Never one to want to interfere with a roadtrip, I've moved a post I put up last night:

Please open this link from the Minneapolis StarTribune, dated 02.28.10: http://tinyurl.com/yfyrdyj as a new tab on the page.

It's two things. The top half is a world-wide map indicating incidence diabetes, and says a lot about diet.

But the bottom half is (at least at first) more interesting. While laid out as a series of lines, charting national per capita health spending and life expectance at birth, among the 30 countries of the Organization for Economic Cooperation and Development (OECD). And which country has the highest life expectancy of the bunch, at 82.6 years, with only an average per capita cost? Japan. Health at a Glance 2009 - OECD Indicators, released December 8, 2009, a PowerPoint presentation, upon which the StarTribune graph is explicitly based. See, http://www.oecd.org/health/healthataglance or if you have PowerPoint loaded on your system, check this out, http://www.oecd.org/dataoecd/24/8/44231736.ppt (Open them as new tabs as well, if you please.)

Now, it might be more accurate, from a statistical point of view, to just have each country as a single point on a two dimensional plane. See, OECD Slide 45. But when laying each country out as a line connecting its per capita spending on the vertical axis, with life expectancy on the horizontal, what becomes salient are the slopes of the respective lines. The average number of doctor visits per year is also represented in the color of the line.

If spending per capita directly translates into whole life expectancy, then you get lines that are flat, which is to say that they have a zero slope, as in the case of the U.K and France. France spends more, it gets better results.

Where the line has a downward (negative) slope, you see less "bang for the buck," as in the case of the U.S. And then there are those many countries represented with an upwards (positive) slope, suggesting better returns than what would be expected from mere spending levels per capita alone.

But where it gets really interesting, is when you take into account that of the 30 countries included, all but three have universal or near-universal health care coverage — Mexico, Turkey and the United States. That's when the comparisons become fun. Why should the U.S. have a steeply negative slope while Mexico's is positive? Perhaps it reflects nothing more than the effect of subsidized access to childhood vaccinations in Mexico? Not clear.

And of the other countries with universal or near-universal health care coverage, why the disparities among four relatively advanced countries that spend about the same amount per capita with equivalent levels of doctor visits? Say, South Korea, the Czech Republic, Slovakia and Hungary. Diet?

And of course, the whole exercise may be subject to the effects of currency exchange rates. But still, it's interesting to see the divergence among countries from which you would expect equivalent results.

And just what is it that Japan is getting so right? Well if you go through the OECD PowerPoint presentation, you will see at Slide 27 that it has, by far and away, the highest average length of stay for acute care among all OECD countries, along with by far and away the highest number of MRI and CT scanners per capita. Slide 23. And how do they do that while keeping their costs no more than average? Well, in addition to not paying its nurses all that well (Slide 21) Japan clearly has the lowest level of obesity in the bunch: for 2006, Japan's rate was 3% opposed to 34% for the United States! Slide 13.*

Thank you, Food, Inc. ! ! !

Mike

* In fact, in comparing South Korea, the Czech Republic, Slovakia and Hungary, on Slide 13 it quickly becomes apparent the South Korea's 2005 obesity rate was second only to Japan's at 4% while the Czech Republic’s 2002 rate was almost 4 times as high - at 15% - although comparable figures were not available for either Slovakia or Hungary.

Thanks for the info fmichael. I'd be curious to see charts from 20-10 years ago to see the comparisons back then. The US is taking a dive and my wife and I are living it. She can't get insurance, so I pay cash and my new employer is having problems with providing insurance because of an ill employee. The rates doubled and the employer is having problems acquiring affordable rates.

Hi Mike,

While I agree with all the above, while in college I learned to never mess with advising someone on what to eat! Food selection is social, cultural and generally something that is very resistant to change unless pressing severe health issue preclude it. And even then, most regress back to a happier days and less healthy diet.

There are many other contributing factors to "health" not least of which is gender, ethnicity, age, personal genetics, etc. and the "x" factors of various co-morbidities that we may have or not have control over.

While I agree that eating the healthiest that can be tolerated (let's face it, ripping up raw cabbage out of the back yard for breakfast is hardly appetizing) I worry that once you start to co-mingle health care with diet and the Feds are then paying for it, penalties for being overweight, eating poorly or other personal lifestyle habits become targets of discipline. Just a thought...

Maybe that opens a new door for the ACLU, yeah?

Jim,

I've read your posts and my heart really does go out to you and your family on insurance issues.

I suppose it is damn near impossible to avoid looming universal care discussion since we all are dealing with ongoing benefit issues, me included.

Having worked as a primary provider for 20 years, I can tell you that while universal care sounds good on the surface, from an "insiders" perspective all of us with chronic illness mine as well be marched out back and disposed of if universal care wins the day. I could write columes on this. Sorry, but after 20 years of watching and participating in the "health care game" we are all out to lunch if we go to a nationally sponsered plan. We will simply lose. Just an informed and educated thought from the "inside..."

I don't think anyone is talking about a regressive obesity tax, but rather attacks on or, at the very least, far more high profile examinations of the industries at the other end of the food chain.

Especially with a senator from of decidedly urban state, if a self-styled "moderate," Debbie Stabenow of Michigan, taking the reins of the Senate Agriculture Committee in January, after Blanche Lincoln is either defeated in the primary or stomped on in November. Stabenow's other major committee appointments are Energy and Finance, and Jeff Bingaman is not about to give up Energy for anything other than Finance, and Baucus isn't moving anytime soon. Nor does Harkin want it back. Not sure, but that just might be enough to take care of federal subsidies for the sugar industry. That's at least where I would place even money bets.

And when the time comes for Stabinow to move on again, which can happen whether or not the Democrats are in power - by becoming the ranking member of a better committee - Ben Nelson will have retired and the top seat would likely go to Sherrod Brown of Ohio, who would then be next in line. See, http://ag.senate.gov/site/cmtemembers.html AND http://brown.senate.gov/senator/committees/ And he is someone else with a taste for domestic food programs, and then some. At which point, bad taste jokes about eating the rich will not only be heard before the Agriculture Committee, but sooner or later make their way into bills passed out of committee.

Face it. Food, Inc.'s sweet days under the gentle hand of the (barely) Senior Senator from Arkansas are fast coming to an end.

Mike

Getting back to Mike's graph--

One of the principal causes of the high cost of medicine in the US is the excessive cost of pharmaceuticals here vs. in other countries. If we took drugs out of the equation, I wonder what the graph would look like? Americans pay an inflated amount of money for their meds compared to everyone else in the world. The pharmaceutical companies have one the strongest lobbies in Washington. One of the biggest reasons why our medical insurance premiums keeps going astronomical amounts every year?? - the continued increase in the cost of drugs.

How come the US is so out of whack compared to other countries? What does Canada do that we don't? And Europe? And Japan?

Sandy

Sandy -

Although it doesn't show up in the OECD PowerPoint presentation, based on the graph in the StarTribune graph of DRUG SPENDING per capita, although while the U.S. spends at the highest rate in the world, the absolute difference between the U.S. drug expenditures and the OECD average was only $430 per capita, while total U.S. health expenditures per capita exceeded that of the next highest country (Norway) by $2,527 and the OECD average by a whopping $4,306.

So, of the U.S. total amount by which U.S. per capita drug expenditures exceed OECD averages, pharmaceuticals make up only 10% of the difference.

I honestly and truly believe that even controlling for all of the greed and avarice in our system - when it comes at least to treating those in a position to pay - the most important variable is obesity and all of the chronic health conditions that follow it. Based on the diabetes map, I can only imagine how high per capita Saudi health expenditures must be!

I addressed Japan in my initial post: it gives the best care of all to the the least obese population this side of North Korea. Look again at thing like it's average length of hospital stay and numbers of MRI/CT scanners per capita.

And as for Canada and the EU, they are delivering rationed care to all. It's worse care than you, I and Dubious currently enjoy, but it far exceeds what easily 35% of the U.S. population has to live with, or not. Witness our below average life expectancy rate.

If we just brought down the level of obesity to OECD averages, we easily could fund a National Plan at the Norwegian rate, and all would live like kings. Of course, to due so, we would have to return to the progressive income tax rates under which this nation rose to greatness during and after the presidency of that great liberal, Dwight D. Eisenhower and the Republican controlled Congress he brought into office with him. The only thing that tax structure couldn't accommodate was the Vietnam War on top of increased social programs, witness the Sequellae of the Seventies.

Remember the great Oliver Wendall Holmes, when he rebuked a secretary’s query of “Don’t you hate to pay taxes?” with “No, young fellow, I like paying taxes, with them I buy civilization.” [As quoted by Felix Frankfurter, another flaming liberal of the 20th Century.]

The fiscal policy of the U.S. must be tax and spend, tax and spend. That is what brought us the Interstate Highway System and put men on the Moon, while at the same time funding the development and deployment of thousands of nuclear warheads - thermo and otherwise - to the extent that, in 1955, uranium separation accounted for 5% of all U.S. electrical demand and a full 50% of its stainless steel production. (Not saying that the arms race was a good thing, just that it was very expensive; citations available upon request.)

And for what it's worth, the first thing Nixon did in a vein attempt to bring the budget under control was to more or less gut NASA: the war went on for another four years. And look at us now, post Reagan and W, a nation of moral pigmies.

Mike

Hmmm....tax and spend?

I already pay 50%+, overall, in taxes of what I make. When is enough, enough?

And if I recall correctly, Kennedy (a democrat) cut taxes as he was instructive about placing men on the moon....he didn't tax and spend.

As for life expectency, can't blame it on health care.....intervention occurs AFTER disease transpires! We might be an inherently unhealthy lot and live life in an unhealthy way by choice on the front end but still have the best damned health care system in existence (once people are ill)! I don't see too many americans going to Canada or the UK for treatment....I do see the opposite, though.

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Dear Dubious –

You may have misapprehended my opening posts. The only part of our low whole life expectancy I attribute to our heath case system is that which doesn’t serve at least a third of the population. I leave it to the experts to figure out the exact numbers.

I am not sure that you are really be suggesting, in an age of fast and relatively cheap manufactured food, filled with all sorts of bad stuff, including high fructose corn syrup in baby formula, that we have by far and away the highest obesity rate among the 30 OECD nations as a matter of personal choice. I suspect that was just a permissible point of rhetorical flourish on your part. And if it is your position, okay, let's just made sure it's sold to and consumed by people over the age of consent. Same deal as tobacco and beer, and there's no issue. And unless I'm missing something, this is where stage would indeed shift to the Agriculture Committees of both the House and Senate. [And note to Jo: the foregoing and what follows is intended to either tie directly to the opening post of this thread, or is included solely as a matter of historical interest. And where I put a P on my last post, I'm happy to do the same again here.]

The point about Kennedy is instructive. His chief economic advisor, Walter W. Heller, was the moving force behind the tax cut in 1962, urging a drop in the cutting, for instance, the highest marginal corporate income tax rate from 52 to 47% (today it's at 35%) at a time when the economy was in what looks today as a minor slump: the unemployment rate, steady for a long time at 4%, had risen to a worrisome 5.5%. But by early 1964, shortly after Johnson had signed the "Kennedy Tax Cut" into law, Heller was already having reservations about the implications of "long-term deficit spending" (sounds quaint today, doesn’t it?) specifically with respect to the risks of inflation, such that, before he left government at the end of that year, he was flat out pleading with LBJ to start the process of raising taxes again, where the economy was out of its slump and expenses for the Vietnam War were already threatening to go through the roof, telling him that if the nation was going to be at war, it had to pay for it and raise taxes. (This was told and retold many times in Econ 101/102 during the time I was at the University of Minnesota in the 1970’s, a class Dr. Heller’s TAs referred to as “Life on the Potomac.")

But for the same reason that LBJ couldn't allow his party to have been seen as "losing Vietnam" - even though it's now quite clear from his recorded conversations with Sen. Richard Russell that he knew it was ultimately a losing proposition - he could not propose what would be a politically unpopular tax increase. So he allowed what was to outlive him, as the "Stagflation" of the 1970s in the minds of many discarded what had actually been the fairly subtle macroeconomic policy of Heller and his contemporaries: to use fiscal policy to stimulate, but once the economy was deemed recovered, to recover the lost revenue, as much as a statement of the confidence of the central government in the health of the economy as a means of reducing the deficit. [Obituaries: WALTER HELLER, 71, ECONOMIC ADVISER IN 60'S, DEAD By PETER T. KILBORN, Special to the New York Times Published: June 17, 1987 http://www.nytimes.com/1987/06/17/ob...60-s-dead.html]

So what came out of it was the idea that it was okay to play with taxes just as long as they were cutting them. And I guess to prove the rule, we have the lesson of Bill Clinton's successful efforts to pass the Omnibus Budget Reconciliation Act of 1993, which actually brought the U.S. government into an economic surplus and lead to the economic boom that was to become the U.S. in the mid to late 1990s [I well recall what a slow time it was for bankruptcy attorneys across the country] only to lose his Congress for having done so.

Forgive the length, but the point is a simple one, and one in which I think you will agree. For the American government to take command of the any truly difficult situation, its political leadership, the President, Congress, etc. must demonstrate that they have the courage of their convictions, and they will bet their political futures that the public will see that they are getting their money's worth. But it won't happen now. Too much of the system has been compromised in one way or another. In Rohm Emmanuel's prophetic words, "a crisis is a terrible thing to waste." And this one was. Whether through design or mischance, it doesn't matter. The results are the same.

Although my household gladly pays 50% of its income to taxes, and most of the rest seems to go to school tuition, I confess with nothing but sadness for and apologies to my boys, that civilization hereabouts seems headed down a steep slope, At least with respect to the provision of social services and public education in the State of California. And Jo's right, there can be broad social, cultural and political divides. In fact, a guy I exchanged notes with in an ABA forum (not sure if he was a lawyer) was up front about his preference to tip his golf pro money he wouldn't share with the poor. The ones like my old friend, now dying of ovarian cancer, too ill to make it down her stairs, and about to lose her home healthcare.

I bid you all a too long deferred goodnight.

Mike