Unexamined Statistics Lead to Dumb Conclusions — the Questionability of Critics’ Use of the United States 26th Place OECD Life Expectancy Ranking — as Evidence for the Inferiority of Our Health Care System

© 2013 Peter Free

 

21 November 2013

 

 

Just because one can drag up some numbers, doesn’t mean that they indicate anything useful

 

Take liberals’ fond critique of American health care — which I share in at least thinking that a single payer bottom tier of service would be better than the inane system we have now.  But that does not mean I favor using foolishly drawn statistics to support the argument.

 

For example, criticism of American health care often cites the United States 26th place ranking in life expectancy — as documented on page 25 of the Organization for Economic Cooperation and Development (OECD) report entitled, Health at a Glance 2013.  Reform advocates often reason that our comparatively low rank in this measure indicates an American health care gone wrong.

 

My contrasting view is that pundit-puffers need to stop citing the life expectancy statistic into evidence, unless they can provide persuasive proof that comparatively small differences in longevity mean something significant about health care quality, across a very wide array of social constructions.

 

 

Here is an example of the weak reasoning that commonly crops up

 

I took this from an always intelligent source, but one (in this instance) representative of the flawed logic that irritates my scientific bent:

 

 

A new report out this morning from the OECD shows that the United States' average lifespan has fallen one year behind the international average, lower than Canada and Germany, more akin to the Czech Republic and Poland.

 

This 213-page, graph-laden OECD report tells the story of why. It shows the United States as a country that is spending tons and tons on health care--but getting way less than other countries out of that investment.

 

It exposes a country that's really great at buying fancy medical technologies, but not so fantastic at using those medical technologies to extend life.

 

What we have, essentially, is a medical system that is heavy on screening and tests, but light on actual trips to the doctor.

 

We're great at checking for problems, but less great at following through with treatment for any problems we do find.

 

© 2013 Sarah Kliff, The U.S. ranks 26th for life expectancy, right behind Slovenia, Wonkblog – Washington Post (21 November 2013) (paragraphs split)

 

 

“But Pete, why aren’t national life expectancy rankings closely correlated to health care quality?”

 

Four obvious reasons:

 

(1) Longevity data is almost certainly imprecise, especially if you consider that the OECD has broken it down into foolishly small tenths of a year.

 

Data of this precision is not reliably collected by some (probably nearly all) nations.

 

And it would take a lot to convince me that the OECD data is not skewed in favor of the nations that do (or pretend to do)— of which the US is not one.  The quality of US death reports vary noticeably from community to community.

 

(2) Second, comparisons in life expectancy almost never take detailed looks at:

 

(a) demographic and cultural differences

 

and

 

(b) variations in economic and social structures among the nations rated.

 

For example, a nation with equitably distributed wealth, a medically more homogeneous population, nice climate and environment, and a reasonably decent health care system is virtually always going to outpoint a nation with the reverse characteristics in regard to the first four elements.

 

With all these varying factors in play, health care structure and delivery alone cannot rationally be predominantly blamed for the slightly shorter life span characteristic of the more complicated nation’s situation.

 

(3) Nor do longevity statistics examine whether longer lives in some nations are at the expense of quality of life.  Which, obviously, might be a “bad” thing.

 

(4) Most telling — the differences in life span among the top 26 nations are comparatively small.

 

The longest lived nation, Switzerland, has a life expectancy at birth of 82.8 years.  The US, ranked 26th, comes in with an expectancy of 78.7 years.

 

This sounds disheartening.  But, looking more closely — we see that the 9th ranked nation, Israel, is already a year behind Switzerland.

 

If we average longevity among the nations which rank from 9th place Israel through 25th place Denmark, we arrive at a mean of 80.9 years.  US longevity is 97.3 percent of this mean.

 

I am not convinced that a 2.7 percent difference is worth quibbling over on the basis of very probably imprecise data and unproven connections.

 

 

The “plausible” argument — for taking longevity data more seriously than I do

 

Without discussing any of the above listed limitations, journalist Sarah Kliff, does toss in a caveat about her reasoning and then immediately tosses it back out:

 

 

To be fair, the health care system doesn't tell the full story of our life expectancy.

 

The United States has higher than average morality rates from violence and traffic accidents, another factor the OECD points to in explaining why the United States' life expectancy has lagged.

 

But the health system likely plays a key role, too. The United States has the highest rate of uninsurance in the countries the OECD studied, right below Estonia and Mexico.

 

It's plausible to think this can make it difficult to seek follow-up treatment when a screening does identify a problem.

 

© 2013 Sarah Kliff, The U.S. ranks 26th for life expectancy, right behind Slovenia, Wonkblog – Washington Post (21 November 2013) (paragraph split, underline added)

 

Not so fast.  A whole bunch of reasoning in science is “plausible” but grossly incorrect.  The plausibility argument is a non-starter.

 

 

The moral? — If we’re going to throw numbers around for policy purposes, let’s make sure they actually support what we’re saying

 

There is far too much self-interested BS flung around, during American health policy disputes.  This trait undoubtedly accounts for much of our failure to confront difficulties effectively.

 

America’s most basic problems with health care delivery are that:

 

(a) we are a highly inequitable society

 

and

 

(b) we like to make lots of money off people’s illnesses, without simultaneously becoming accountable for either medical follow-through or efficacy.

 

Greed is the basic problem.  Proof of that is everywhere we look.  We do not need questionably-based and arguably irrelevant international longevity rankings to see it.