The US has top-tier cancer survival-after-diagnosis outcomes. We spend too much to get there, and other countries in our cohort would "argue" that we get those numbers in part by diagnosing earlier and that our outcomes are broadly similar, but if you're going into these debates with "the US private health care system causes cancer deaths", that's a pretty rebuttable argument.

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vlabakje90 a day ago | parent | next [-]

That overlooks the 27 million uninsured Americans. Uninsured cancer patients are more likely to be diagnosed at a late stage, less likely to receive treatment, and have substantially higher mortality than insured patients.[1] They also have worse survival, even after accounting for cancer stage.[2] So excellent U.S. outcomes among those who access care don't rule out preventable deaths caused by barriers to accessing it.

[1] https://pubmed.ncbi.nlm.nih.gov/25092774/ [2] https://doi.org/10.3322/caac.21732

	▲	tptacek a day ago \| parent \| next [-]
		No, uninsured Americans are captured in those numbers.
	▲	s1artibartfast 11 hours ago \| parent \| prev [-]
		entirely beside the point. It is fine to look only at patients with insurance/ access to refute the claim that US doctors dont cure cancer so they can make more money.

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ryanackley a day ago | parent | prev | next [-]

This is a cherry picked statistic. We still have lower life expectancy, high infant mortality rates, and one of the highest rate of preventable and treatable deaths among developed countries

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caseysoftware a day ago | parent | next [-]

The unfortunate truth is that if you break life expectancy out by ethnicity, it tells a different story. Generally Asians, Latinos, and Whites are above while Blacks and Native Americans are below and pull down the average: https://pmc.ncbi.nlm.nih.gov/articles/PMC9256789/#S12 If you break the groups out and individually compare against countries of similiar ethnicity, the US is often ahead.

For infant mortality specifically, in the US we count every baby with a sign of life, regardless of the age. In many developed countries, they simply don't count too premature (under 22 weeks or 500 grams, iirc) and therefore don't consider them in the metrics. It makes for an apples to oranges comparison.

You're right on "preventable and treatable deaths" with heart disease and diabetes being the biggest contributors. The question for that comes down to "is that a result of systemic issues or individual choices?" because we can do lots about one of those.

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soundwave106 a day ago | parent | next [-]

Um... really?

When I Googled life expectancy by ethnic group in the United States, it gave me the following numbers:

Asian: 85.2 years

Hispanic: 81.3 years

White: 78.4 years

Black: 74.0 years

American Indian and Alaska Native (AIAN): 70.1 years

Along with a source. (https://www.kff.org/racial-equity-and-health-policy/racial-d...) (Note: Based on the source, these numbers are for 2023.)

Overall, life expectancy in the United States in the last few years is around 79ish per the sources listed here in this Wiki article: (https://en.wikipedia.org/wiki/List_of_countries_by_life_expe...)

This means that the average life expectancy of white Americans is actually slightly below the average life expectancy of all Americans.

Incidentally, while a lot of developed countries do not track life expectancy by ethnicity, the UK seems to have a few some studies. (https://www.ons.gov.uk/peoplepopulationandcommunity/birthsde...) Though the data is very old (2011-2014), and the data is broken out by sex with no summaries, whites actually fare the worst. Black African females came out at the top, with a life expectancy of 88.9. I asked Google's search what the comparable black American female life expectancy was in 2011, and it gave me 78.2, along with a link. (https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6244a8.htm)

Our overall ranking generally is below all "developed countries" that I can see, which range from Germany (~80) to the ~84 of "developed" countries like Japan, Switzerland, and Sweden (along with a few countries still classified as "developing" like Kuwait). It's not completely terrible, but considering how much the United States spends on health care, that's quite a poor value.

There are multiple identified factors for explaining life expectancy, but access to healthcare is identified as a very significant factor. In a system, like America, that is very expensive (likely due to highly inefficient, over-bureaucratic, overly complex, and over-quasi-monopolized systems) and without universal coverage, it follows that those who are poorer may not have the same access to healthcare and may succumb to entirely curable illnesses. So I don't think it's a coincidence that the racial breakdown above almost matches the median ethnic household income (the median white American household earns more than the median Hispanic household, but elsewise it aligns).

On infant mortality, at least one link I found -- https://www.healthsystemtracker.org/chart-collection/infant-... -- which adjusted data due to the reported difference, and still found significantly higher infant mortality in the United States. Though the data is a little old (2016).

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tptacek a day ago | parent [-]

Cite the source for "access to healthcare" as a "very significant factor" in US life expectancy? We have pretty good numbers on the mortality cause differences between the US and other countries and they don't align with this claim (unless you're doing some bank-shot argument about how access to health care makes our car crashes more lethal or something).

You'd want to be looking for a scholarly source that puts numbers on this. It's been done! As I noted elsewhere on the thread, the study we're commenting on is based on 1990s numbers about differing mortality of the uninsured. But here you're looking breakdowns of all mortality causes and tying them to insurance, a trickier proposition. Will be interested in whatever you come up with.

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soundwave106 7 hours ago | parent [-]

https://www.ncbi.nlm.nih.gov/books/NBK62376/

	▲	tptacek an hour ago \| parent [-]
		This article repeatedly makes the point I made; I assume you cited it to back me up?

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smallmancontrov 3 hours ago | parent | prev [-]

> they simply don't count too premature (under 22 weeks or 500 grams, iirc) and therefore don't consider them in the metrics

Nope, that's not the reason.

> The U.S. infant mortality rate was still higher than for most Europeancountries when births at less than 22 weeks of gestation were excluded.

https://www.cdc.gov/nchs/data/databriefs/db23.pdf

Statistical hustling is common, but the most usual form is that the US excludes uninsured individuals to make itself look like it belongs in the developed country cluster.

	▲	tptacek an hour ago \| parent [-]
		No, the uninsured are included in both infant mortality and, even more obviously, death statistics.

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tptacek a day ago | parent | prev | next [-]

Life expectancy differences between the US and other countries are dominated by just a few factors:

* Car accidents, because we drive much more and are much more spread out than other countries.

* Drug overdoses, though other countries are starting to catch up to us there.

* Homicide, because of our gun policy and the universality of firearms (which also bears on our suicide stats).

* CVD.

That last item sounds like an indictment of the US health care system, but it isn't. If you break CVD out by state, northeastern states like Massachusetts have outcomes resembling the Nordics, and Mississippi has outcomes like a developing country. But the structure of the health care system is the same in both places.

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ryanackley 3 hours ago | parent [-]

I'm sure there are qualifiers and rationalizations when comparing cancer survival statistics as well. As someone already pointed out, uninsured Americans aren't necessarily included. They cited sources, you rebutted without sources.

I believe a single payer system is a matter of when not if. It works just fine in other countries. In our country, the healthcare industry has evolved into extracting as many dollars as it can from the economy. This is because when someone is sick and needs treatment, healthcare providers hold all of the cards.

	▲	tptacek 3 hours ago \| parent [-]
		Uninsured Americans are in fact universally included in death statistics and in cancer survival outcomes; we have top-tier cancer outcomes. Europe has several universal coverage systems without single payer. The original sin of the US system isn't private insurance, it's employment-based coverage; that's the thing nobody else has.

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loeg 16 hours ago | parent | prev | next [-]

Our life expectancy and infant mortality rates are downstream of driving a lot of miles and unhealthy behaviors (mostly diet and exercise) of American mothers (i.e., obesity). Those are things it would be good to improve, but it isn't the fault of the ER or L&D departments or their billing models that people get in car accidents or mothers are obese.

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a day ago | parent | prev | next [-]

[deleted]

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HDThoreaun a day ago | parent | prev [-]

Life expectancy tells you very little about healthcare without controlling for confoudners

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Alex3917 a day ago | parent | prev | next [-]

I think the parent comment was a reference to the famous “Economists must learn to subtract” commercial that AdBusters ran.

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forshaper a day ago | parent | prev | next [-]

Some good news is that ISH diagnostics manufacturing can go through 510(k) instead of PMA on Sep 16 onward, which should make those diagnostics 10x cheaper and twice as fast to get through.

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well_ackshually a day ago | parent | prev [-]

>The US has top-tier cancer survival-after-diagnosis outcomes.

"Airplanes that get shot in the wing always survive" logic. People _do not get diagnosed and die_ because the US healthcare system is inaccessible to close to 50% of your population. A diagnosis easily reaches a few hundred dollars for the best cases (and several thousand if you need multiple tests/blood tests/operations like colonoscopies). And when you do get diagnosed, then you've just entered a world of having to pay hundreds of thousands of dollars.

>we get those numbers in part by diagnosing earlier and that our outcomes are broadly similar

lmao no you simply don't diagnose people and they just "die of natural conditions" early because they couldn't afford the treatment even if they were diagnosed.

	▲	bpt3 a day ago \| parent [-]
		> US healthcare system is inaccessible to close to 50% of your population So you have no idea what you're talking about. What is the point of making comments like this that are both verifiably false with about 2 seconds of online research and just sound incorrect based on anecdotal data to anyone living in the US.