Infographic comparing health care spending to life expectancy

From National Geographic, an infographic comparing health care costs per person to life expectancy (line thickness indicates the number of doctor visits per year). No surprise: The USA's line is a bummer.

Boing Boing editor/partner and tech culture journalist Xeni Jardin hosts and produces Boing Boing's in-flight TV channel on Virgin America airlines (#10 on the dial), and writes about living with breast cancer. Diagnosed in 2011. @xeni on Twitter. email: xeni@boingboing.net.

MORE: Culture

More at Boing Boing

Eurovision 2013: An American in London

The technology that links taxonomy and Star Trek

Anonymous

What I’m taking away is no matter how often you go to the doctor, or how much your country spends on you, everyone still has a life expectancy within about ten years of each other – 73 to 83 years it looks like. Hardly worth haggling over once you consider how much genetic predisposition to longevity plays in there.
- Avram / Moderator
  
  “Hardly worth haggling”? The chart shows that Americans pay more than twice the average for health care, without getting any extra benefit for it.
  
  If you discovered that a store was charging you twice as much as everyone else for the same products, you’d raise hell over it, wouldn’t you?
  - sabik
    
    If you discovered that a store was charging you twice as much as everyone else for the same products, you’d raise hell over it, wouldn’t you?
    
    And, of course, if the store is facing a 50% price drop and knows it, it’ll try to prevent it in any way it can.
    
    That’s the elephant in the room â€” any reasonable health care reform means a trillion-dollar/year budget cut for the US health-care industry. Nobody likes a budget cut.
insert

I don’t think many people, Repubs and “anti-health care folks” included, deny that we have a problem with our healthcare system. People just disagree about the right way to fix it.

I’m frankly sick of the rhetorical canard used by pro-ObamaCare (for lack of a better word) that basically says “The situation sucks => we need this particular type of reform.” Yes, I agree the situation sucks, but I’d like to see reform that doesn’t drive us further into debt.

Plus, America is not New Zealand or Switzerland. We have far more people and far more different types of people with different genetic predispositions. And, our culture is different. I suspect if the Swiss or the Kiwis started eating McDonalds as much as we do, without changing their healthcare, they’d be doing rather poorly as well.

Finally, the Law of One Price doesn’t apply to medical care. Many of these smaller countries are free riders on medical innovation that is paid for fully by US consumers because, for whatever reason, we don’t use our (potential) collective bargaining power. If America started using collective bargaining to get lower prices on drugs and tech, then prices would likely rise all over the world.
- Itsumishi
  
  The US isn’t New Zealand or Switzerland.
  
  The population of the US (and overall lifestyles) is not that different to Australia though.
  
  Both countries are massive, with large rural and farming areas as well as some of the most spread out cities in the world. We have similar eating habits and apparently are two of the fattest nations on earth. Both countries also are extremely multicultural and therefore have a large cross section of genetic differences that might contribute to life expectancy.
  
  The two obvious differences would be population size and motor vehicle deaths. Australia has a much lower rate of motor vehicle deaths and a much smaller population.
  
  Population vs healthcare however is scaleable. If a system is paid for through taxes, more people paying taxes means you’re still talking about a percentage of overall tax spending. Motor vehicle deaths I’d say is just another reason why you would want to make sure there was no thought to “will this persons insurance pay for this operation”.
Rindan

No, it really is the average health plan that pushes these developments. This is why the idea of importing drugs from abroad comes up every few years. In fact, it just came up during the current healthcare debate and got crushed. The US pays a LOT more on drugs. It isn’t due to bureaucracy, insurance companies, or anything of that nature. Canadian drugs are not cheaper because there is some bureaucracy between the local pharmacy and the drug company. It is purely because pharmaceutical companies can and do charge more when they sell to all Americans. This is true across the board on all health services. Americans pay more for the same thing because the companies offering the services charge more.

They charge more because they can. When you have a nationalized health system the government has a massive amount of price control that doesn’t exist in the messed up US hybrid system. Shockingly, like most things in life, this isn’t straight good or bad. It is certainly bad in terms of the American pocketbook. It is good collectively for world health in that the US is willing to pay an early adopter cost and subsidize the cost of drug research, development, and product by overpaying.

This is also by the way why the Obama plan as it is currently written is going to do squat in terms of reducing how much Americans pay for health insurance. The “public option” would have dragged those per capita figures down by giving the government bargaining power like what other nations with nationalized healthcare enjoy. With the public option stripped from the bill, the bill is going to add a lot more people to the rolls consuming healthcare, but do precious little control the cost.

Most Americans have insurance, and most of them overpay for everything related to health as compared to their nationalized system conterparts. It isn’t bureaucracy that nationalized systems have some how managed to magically avoid that makes Americans overpay by over double what other industrialized nations pay. It is the fact that the government doesn’t have any bargaining or cost setting powers that results in Americans paying more. Like I said, when a companies does the cost-benifit analysis about whether or not to move forward with a drug or treatment, pretty much without exception, the average overpaying American is what determins if the drug moves forward or not.
apoxia

I’m well versed is stats, both descriptive and inferential. The graph is very descriptive, so descriptive it doesn’t mean for the lines to be any kind of regression line, just linking average price per capita with average life-span. I understood it as soon as I saw it. I have no need for an x-axis. This isn’t what the graph is about, and yet it is still informative.
gfocus

Can somebody please explain to me, in rational terms, how your exorbitantly high treatment costs advance the medical care of the whole world? It just sounds like a nationalistic argument. It seems to me you think of yourselves as good Samaritans, bringing peace and immortality to the whole world while all you do is feeding your military/corporate Moloch.
- Rindan
  
  Can somebody please explain to me, in rational terms, how your exorbitantly high treatment costs advance the medical care of the whole world?
  
  You are company that dispenses health products. You might be a pharmaceutical, you might be one that develops surgical procedures, or prosthetics, or whatever. You have a product that is supposed to make people healthier/happier/whatever. It is in its early stages with low production volumes so it costs a lot. Nations with nationalized healthcare try and control costs and so won’t pay for the drug because it is too expensive and there is already a cheaper alternative. In the US on the other hand, you can sell the drug. The US system makes pretty minimal attempts to control costs, and so very expensive treatment option become available.
  
  Now, most of the expensive treatments turn out to be junk. A few though go on to become useful and popular drugs. As they become popular the cost of production drops to the point where all nations are willing to pay for the drug.
  
  The US basically increases how expensive a drug can initially be and still be sold. Without the US overpaying for healthcare, you would have more drugs being killed off earlier due to cost. Like any product, the more you make it, the cheaper it becomes. So, a product that is initially so expensive it can only be sold in the US will become cheaper if it is a success to the point where it can reach a world wide market. It also lets companies charge less to the rest of the world by having the US subsidize what might otherwise be profit margin not worth going after. It is like anything where one party is willing to pay more than the rest for the same thing… good for the guy paying less.
  
  The US acts as an early adopter. If the US was a person, it would have bought an Apple Newton, PS3, HD-DVD player, a life time supply of New Coke, an HDTV, and a Betamax. You can thank the earlier adopters for shelling out to make the PS3 and HDTV possible and cheap enough where the masses can afford it. The rest of that stuff was money wasted.
  
  US citizens are almost certainly getting the shaft under this system. The rest of the world on the other hand is nuts if they try and talk the US into a nice reasonable nationalized healthcare system. Early adopters are a good thing for any industry that wants to take some risks.
  
  I don’t think anyone in the US arguing that vastly overpaying for healthcare is a good thing because it improves world wide health at absurd cost to American citizens. I think it is more an argument for when non-Americans come finger wagging into the argument to point out that there happy healthcare is subsidized in part by Americans overpaying.
  - Itsumishi
    
    Except in a lot countries with Nationalised Healthcare systems there are private systems running parallel.
    
    In Australia you can still buy Private Health Insurance. It covers stuff like elective surgery, or operations that are deemed to expensive and unproven to be covered by Medicare. Your point is mute.
Kevin Kenny

The biggest single factor that affects “life expectancy at birth” is infant mortality. In which the US does poorly for multiple reasons. One biggie is the consequences of puritanical laws that produce the possibility of a “crack whore” who sells herself, gets pregnant, can’t get detoxed without going to prison, and gives birth to an addicted, premature and defective baby, who gets counted among the ghastly statistics. Adopt sensible drug laws (so that the drug trade isn’t all organised crime), make contraception universally available, and stop punishing the victims (prostitutes are even more victims than their clients are), and we’ll probably gain a year or two from that alone.
Tzctlp

Gosh. What do they teach in US schools? The graphic says that Mexicans spend one ninth of what US people do, but the life differential is only 3 years (statistically this is noise, in practical terms we could say Mexicans live as longer).

Think about it: a country whose economy has been in permanent state of crisis for 40 years, with 40% of people in poverty, ravaged by unemployment, can do almost as well as the US when it comes to a major health indicator.

BTW, the graph says, correctly, that in Mexico health coverage is not universal. What should be known is that in Mexico most health coverage is provided by the state (the Socialist pigs!).

But please carry on denying the obvious dear USians, it is an amusing spectator sport watching your masochist inclinations as a country.
Rindan

I don’t think this info graph really tells you much other than that Americans die at a roughly average age among the countries listed. If this shows anything, it is that there is no obvious straight correlation between life expectancy, doctor visits, nationalized health care, and money spent on healthcare.

Stuff like this tries to simply a debate on what is truly a complex issue. Playing devil’s advocate, what if the US gets dully average results, but US consumers finance the health of the rest of the world by acting as a high cost drug testing ground? In other words, if the US joins the rest of the pack and suddenly a nation with 1/5 of the worlds GDP starts paying 50% less per person, does it mean everyone drops a few notches on the life expectancy chart from what they could be?

Further, what if the US’s excessive spending is what is preventing even worse health outcomes due to non-spending related issues? i.e. what if the shitty American diet isn’t giving Russian like life expectancy due to how much Americans spend on health care?

I’m now saying any of the above is true, just that trying to use straight line correlations like this perhaps good fodder for the gullible masses, but is a shitty way to make policy.

In the context of health coverage it should also be pointed out that the Obama plan as it is currently written is going to do exactly jack and shit to change this graph for the better. The Obama plan is going to dump more people into the insurance pool who normally would not be, and these people are NOT going to make costs go down. In fact, simple laws of supply and demand makes it is a pretty safe bet that adding in more poor and unhealthy people who don’t currently have insurance is going to make costs go up. I’m not saying that this is a bad thing. I really do believe that we are rich enough and wealthy enough to ensure that all get coverage, just don’t kid yourself into thinking that the Obama plan is going to do anything other than make that chart look even scarier for Americans.

The US spends an ungodly amount of not only its own GDP, but the WORLD GDP on health coverage. Frigging with such a complex system consuming such a horrific amount of world resources should make you very nervous. I find it deeply unfortunate that instead of policy experts working this issue and really thinking it over, we have democrats ramming through anything that they think they can pass, especially if it hits health unrelated political goals, and republicans closing their eyes and screaming no to everything and anything.
Robert

Were the dollar figures also adjusted for cost of living?
- sabik
  
  Were the dollar figures also adjusted for cost of living?
  
  The PPP (adjusted) figures are pretty similar.
Cowicide

Conservatives…

I know you’ve already dismissed this chart for various reasons and that’s fine. So let’s get rid of charts and talk good old American common sense and talk about the most important thing on this planet besides Jesus and that is MONEY.

Healthy people are on average far more productive than sick people. How fast did George Bush clear brush when he had the flu? Not very fast. Actually, he never cleared brush at all when he was sick with the flu. The brush went uncleared.

Bringing basic health care to everyone in this country will make the people of this country far more productive and (God forbid) happier. We all know a more productive farm makes more money and happier animals produce better quality milk and meat and that, in turn, makes more money.

Why do you hate money?

http://www.banglajol.info/index.php/IMCJ/article/viewArticle/2923
SamSam

Great graphic. It might also be interesting to see how someone could create a great graphic showing this data as ratios of spending to life expectancy (which would place the US at the bottom, according to this data).

Can they do the same for the incidence and prognosis of various illnesses, such as cancer? I know the anti-health care folks are always pointing to one random form of cancer as having a better prognosis in the US, but according to some Al Franken clip posted here a while ago (if I remember correctly), the US actually is far behind on most other forms of cancer.
Brainspore

I don’t know what Japan is doing at the doctor’s office but I want some.
Dan Mac

I think the health care providers in Luxembourg need to have a long chat with those from Australia.
jmzero

These people really clicked the wrong graph button. A 2d scatter (with varying dot size or something for visits) would have conveyed the same information a lot more clearly. It’s not wrong, and I can kind of see what their intent was, but a graph with a clearer visual metaphor could have made the results much clearer I think.
Baldhead

it’s clear= more doctor’s visits means more life for your dollar
strangefriend

Instead of the chart, I’d like to see a list, country by country, of how many people die each year from not having health care. For the US, it’s 45,000.
About ‘ObamaCare’: C’mon, man, Obama got most of his money from Wall Street during the presidential campaign. So no wonder he made sure Pharma/insurance companies will make out good. Of course, I don’t think the Supreme Court is going to rule unconstitutional the plan to make everyone buy health insurance. All US states make it mandatory for motorists to have car insurance. That’s been settled law for 30 years.
The free market sucks. It’s cheaper & more logical to have a single-payer Medicare For All system. The rest of the western world proves that.
skatanic

I have to agree with @jmzero. The overall message of the graph is striking (not to mention a bit horrifying), but i spent 5 minutes trying to figure out what the x-axis represents before realizing there isn’t supposed to be an x-axis. When i see lines like these on a graph I usually assume they represent a passage of time. In this case, the lines are connecting country with life expectancy; the space in between the two is arbitrary.
- EvilSpirit
  
  Not only is the existence of the x-axis misleading, it allows an arbitrary relationship between the two y-axes. Larger slope is clearly better, but the choice of which ratio constitutes zero slope is arbitrary, even though upward *looks* much more positive than downward. The UK comes out looking like a baseline (near zero slope), but for no particularly discernable reason.
Anonymous

Someone do corn subsidy versus life-expectancy?
SamSam

Although I initially said that this was a great graphic, I’m taking that back.

There’s a great take-down of it here (linked to from fivethirtyeight), which shows a much better, albiet less sexy, representation.

One key point is that this graph actually masks a big trend: if you remove the US, there is actually a very strong correlation between healthcare spending and life expctency.

This fact is hard to discern from the above graph even if you remove the US line.

This shows:

1) The US is a major outlier, but it probably has little to do with spending and more to do with other factors, lack of universal health care obviously being the biggest

2) However, you can’t hope to do well by spending nothing. Countries that spend more on health care are healthier overall.
Maneki Nico

@jmzero, skatanic, EvilSpirit,

Moreover, the right-hand y axis (let’s call it Y2) is somewhat misleading. Make Y2 the same height/scale as the left-hand y axis (Y1), or keep Y2 the same height but move it up or down, and all the slopes will look different.

Lies, damn lies, and infographics?
IronEdithKidd

How many years have insurance companies and politicians been insisting that we have the most affordable and best health care in the world in the US? Has it been true for even one of the post-WWII years?

Brainspore, not that I’d want to see the doctor every month, but yeah, what you said.
matman

fivethirtyeight.com has a much clearer graph.
Anonymous

Graph shows absolutely nothing. The high amount of money spent in the US on health care is by the wealthiest Americans, advancing medicine for everyone else.

The lower average lifespan only shows the A. diversity of America (yes people of different ethnic backgrounds are prone to different health issues.) And B. Yes there are more unhealthy among the poor & uneducated. However, look at the hordes of money per student we’ve been spending to educate people (20K per student in Chicago anyone?). Throwing money at a problem (especially via an unaccountable government bureaucracy) DOES NOT WORK.
- eviladrian
  
  “The high amount of money spent in the US on health care is by the wealthiest Americans, advancing medicine for everyone else.”
  
  On behalf of my fellow Australians, thanks!
- Brainspore
  
  Graph shows absolutely nothing. The high amount of money spent in the US on health care is by the wealthiest Americans, advancing medicine for everyone else.
  
  It may shock you to learn that wealthy people in ALL those countries are free to spend as much as they want on private care.
Rindan

It is true that there exist private options in some countries, and that they certainly do contribute to funding expensive drugs and procedures. The issue is the scale at which the US does it. Hell, just look at the little info graph. Australia might have private insurance options, but they still spend a paltry 3000 to the US 7000… and that is with the US using a population over an order of a magnitude bigger. $7000 USD per capita in a nation of 300+ million is a crap-ton of money.

When a health care provider does a cost calculation over whether or not it is a good idea to go forward with a drug/procedure/whatever, they do it off of US numbers. If Australians with private insurance are included, it is a footnote.

You don’t have to like the US system. In fact, US citizens should probably be pissed about their system. However, the truth is that the absurd amount Americans are shelling out really does subsidize world wide health care R&D.
- Itsumishi
  
  Except that it’s not the average health insurance plans that are pushing these developments. Most the time it’s the very rich people forking out massive amounts out of pocket (often flying in from other countries) or with the highest end private health plans available, there is no reason why these plans or people would disappear with a nationalised system.
  
  What would disappear would be massive amounts of wasted expenditure that is currently eaten up by bullshit bureaucracy and a massive gap of people that are not covered.
lasttide

This is just a terrible graph. Why is there no X-axis? Why would you bother to make a line graph if the slope is totally meaningless, other than for the shock value of having a huge negative slope for the US? I suppose its cost vs life expectancy as compared to the UK, but thats just dumb.
efalchuk

You know why this chart is wonderful?

Because it captures so many of the flawed assumptions underlying the reform debate.

There is no correlation between higher rates of spending and life expectancies.

There is no correlation between having a “universal” system and life expectancies.

Nor is there a correlation between number of doctor visits and life expectancy, or, for that matter cost.

Bad assumptions are almost certain to lead to bad conclusions.

In this sense, the chart shows far more than its authors intended.

More here: http://bit.ly/8fdZfc

Evan Falchuk
- Brainspore
  
  In this sense, the chart shows far more than its authors intended.
  
  How are you so sure of the authors’ intent?
  - efalchuk
    
    Brainspore,
    
    It’s likely safe to say that the words of the author of the National Geographic blog post reflect her intentions.
    
    I suppose I could add the word “probably” before “intended” in my comment, just to be sure.
    
    But even still there wouldn’t be a correlation among the data.
    
    Evan
Anonymous

I want to know what Mexico is doing right, actually.

EvilSpirit: The Y-axes are aligned so that the averages line up. The only free (arbitrary) variable is the scales; changing those wouldn’t hugely change the look of the graph.
Tzctlp

Really? Would you live in average to 560?

I mean, if you are spending 9 times more than Mexicans, you should live 9 times longer, right?

But lets not be harsh, I am sure that what you mean is that removing car crashes and gun crime (both proudly USian activities) is that you would live twice as the Brits, a reasonable 140.
SamSam

An amendment – if you remove traffic accidents and murder, American health care is in the top tier. Lies, damn lies, and statistics.

And citationless comments are even worse than statistics. Would you care to cite any evidence for this ridiculous claim? Can you create a chart which has the life expectancies of these countries listed with murders and traffic accidents removed from each of them?
Avram / Moderator

Djn, that auto-deaths chart is weirdly using the phrase “per capita” to mean “per 100,000 people” instead of the usual meaning of “per person” (literally “per head”). I was stumped for a bit, trying to figure out how 14.53 Americans could die for every American.
djn

If someone feels like doing the math:
http://www.driveandstayalive.com/info%20section/statistics/stats-multicountry-percapita-2004.htm

A few selected countries: The US had 14.53 per capita traffic deaths, the UK 5.34, Denmark 6.83, Japan 5.76 , Switzerland 6.85 .
djn

Uhm, excellent point. I should have mentioned that. x)