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Single Payer's Misleading Statistics



Critics of American heath care—and advocates of single-payer insurance or other forms of socialized medicine—point to poor U.S. rankings in infant mortality and life expectancy. It turns out both are grossly flawed calculations that misleadingly make the U.S. rank low.

America’s rate of infant mortality—death within the first year after birth—was 5.9 per 1,000 live births in the latest statistics, 32nd among 35 developed countries, according to the Organization for Economic Cooperation and Development. But these aren’t apples-to-apples comparisons. Unlike many other countries, the U.S. strictly adheres to the World Health Organization’s definition, recording as a live birth any baby, “irrespective of the duration of the pregnancy,” who “breathes or shows any other evidence of life.”

By contrast, WHO noted in a 2008 report, it is “common practice in several western European countries to register as live births only those infants who survived for a specified period.” Infants who don’t survive are “completely ignored for registration purposes.” A British Journal of Obstetrics and Gynaecology study of Western Europe found that terminology alone caused up to 40% variation and 17% false reductions in infant mortality.

Partly because of harmful behaviors during pregnancy and socioeconomic factors, premature births—the main risk factor for infant death—are far more common in the U.S. than in any other developed country. The U.S. prematurity rate is 65% higher than in Britain and more than double that of Ireland and Finland. A Centers for Disease Controlstudy found that standardizing for gestational age eliminated 68% of the difference in infant mortality between Sweden and the U.S. The CDC concluded “the primary reason for the United States’ higher infant mortality rate when compared with Europe is the United States’ much higher percentage of preterm births.”

American physicians consistently make heroic efforts to save extremely premature infants—unlike their European counterparts, who limit necessary technology and then don’t even count such babies when they die. Official data from the U.S. National Center for Health Statistics and the European Perinatal Health Report show that when it comes to newborns who need medical care and have the highest risk of dying, the U.S. has the world’s third-best infant-mortality rate—trailing only Sweden and Norway.

Demographic differences also play a role. Throughout the developed world, racial and ethnic minorities have double the infant mortality of the majority—including in countries with government-run medical systems like Canada and England. U.S. population heterogeneity is four to eight times as high as in countries like France, Norway, Sweden and the U.K. Countries with more homogeneous populations have lower infant mortality, but that doesn’t necessarily reflect better health-care quality.

Similarly, U.S. life expectancy in 2017 was 76.1 for men and 81.1 for women, 26th and 29th respectively among the 35 developed nations.

But personal lifestyle choices—especially obesity and smoking, but also nutrition, risk-taking, exercise and sexual practices—all affect life expectancy. International differences in violence, urbanization, marriage and economic inequality also have an effect on averages.

The Global BMI Mortality Collaboration reports in the Lancet that overweight and obese populations have higher mortality, regardless of country. The U.S. has a substantially higher obesity rate than any other developed nation—again, a problem, but not one of inferior medical care. According to the Organization for Economic Cooperation and Development’s Health Statistics 2018, 40% of the U.S. population is obese, compared with 17% in France, 13% in Sweden, 10.3% in Switzerland, 9.8% in Italy and 4.2% in Japan, the country with the longest life expectancy. Based on the estimated 6.5 years of lost life expectancy, obesity alone accounts for approximately 40% or more of the differences in life expectancy between the U.S. and almost every other country.

Life expectancy for smokers is at least 10 years shorter than for nonsmokers. Despite declining rates, the U.S. had the highest level of cigarette consumption per capita compared with all other developed nations over a 50-year period ending in the mid-1980s. Smoking generally causes death after a 30- to 60-year lag, sometimes long after cessation.

The life-expectancy average doesn’t separate deaths caused by illness from those caused by violence and accidents, many of which are immediately fatal and thus not reflective of health-care quality. Two-thirds of deaths among Americans between 1 and 24 are not from illness, and so are more than 40% of deaths from 25 to 44. For men between 20 and 24, accidents and homicides account for 84% of the gap in mortality rates between Canada and the U.S.

If infant mortality and life expectancy are not valid indicators of health-care quality, what might be a reasonable way to compare? Let’s look at outcomes for the illnesses that cause the most deaths and the common chronic diseases that lead to the most disability and death. And let’s consider access to medical care for those illnesses—to specialists and other doctors, to procedures and drugs.

The world’s leading medical journals report the U.S. has superior results, including for cancer, heart disease, high blood pressure, diabetes, and high cholesterol; the quickest access to life-changing surgeries that permit pain-free mobility and restore vision; superior screening rates for cancer; the earliest access to new drugs; and broad access to safer, more accurate diagnostic technology that forms the crux of modern health care. Even for the lowest-priority care, U.S. wait times are far shorter than for seriously ill patients in peer countries like Canada and the U.K.

Experts have proved that infant-mortality and life-expectancy calculations are filled with inconsistencies unrelated to health-care quality, reflecting significant deviations in terminology, reporting, populations and lifestyle choices, all of which deceptively skew the U.S. ranking downward. Instead of propagating such misinformation as a false justification for change, Americans should focus on how to lower costs and broaden access to American medical care—the world’s best.

Dr. Atlas is a senior fellow at Stanford University’s Hoover Institution and author of “Restoring Quality Health Care: A Six Point Plan for Comprehensive Reform.”



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