American Lifespan By County
tobiasbuckell.com
tobiasbuckell.com
That shows a very inefficient use of USA's wealth and a very poor healthcare policy.
US states may be very different from each other, but their difference is far less that the ones between European states. You speak a single language, you have a single president, a federal senate, a federal army, a federal police, a powerful federal intelligence agency, and many institutions at the federal level. You have 200 years of common history as a single country, if we except the Secession period. Actually, I could understand that you could say that US is an union of two countries because of this episode, but a union of 50, no way.
Europe on the other hand is a territory that is divided in several countries with different languages, different religions, different history, several wars between them (the list is really really long). Being generous, you could say that we began a common history 50 years ago, but this was in fact only an economic union on a small set of goods (steel and coal IIRC) between 5 countries.
Apple to oranges, really.
We're one big family who've been all over each other for thousands of years.
What used to be the Duchy of Savoy is now split between Italy and France.
EDIT: A map of Savoy in the 16th century: https://en.wikipedia.org/wiki/File:Savoy2.png
When talking about history there are very few "correct" and "right" answers, since one would have to first define what one means by "Germany" and "Austria".
What about the Holy Roman Empire?
Of course it is even more accurate to say neither is true, since the holy roman empire was more of a loose confederation than a country, i.e. closer to something like the EU than to Germany or Austria.
That's the thing with this history stuff, it's rarely as clear cut, nor are today's examples (e.g. modern Germany, EU) totally relevant for examples of the past.
It's like how if you took Canada, with our pretty good (I like to think so) health care and general infrastructure, and more or less respectable indicators of health and safety.... and then decided to just look at our reserves. Huge WTF.
Natives are 1/30th of the Canadian population (so significant, but not huge), and their average life expectancy is ~10 years less than the national average. How does this happen?
Situations like this shows that it IS important to consider internal divisions like this. If the native population in Canada happened to be doubled or something, then you would run in all sorts of problems trying to improve out overall health care without addressing specific issues regarding why the native population appears to have such poor outcomes.
Also low-density population means smaller sample sizes thus larger error. Again, surprise.
Even in the semi-rural area where I live, if I needed heart surgery, the local cardiologists won't do the surgery. They would send me up the road to DC, two hours away, like they did with my father-in-law. And I live in a county with a high median income.
http://www.instantpatientnewsletter.com/images/USA-2000-popu...
which looks very much unlike the map of life expectancy.
The truly low-population areas of the US (the non-coastal western half, the tip of Maine, and the whole of Alaska (where medical care is truly remote) seem to have fairly long lifespans. The South, where lifespans are short, is mostly fairly densely populated.
A map which correlates much better with the lifespan map would be this one http://1.bp.blogspot.com/_2lW15AgGThE/S_7yokwe3zI/AAAAAAAAAB... showing the percentage of black people in each county. It's still not a perfect match, though, and it's clearly not just about race because the average lifespan for a black man in the US is 75 and for a white man 79; a much smaller disparity than the county-by-county disparity we're looking at there.
If the men in your county are dropping dead at an average age of 66, it's not just about health care, it's gotta be some combination of:
1. Widespread substance abuse or alcoholism, and
2. Serious widespread obesity.
Come to think of it, we can probably find a map for the latter too; here it is:
http://graphics8.nytimes.com/images/2009/11/24/business/econ...
I love southern food and all, but it should come as no surprise that if you eat fried chicken, biscuits and gravy every day for breakfast you're gonna wind up dead.
Further, culture determines willingness to USE available healthcare. Southerners have a culture of independence. Men are reluctant to complain about health anyway; compound that with stubbornness and phobias about large institutions.
You can even argue its not a Problem than some folks have lower life expectancies; they chose that lifestyle. God bless America, they're allowed to do that.
In the southwest there are vast stretches where nobody lives, dropping population density in a distorted way.
In the southeast, there are vast stretches of lightly-populated land.
These are not at all the same thing in this context.
This one sentence does an excellent job of summing up our failures as a nation over the last 236 years. One, gargantuan government can never hope to meet the vastly different needs of 300 million people living in highly diverse geographies, population densities, and climates.
So while the US should be treated like one country for all those reasons, those reasons should also be blamed for most of her failures.
One monolithic government is a myth. It could even be argued that the fractured nature of US govt is responsible for wide variation is schools, infrastructure, moral laws etc.
And your representative and senators vote consistently along party lines, and, again, get re-elected almost entirely based on how much of their constituents' money they bring back from Washington.
Make me dictator for a day, and I'd change the whole tax system so that the local govt gets 30% of your income and th e federal gets 1%.
The military and entitlement programs in particular would serve the wants and needs of the people better if they were structured and deployed by local power as opposed to a large, centralized one.
Did you want published evidence of the structure of the government, or my personal conclusions?
If you don't believe the federal government is far and away more powerful and influential than all lower governments, just follow the money:
Tons of info there on US tax revenue.
If you are more specific with what you want me to cite, I could provide better citation.
Let me address your points one by one:
1. Comparing us to Japan is really a poor choice. Japan is a highly uniform society and very xenophobic. They have an almost uniform cultural, religious, and genetic makeup.
2. We don't have a single language, a single president, a federal police, or any of the other things you are mentioning in the same manner of which you think of them in your country. The authority of those particular institutions is VERY limited in some very crucial ways. We are more like a strong union of 50 separate states, each with its own government (and president, called a governor here) with its own particular political challenges. There have been SEVERAL fights between the state and federal government over things like national policy and states rights that run counter to your argument. For example, Arizona is fighting with the federal government over immigration enforcement. California is fighting with the federal government over marijuana. Nevada fights with the federal government over online gambling. etc etc etc. During the civil rights era, some southern states mounted what almost became an armed rebellion against the federal government.
We also dont have a single language. LARGE parts of this country speak ONLY Spanish, or ONLY Haitian, or ONLY Russian. There is no requirement for someone living here to speak English and it's been a HUGE problem politically in places like California, Texas, and Florida. In California and Washington State, there are large Chinese and Japanese populations that only speak their mother tongue.
Furthermore, the country itself is changing constantly. Dearborn, Michigan is home to the largest concentration of Muslims in the USA, and that is having an interesting effect on the political and social dynamic of what was once a very very white/european part of the country.
It's easy here to understand how we can identify a Southerner or a Californian by their manner, diet, and dialect. I feel like the rest of the world is often confused by the idea that the USA acts and thinks alike as a uniform country. We're not.
Examples where it is not true: Russia, India, China, Germany, Spain, Italy.
I'm French, my wife is Japanese. We have experience of both immigration procedure. Let me tell you that Japan's xenophobism is a myth that dates from WWII. France is far more tough for foreigners.
It is true that they are basically more uniform culturally and probably genetically and religiously than US. But you missed an important point : I did not compare US's healthcare to Japan's. I compared US' best county to Japan's average. That makes the uniformity of the country quite irrelevant, don't you think ?
2. You exaggerate the differences. 96% of Americans speak English. 87% as their primary language. Of course institutions are limited ! That's how it works in a democracy ! I agree that states are different, have some freedom (but probably not much more than a German Land or a Swiss canton, these are federal countries too) but my point is that stating that these differences are as big as the ones between EU countries is ridiculous.
Actually it doesn't.
Suppose we compare the lifespans of Japanese-Americans to Japanese in Japan. Your theory predicts that Japanese-Americans will have a shorter-lifespan. Reality says otherwise.
The populations are different. The US is incredibly diverse, and much of that diversity is correlated with geography. Japan, not so much.
I think in America you also have to account for socio-economic status more than in other first world countries. Also where do Japanese-Americans tend to live? I find it hard to imagine that immigration is as high in the poorest regions.
I don't know why it's different. I'm just pointing out that it is, so any theory that predicts otherwise ....
> I find it hard to imagine that immigration is as high in the poorest regions.
I'm often surprised at where I find people. For example, there are lots of Vietnamese on the gulf-coast. I was treated by a Thai doctor in the middle of Ozarks.
> I think in America you also have to account for socio-economic status more than in other first world countries.
Why? Are you assuming that health insurance affects life-expectancy? (The effect, if any, is almost in the noise.)
I'd expect that rich people in New Orleans would have the same exposure to carcinogens as the poor as they drink the same water.
How many, and which, states have you lived in?
Heck - if you live in CA, how much time have you spent outside LA/SF Bay area? The central valley (where I grew up) is very different, as are the sierra folk.
And no, ski trips or summers at Tahoe don't count.
Go to North Carolina or Georgia? I may as well be in Greece for how at "home" I feel there.
Similarly the stretch from SF to Vancouver (Canada) feels relatively homogeneous to me (as an outsider) but distinct from the stretch I grew up in. It's only similarity is the relative wealth. But everything looks and feels different.
While San Simeon, CA on south feels like yet another distinct place.
Texas is southern but very different than say Kentucky. And Colorado and surrounding have a distinct feel as well.
But the language is the same, the newspapers are the same, the political parties are the same. Compare that to Europe where there are, what ? 23 languages for 27 countries, political parties specific to each and news sources totally different.
Umm, sort-of. I have relatives whose local dialect is almost incomprensible to me. (They can understand me because they can understand "TV American".)
> Compare that to Europe where there are, what ? 23 languages for 27 countries
How many of them have a significant number of people who are monolingual? To put it another way, how many languages do I need to know to talk to 95% of Europeans?
> the newspapers are the same,
No, they aren't.
> the political parties are the same.
Nope. They merely have the same names, and sometimes not even that. (see http://en.wikipedia.org/wiki/Minnesota_Democratic%E2%80%93Fa... .)
Yes, there is a national Democrat party, but there are also 50 state parties and they don't take orders.
There are "national coalitions" that don't cover all states.
You would be surprised. Half the people in France speak only French (and maybe one local dialect). And it is far from being the worst country. So with English, French, German and maybe Russian you would maybe get close to 80% but far away from 95%
By "newspaper are the same" I meant that you have national newspaper that one can find everywhere. I didn't travel a lot in USA, but I remember that USA today was available everywhere I went to (mainly west coast I admit) I doubt it is the only newspaper in that case. Science, National Geographic are two publication that I believe must be nation wide. There is no EU-wide publication.
By "same political parties", I mean that you know which is rep and which is dem. Which one will support your current president and which won't. Arguably, we begin to have a similar structure appearing in EU. It is recent and still approximate, but EU MPs now try to share some labels.
Actually there are about 5. But 3 are really local metropolitan papers that happen to cover cities that are of interest to the rest of the country (New York Times, Wall Street Journal and Washington Post).
But to give you an idea of perspective, USA Today, which circulates nationally, only moves about 1.8 million copies a day (in a country of over 300 million people). Local papers are far more important to most people and circulate many more copies than any of the national papers touch.
>By "same political parties", I mean that you know which is rep and which is dem. Which one will support your current president and which won't.
At the local level this isn't always true. Local politics in the U.S. can be tremendously parochial and can often not map well to national platforms. For example, in my area the local Republicans have been more focused on raising tax revenues to fund mass transit expansion than the Democrats -- almost the exact opposite of the National parties' focus. And I'm not talking about State level. County and District politics are local...or in cities districts or wards. It can be maddening to try and explain local or national political behavior by using one to explain the other.
"everywhere I went to" is a long way from "find everywhere".
I've only seen USA Today in hotels and airports that were in fairly major cities. Outside of travel, most folks don't see them.
> Science, National Geographic are two publication that I believe must be nation wide.
The Financial Times is available by subscription, just like those pubs. Does that make it national? How about the Bolivar Herald Free Press (from Bolivar Missouri)? Like every small town newspaper, it's available by subscription. Are they all national?
Heck, I can even get the London Times by subscription anywhere in the US. Is it a national newspaper of the US?
Your definition of "nation wide" is absurd.
> There is no EU-wide publication.
What? I can't get the London times throughout the EU by subscription?
Not only is your definition absurd, but you're not even applying it consistently.
I don't disagree, but only if you generalize at a high level. It's absolutely amazing how much of the world you can cover with something not much more general than this -- all you need is a fluency in English, the BBC/Al Jazeera and a working knowledge of the basics of left/right politics.
I've personally managed to get by just fine in most of Europe, parts of Asia, the Middle East and North Africa with these three. It takes about as much work to figure out, for example, the local politics in Paris, France as it does the local politics Angelina County, Texas and have a competent discussion with a local.
All that being said, growing up in a the more industrial and densely populated part of the U.S. I feel more at home Paris than I do in Angelina County.
Remember, only about 80% of Americans speak English as a native tongue, we have as many dialects and accents as the U.K. (and some are not mutually intelligible to outsiders). Some dialect of Spanish is the second most common. But it's as varied as dialects in Spain are.
In the more metropolitan areas, I suspect the percentage of native English is much lower. In the area I spent my childhood in (just outside of Washington D.C.) I was the only child under 18 who spoke English as my native language...and the parents of my friends spoke languages as diverse as Turkish to Korean -- often with little or no English. Only one of my university friends spoke native English, the rest were Persian, West African, Turkish, Arabic, Vietnamese, Korean and Indian.
I've gone weeks without eating "American" or Western European food without even it being an effort or something I noticed much later.
That flavor, that huge variety, is a hallmark of the area I identify with...and I can find an area that feels like that from D.C. to Toronto. Angelina County, TX doesn't feel like that. It also looks different. The ethnic groups are all different, all the place names are different. Politics changes and suddenly boarder control and water rights are major topics of discussion. Head over to San Antonio to get some urban flavor and it still doesn't feel like home.
London on the other hand feels more like where I grew up than Houston. Lots of the Television is the same, the politics at least sound familiar in some sense (lots of the same names show up), the ethnic breakdown feels similar, food variety is about right. Sure cars drive on the wrong side and the money looks funny. But it feels similar and the buildings kind of look similar.
Minneapolis? As out of place as I was in Paris.
I've digressed, but I think the original point still stands. The U.S. shouldn't be thought of as 1 country or 50 countries, but maybe about 5-8.
Here's one that's about as good as any other
http://sperglord.files.wordpress.com/2011/06/cultural-usa-ma...
Heck, Americans move around so much that most people I've met in urban areas are not "from" that state in the first place. Some of the friends I made in Atlanta were from New York City, others from San Francisco, others from Iowa. Some of the friends I made when I lived in the Bay Area had grown up in the Midwest. For my part, I grew up in a mixture of Chicago and Houston, but don't feel any more "at home" in either one than in the Bay Area or Atlanta.
Also many of the European cities have such a different flavor than U.S. ones, how they're laid out for example, that going from Munich to Paris is a tremendously different experience. More than Atlanta to Minneapolis? Yeah I think so. But likewise Paris to Tokyo is even more of a difference than any other comparison above.
Not vouching, just citing. (I haven't read it.)
The greatest factor in longevity is genetics, not wealth expenditure. Ever consider that the average genetic makeup of someone in Japan may be quite different from the average in the US?
Now, compare those of Japanese ancestry living in the US with those in Japan and I might be interested in your theories.
Lots of people say if you remove the US, the greatest correlation (not causation and all that, yes yes) to longevity is health care spending. Picking the first result off google, here: http://andrewgelman.com/2009/12/healthcare_spen/
Japan is a clear outlier but so is the US.
http://www.sciencedaily.com/releases/2011/02/110207112539.ht...
Don't smoke, drink coffee moderately, have low cholesterol, and be wealthy.
That's actually not true...even remotely. California and Texas for example have been part of at least three different countries. Texas for example has had six different national owners, including a stint as an independent country. Alaska wasn't a state in the U.S. till 1959!
Something like half of the land territory of the U.S. was added in the 20th century. And territories like Virginia have around 400 years of history, only half of which is with the U.S.
Oklahoma (a non-European word) held out till 1907 and has at least 25 Native tongues and presently is home to 39 recognized nations protected by treaty!
http://www.cdc.gov/obesity/data/animated_map_slides/map26.jp...
If nation A has 60 people living to 79, and nation B has 59 people living to 80 and 1 person being murdered at 20, A and B have the same mean life expectancy (of 79).
Though I suppose you could call things like murders and road safety "cultural".
Obesity has been found to take 10yrs off lifespan.
Also, smoking: http://labs.slate.com/articles/cigarette-map/ (click tab to see by county).
http://www.healthmetricsandevaluation.org/tools/data-visuali...
I would guess most of that difference is due to migration of elderly persons to Florida, not due to Florida being healthier or health care being better there.
You're confusing something else, possibly average age, with life expectancy.
If the elderly populations of long-lived Florida counties still largely come from migration, longevity may say much more about living and healthcare conditions elsewhere. As well as wealth effects reflected by the ability to retire to Florida.
It may increase the average life expectancy of the area you are moving to, though.
In other words, while the people who were born and raised in the area may have a low life expectancy, an influx of wealthy retirees will drag up the average life expectancy. In some cases the people moving to these areas may already be older than the average life expectancy.
http://aging.senate.gov/crs/aging1.pdf (see page 8)
I'm not sure that the delta from, say, 40-ish median to the slightly older skew of a retirement-centric Florida community would be great.
WILL be? It already is. It's pretty much in line with the so-called red / blue divide in the nation.
There's a reason it's referred to as the united states.
In most of the world, "state" == nation. The US is an exception, but it's because the initial concept, pre-pivot, was of a confederated union of independent states.
Industry (dots) lined up with Obama voters from the article: http://strangemaps.files.wordpress.com/2008/11/strangemapsov...
a) Too poor
b) Too far
If a resident of that area can even get their hands on a car, a 3-4 hour round trip to visit the medical center (not counting time at the center) vs. putting in another day on the job would certainly give me pause.
But does that change your life at all? No, your life is exactly the same as before.
Same with these stats. Just because people who have lower life expectancies move or happen to live near you, it doesn't change anything about your life.
If canada and the US merged, the average life expectancy of the new country would go up, but that number itself wouldn't change anyone's life.
It's the same with arbitrary county groupings. If you live in a county with lots of poor people, they will have a lower life expectancy. That doesn't mean anything about you, though. If the border was different, you might live in a county with lots of rich people.
However, in the UK we went for the option of having pretty good, but perhaps not the absolute best, available to everyone, free at the point of delivery, regardless of wealth. With the option to pay for private care if you want it - either in the UK or abroad. Personally, I think this is a pretty good compromise.
I value living in a place where I can work harder to get better things for my family. Or work less hard and coast, my choice.
Making money is not a sport or game in America. Its real, its important, its meaningful and it motivates millions of us to work hard and smart.
I can pull out my gold card and get to the head of the line for a heart transplant, sure. That's not a failure, thats one of the strengths of a capitalist/free market country. It can be cruel, but life is cruel and honestly there is no 'fair' way to ration such healthcare. If you tried, the 'black market' (read: free market) would and does compensate anyway.
The free market motivates me. Some hunky-dory view of the world as full of free services for everybody does not.
I'm not in favour of communism, but as far as I'm concerned, medical care should be considered a right not a priviledge - there's really no benefit to denying it for the poor.
(For the record, I fit into the group of people who could easily affordto go private with Bupa here in the UK, and I'm far happier paying more in taxes to subsidise the NHS.)
I believe keeping what you earn is a right. You believe free medical care is a right. Not mutually compatible. Glad I don't live in the same country as you.
No.
And I do have to pay taxes. I live in a country where there are a lot of people that do agree with you (the US), so my remark was a bit facetious.
Actually, it's a double punishment to live here, because not only is the government taking lots of money to pay for the medical system, but Americans are too incompetent, broadly speaking, to run a centralized medical system. So the more the government spends, the more it sucks. At least you Europeans can make socialized medicine "work" in some sense of the term.
Spoken like someone who's never experienced illness or injury in the US without the benefit of insurance.
Sure its a hassle. A doctor who doesn't know you, no followup, hours in a waiting room.
But is your HMO really any better? Any healthcare run on a budget gets pretty dismal. Any healthcare run by the govt will be run on a budget.
I maintain that if I pay more, I should be able to find the quality of health care I want/can affort. If not, then what's all this working and striving for? Just a game?
I'm covered by the NHS, I still find plenty of reasons to cash my paycheques.
Having to wait until things become serious has long term negative effects on your health. (e.g. delaying getting checked out for a persistent cough until you have pneumonia)
Further hospitals are not ignorant of the issue of people without money or insurance. Unless you were delivered by an ambulance, they will run through your entire financial situation and demand up-front payment. They will bill you and they will send bill collectors. And they will happily bill you far more than what any healthcare provider on the planet pays for those services, let alone what they'll see after giving bill collectors their cut.
And they will happily provide inscrutable bills, separated between each legally-distinct part of their operation. (A bill from the ER, a bill from the doctor, a bill from the lab, a bill from the x-ray service). These bills will show up months apart and months after you were seen. And you'll have absolutely no clue how many to expect.
Unless you spend hours with their payment departments trying to get estimates. (Good luck if you were seen after normal business hours.) And even after you spend hours getting these estimates and negotiating fees and payment schedules, these have absolutely no bearing on what you'll ultimately be billed. Nor will the various legally-distinct parts of the ER necessarily be clued in or included in your discussions.
And ERs and ambulatory care centers will turn you away if you can't pay, up until you are delivered by an ambulance (or in that kind of state).
And, yes, HMOs and the like are a wild improvement over that. You may have crappy care with piles of restrictions, but the starting point for your fees will be far lower than if you were on your own. And the plans' coverage will spare you from hospitals pushing expensive services when cheaper ones will do. And it will spare you from other hospital shenanigans, like the $40 over-the-counter aspirin. The $200 saline when a gatorade will do, the procedures that were never performed, the ambulance rides you never took, etc.
And you will receive 1 bill. And have 1 company to deal with to pay it. And whatever you work out with that company will be binding on the entire event. There will be no surprise follow-up bills from parts of the hospital that you didn't even know you received a service from. (And you legitimately may not have)
My parents were self-employed when I was growing up. I've had health coverage on and off over the years. I know of what I speak. Not from a one-off event in a relatively healthy youth. But from 30 years of experience seeing an entire family having to deal with health care. And let me assure you, that the billing shenanigans are the rule. Fee-for-service has warped the practice of medicine and the uninsured feel the pain disproportionately.
Also: what do you think insurance company healthcare is, if not run on a budget? It all is. Even your hypothetical 'the best i can afford' care. Up until you reach a budget of tens of millions of dollars.
And you'll always be able to get better care if you pay more. That's true if you're uninsured, if you bought your own care, if your employer pays your coverage, or if you get coverage from your government. The UK has higher levels of care available. As does Canada. As does Australia.
Why do you assume that correcting the problems in our healthcare system and providing everyone with a sane base level of care remove any incentive to get better care? Are you suggesting that for-profit healthcare will evaporate in a single payer system in America, despite that having never happened in any other country with a single-payer system?
Excluding people from good health causes others to have poorer health. And compared to other countries, the USA does exclude people from proper health care.
> Anybody with the wit to stand in line can get free healthcare at an emergency room or local hospital.
There is so much wrong with this sentence.
To paraphrase someone else, you sound like someone who has not been kicked out of the emergency room for having the wrong kind of insurance. I found out later that it is illegal to do so, but since hospitals don't get compensated for nonpaying people(varying state by state), emergency rooms do anything not to provide it.
Emergency room care is not health care, it is patching you up until you can get health care. Last time I was in the emergency room, they put on a temporary cast, with a proper one to be put on Monday.
And lastly, emergency room care is the most expensive care available. Suggesting that taxpayers foot the bill of emergency rooms as an alternative to having taxpayers foot the bill of health care is one of the most insane ideas I've ever heard of.
> Some hunky-dory view of the world as full of free services for everybody does not.
Some hunky-dory view of the world making everything available via the free market would be nice if it actually worked that way.
Edit: (To my many silent downvoters..) Healthcare being tied to your employer is a competitive advantage of larger companies, isn't it? Either way, speak up!
In most states, if you have 2 employees you are eligible for a group plan. In a few states even a single founder is eligible.
You aren't just computing with large companies either. At my last job I worked for a small business. Less than 25 employees. We had group health insurance. Talk to an insurance agent. It is not as hard as it seems and if you go with a high deductible plan, it is not as expensive as it seems either.