Don’t Expect Life Expectancy To Explain American Health Care

Misinformation is killing Americans. At least, that’s what one of America’s top public health officials says.

Speaking to CNBC in April, U.S. Food and Drug Administration Commissioner Robert Califf said misinformation is part of the reason Americans have lower life expectancies than people in other wealthy nations.

The FDA chief is hardly alone in raising the alarm about U.S. life expectancy. Every year pundits react with horror to the fact that, despite spending more on health care than other developed countries, Americans seem to die earlier.

But lagging U.S. life expectancy has little to do with the quality of our nation’s healthcare system. Americans die younger than their peers abroad because of a number of social and cultural factors unrelated to medical care.

Indeed, the American healthcare system outperforms the government-dominated systems of comparable countries on any meaningful metric. Simply put, there’s no better place to get sick than the United States.

This past December, the Centers for Disease Control and Prevention announced that American life expectancy in 2021 had dropped to 76.4 years, the lowest level in two decades. That’s 0.6 years below the 2020 figure—which was itself 1.8 years lower than life expectancy in 2019.

In other words, life expectancy at birth declined almost 2.5 years between 2019 and 2021.

Meanwhile, the average life expectancy across comparable countries in 2021 was just over 82 years—nearly six years longer than in the United States.

How do we square that with the fact that the United States devotes nearly 18% of GDP to health care—nearly double what the typical OECD country spends?

The major drivers of America’s comparably-low average life expectancy have nothing to do with health care.

For instance, 16% of the drop in life expectancy from 2020 to 2021 was the result of deaths from accidents or unintentional injuries. The fourth-leading cause of death in this country is unintentional injury.

Half of deaths by unintentional injury are the result of drug overdoses. About 320 people out of every million Americans died of a drug overdose in 2021, according to estimates from the Commonwealth Fund. That would make the U.S. overdose death rate the highest in the world.

The firearm death rate in the United States is eight times greater than in Canada, 22 times greater than in the European Union, and 23 times higher than in Australia.

Nearly 43,000 Americans died in car accidents in 2021, compared to just over 1,600 in the United Kingdom that same year. That’s nearly 27 times as many auto deaths in a country with only five times the population.

Per-capita road traffic deaths are more than twice as high in the United States as they are in Canada.

Each of these metrics is unfortunate. But they’re largely beyond the control of our healthcare system.

Consider how Americans fare when they experience a problem our healthcare system can address.

The cancer death rate in the United States, for example, has dropped by a third since 1991, thanks in large part to advancements in treatment. American patients are the first to get access to those treatments because our market-oriented system will pay for them. American patients had access to 96% of oncology drugs launched between 2011 and 2018. Patients in Germany, by contrast, had access to just 73%; Irish patients only had access to 51%.

Perhaps unsurprisingly, the cancer death rate in the United States—182 per 100,000 people—is better than Germany’s 206 per 100,000 people or Ireland’s 234 per 100,000 people.

U.S. patients also have superior access to advanced medical technology. The United States has 43 CT scanners per million patients, compared to just 10 per million in the United Kingdom. The United States also has more MRI machines and hospital beds per million patients than the United Kingdom and other OECD countries.

The recent decline in U.S. life expectancy is a tragedy. But our healthcare system has relatively little to do with it. In fact, life expectancy might be even lower in the United States but for our world-class healthcare system.