in your second demographic don't even get that.

They finally take unpaid time off work to see the doctor when they start pooping blood, and the doctor tells them to get their affairs in order in the few months they have left.

[rayiner]

If that was true, the U.S. wouldn’t have among the lowest cancer mortality rates in the world: https://www.politico.eu/article/cancer-europe-america-compar....

> And yet, in 2018, there were an estimated 280 deaths per 100,000 in Europe, compared to 189 per 100,000 in the United States, according to the International Agency for Research on Cancer.

[dangus]

The article you linked explains this by pointing out how Medicare generously covers cancer drugs compared to European healthcare systems. It seems to have nothing to do with the private insurance system, which is what I was criticizing. Americans get great taxpayer value out of Medicare, much more efficient and equitable than private insurance.

Basically, America has the best socialized healthcare in the world for cancer, but only if you’re older than 65. Cancer just happens to be an illness that is primarily affecting that age group.

Americans have to wait until age 65 to get socialized medicine, which is why the majority of Americans approve of expanding Medicare to all age groups.

And there’s also a huge gap in smoking rates with the US smoking far less which was discussed in the article you linked.

I would love to see a comparison on outcomes for people below 65 especially as it relates to medical bankruptcy and inequality of access to care.

I’m quite doubtful that affluent European countries have similar inequality levels that the US has with, e.g., the wide gap between infant mortality rates between Black and white women.

[rayiner]

> Americans have to wait until age 65 to get socialized medicine, which is why the majority of Americans approve of expanding Medicare to all age groups.

It’s hard to analyze. But people slightly under the age 65 line with private insurance (60-64), and those slightly over with Medicare + private insurance (65-69), have higher survival rates than those with Medicare alone (65-69). https://hollingscancercenter.musc.edu/news/archive/2021/05/1...

> I’m quite doubtful that affluent European countries have similar inequality levels that the US has with, e.g., the wide gap between infant mortality rates between Black and white women.

It’s even higher outside the U.S. In the Uk, the black infant mortality rate in the UK is 3x the white rate, versus 2x in the U.S. https://www.theguardian.com/global-development/2023/nov/09/b...

https://abcnews.go.com/Health/black-infant-mortality-rate-do...

France would be the other Western European country with a large black population, but they don’t allow collecting racial statistics.

[xenospn]

>> Did you know that over 40% or people who get cancer in America lose their life savings within two years?

I personally know someone who lost everything caring for their (very young) spouse who died of cancer. They had insurance.

[rayiner]

Don’t forget the additional 20% of people on Medicare.

What percentage of people who get cancer have to leave their jobs as a result? What’s the corresponding statistic in other countries?

[rayiner]

Sorry I meant medicaid

[_heimdall]

Having had to take a few different family members to the ER over the last few years, I'd rate their care as pretty bad. If your metric for success is staying alive they did okay, but I can't say much good beyond that.

[rayiner]

I have two elderly parents and three kids, and take them to a mid size hospital near a small city (under 50k people). The ER waits can be long, but they’ve accurately addressed the problem every time. Are ER waits shorter in other countries?

It also takes no time at all to get an appointment. I take my kids to the pediatrician for basically nothing. My 5 year old ran face first into the edge of a table. The pediatrician saw him an hour later, authorized a CT scan, and we got the images and the doctor reviewed them an hour or two after that.

[_heimdall]

Sounds like you definitely have better access to good care than I do. In live in a bit more of a rural area, but were only 45 minutes from two different cities with large medical support, including one of the larger medical schools.

I haven't actually had issues with wait time but with actual quality of care. I'm by no means a medical expert, but on at least two recent occasions I had to be the one pointing out factors to the doctor when my father in law had a kidney stone then gall bladder issues. Specifically, the doctor simply forgot about the gall issues an hour later and was pointing back to another potential kidney stone.

Its been a while since I've had to schedule a doctor's appointment, but anecdotally I hear it is pretty slow. After the stones my father in law had an annual checkup and was referred to a cardiologist, the fastest they could book was 2 months out though that was for a check without immediate symptoms which would play a factor.

Once at the hospital I haven't seen issues getting specific tests run, like a CT scan for example. Here it does seem like they have the bandwidth for that kind of stuff once you're in the door.

[xenospn]

Oh it’s very bad. And I say this as someone very healthy (luckily). I grew up in a different country with a functioning healthcare system system, and the US one is horrible.

[throaway2501]

which country?

[chownie]

I mean, there kind of is a special Mormon healthcare system in that they are traditionally forbidden to take part in drug use or to drink alcohol. I would not be super shocked if alcoholism made up some of that seven year gap between non-LDS and LDS males.

[rayiner]

It sounds like lifestyle has some significant effect on life expectancy. The difference in life expectancy between the U.S. and Canada pre-Covid was about 3 years—half as much as the difference between two mostly white groups within the state of Utah that differ mainly based on religion. How much of the life expectancy difference between the U.S. and Canada is attributable to lifestyle versus healthcare system?