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Culture War Roundup for the week of December 9, 2024

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In his 261 word "manifesto"[1], the UnitedHealthcare CEO assassin cited that the US is 42nd in the world in life expectancy but first in health care spending. Cremieux reviews it in more detail here and makes something similar to the RCA argument that the US spends more because it's wealthier and gets more medical procedures done and offers alternative explanations for why the US has low numbers.

By coincidence, while this CEO shooter drama was going down, I was listening to Peter Attia's podcast where he interviews Saum Sutaria, the CEO of a health care system[2]. He drops the following claim (copied from the show notes):

Life expectancy has improved remarkably. A lot of that has to do with infectious disease and other things. So when we say our life expectancies in the US are paltry, what we’re really asking is, “Why are we 3 years behind everybody else?”. Especially when we’re spending 60-100% more. “Spending the most, we’re not getting the best out. And I think you make a really good point… somewhere between 60 and 75, the equations slip" Somewhere between age 60 and 75, we go from dead last to first (and the lifespan is the best in the developed world) Because the medical system we’ve created that optimizes for access, quality, sophistication, technology, the best drugs, flips It’s actually quite effective at creating longevity from that standpoint We can discuss whether the lifespan is improving with or without the healthspan

He further argues that US life expectancy is reduced by factors like cultural issues: gun violence, car accidents, etc. Indeed, the US has high infant mortality but also high rates of teenage pregnancy, which are risk factors for higher infant mortality. This echoes Crimeiux from earlier.

Anyway, I went about looking for a source for the claim that longevity rankings increase as we age in the US and found one in Ho and Preston (2010)

US life expectancy at birth sucks versus peer countries, and even still sucks around age 40. But as you get into retirement years it reverses, and the US eventually climbs to 4th place among the 18 countries

The paper tries to explain this but mostly doesn't find anything satisfying.

One interpretation (not from the study, mine and perhaps the Tenet Health CEO's) suggests if you don't get murdered, or into a car wreck, or overdose, or kill yourself, or your mom didn't attempt a home birth at age 16, you actually have good survival odds. The best in the world. The health care system can actually help you. That's what that $10k/capita is all about.

There's some obvious alternate explanations too. Maybe those extra ten years of life are when you're stroked out and have a pretty terrible quality of life and it would've actually been great to meet a health care system with a death panel that said "mmmm actually, there's no treatment available for this condition. so sorry" and you could die with dignity and your family (or someone's family, or maybe collectively) could have an extra $400,000.

Whatever this is, I think it's pretty clear that the health care system in the US exists and can deliver results. Whether or not these results translate to best QOL is more murky and we can debate that effectiveness. Either way, that doesn't have the same revolutionary zeal!

Coming up for air here, and approaching the #assassinbae story from a different angle, at what point can we consider misinformation surrounding this life expectancy vs health expenditure chart as stochastic terrorism? I don't know a single left-of-center person who has more than 2 brain cells to rub together who doesn't allude to this as Exhibit A in every discussion about how corrupt the US health care system clearly is[3]. And it's arguably wrong. And it's now getting people murdered. It's not quite as psychotic and singular as Alex Jones, but it's definitely something sinister. Maybe even more dangerous if it's the start of a trend.

  1. people are beating him up for writing such a short and lame manifesto but he might not have intended it as a manifesto, more of a confession

  2. guessing this is the last we're going to hear from a CEO of a health care system for quite awhile, so this was well timed

  3. which isn't to say it can't be corrupt, just, again, the health care system failing to save people from high rates of car accident deaths and also for maybe keeping grandpa alive because their family doesn't want them to die is not exactly a stinging indictment of health care itself

There might be a much simpler explanation: demographics.

It’s not that the US medical system is doing great work (sorry Peter) it’s that the US has a large underclass which drags it down.

Once the underclass starts dying off, the demographics of the surviving people are going to look a lot more like Sweden’s. The results will be similar.

Many disparities between the US and Europe can be explained by demographics. Swedish-Americans do just as well as Swedes, etc… Sometimes there will be legit cultural differences (car culture for example) but demographics tend to have the greatest explanatory power in any social science realm.

Once the underclass starts dying off, the demographics of the surviving people...

Wait, what? How?

Opioids, murder, suicide, car accidents, obesity, smoking, unchecked diabetes, alcohol abuse, untreated disease, etc...

The demographics of people who reach age 70 are quite different than the same cohort at birth. Asian Americans live something like 15 years longer on average than African Americans for example. And people with high IQs live far longer than those with low IQs.

Oh, you were just talking about age cohorts, not society as a whole. Never mind.