American Lifespan By County(tobiasbuckell.com)
tobiasbuckell.com
American Lifespan By County
http://www.tobiasbuckell.com/2012/05/03/american-lifespan-by-county/
88 comments
His argument doesn't really hinge on states. He's arguing that the there's a hilarious geographical disparity going on, in that big bits of rural backwater America is nothing like the America people like to believe in.
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.
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.
Population density may explain the whole fabricated issue. Where medical care is hours away and expensive to reach, life expectancy drops. Surprise.
Also low-density population means smaller sample sizes thus larger error. Again, surprise.
Also low-density population means smaller sample sizes thus larger error. Again, surprise.
This is a good point. Every year in various parts of Appalachia there are health festivals were doctors come and volunteer their time to give free medical care of various kinds, from eye exams to cancer screenings. This is intended for the poor and uninsured, but around 1/3 of the people who attend have health insurance that would pay for the exams. They still don't have real access to healthcare, though, because it would take over 3 hours each way to get to the appointment.
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.
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.
Except this is the map of population density:
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.
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.
Population density doesn't account for geography and infrastructure (roads). That's the healthcare delivery hotspot. Is there a map for that?
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.
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.
The population density map is misleading in this context.
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.
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.
Well I've lived here all of my life and in many different parts of the US. I've also lived for short periods abroad.
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.
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.
> Japan is a highly uniform society and very xenophobic. They have an almost uniform cultural, religious, and genetic makeup.
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.
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.
Only about 80% of Americans speak English as their mother tongue. And I can tell you pretty readily that even if 16% of the remainder speak "English" the level varies wildly.
The same applies to almost any large country. Outsiders tend to think that every country has a single culture, single language, etc. (I am from Sweden so for us that assumption is basically true.)
Examples where it is not true: Russia, India, China, Germany, Spain, Italy.
Examples where it is not true: Russia, India, China, Germany, Spain, Italy.
Europe has had a common history for thousands of years. Constantly forming, splitting and reforming. The Hellenistic Greeks were all over the Mediterranean, the Roman empire was all over the place, these England was a subsidiary of the kingdom of France, then not, then Ireland of England. Netherlands was part of Spain, Belgium was part of France. Lots of western Poland was in Germany, Austria was part of Germany, Nice (now in France) was part of Italy.
We're one big family who've been all over each other for thousands of years.
We're one big family who've been all over each other for thousands of years.
Technically Nice was never a part of Italy. Nice was most of the time part of the Duchy of Savoy (later called the Kingdom of Sardinia when the Duke of Savoy also became the king of Sardinia). Nice became French in 1860 while Italy was formed in 1861.
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
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
Austria was part of Germany only between 1938 and 1945. 7 out of ~1000 years of existence.
What about the Holy Roman Empire?
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".
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.
And what about East Fracia, or even the Carolingian Empire itself? Austria & Germany together.
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.
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.
> That shows a very inefficient use of USA's wealth and a very poor healthcare policy.
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.
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.
Are you saying that it's genetic or that it's cultural (e.g. food, exercise and lifestyle choices)?
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 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.
> Are you saying that it's genetic or that it's cultural (e.g. food, exercise and lifestyle choices)?
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.
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.
> 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.
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.
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.
I've lived in a few, and I agree that, say, the central valley and LA/SF are very different. But I think SF and Boston, say, share a lot in common, enough to be roughly the same country, at least in the way that Paris and Bordeaux, or Oslo and Bergen are the same country (some cultural differences, but not completely foreign). So I would guess there are fewer than 50 really distinct social groups in the U.S.--- several urban social groups, several small-town groups, several rural ones, maybe 5-8 total.
I agree with this. I grew up in the mid-Atlantic of the U.S. and feel comfortable anywhere from D.C. up to say...Toronto. Similar enough culture, language, food, architecture, etc. that I don't feel out of place anywhere in that stretch.
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.
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.
Maybe it's because I've moved around too much (and also lived in Europe for a bit), but I don't actually find urban areas in the U.S. that tied to their geographical area. Atlanta is different from Los Angeles, sure, but in broad strokes they share a lot of similarities, certainly more than either one shares with Paris, Rome, Tokyo, or Copenhagen---or with the rural areas 100 miles away from each.
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.
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.
I agree. I think the urban areas in much of Europe are a much better reflection of their surrounding areas than those in the U.S. Atlanta for example really is different than surrounding Georgia. But I wouldn't say that Atlanta feels anything like Minneapolis for example.
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.
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.
> Go to North Carolina or Georgia? I may as well be in Greece for how at "home" I feel there.
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.
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.
> But the language is the same,
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.
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.
> 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?
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.
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.
> I didn't travel a lot in USA, but I remember that USA today was available everywhere I went to
"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.
"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.
>By "newspaper are the same" I meant that you have national newspaper that one can find everywhere.
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.
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.
There's a big difference between an Alabama Democrat and a Massachusetts Democrat. You certainly could not always count on them to vote the same way.
"But the language is the same, the newspapers are the same, the political parties are the same."
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...
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...
http://en.wikipedia.org/wiki/The_Nine_Nations_of_North_Ameri...
Not vouching, just citing. (I haven't read it.)
Not vouching, just citing. (I haven't read it.)
> That shows a very inefficient use of USA's wealth and a very poor healthcare policy.
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.
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.
The greatest factor for longevity in an individual is genetics. For a population not so much.
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.
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.
Wow ! very interesting graph!
Cultural habits are probably the dominant factor. The extension of longevity these last years is mainly due to people stopping smoking.
http://www.sciencedaily.com/releases/2011/02/110207112539.ht...
Don't smoke, drink coffee moderately, have low cholesterol, and be wealthy.
http://www.sciencedaily.com/releases/2011/02/110207112539.ht...
Don't smoke, drink coffee moderately, have low cholesterol, and be wealthy.
"You have 200 years of common history as a single country..."
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!
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!
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.
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.
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.
I vote for school board, county supervisor, state governor, representative and two senators.
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.
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.
Your school board, county supervisor, and state governor are flacid, neutered versions of their virile predecessors of the 19th and 20th centuries. All of them spend most of their time wrangling federal money.
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.
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.
[citation needed]
http://en.m.wikipedia.org/wiki/Federal_government_of_the_Uni...
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:
http://www.irs.gov/taxstats/
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.
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:
http://www.irs.gov/taxstats/
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.
Okay, so now you have something to blame. Is that as far as you wanted to go, or did you want to also remove these things? Genuine question.
I wouldn't remove them, but I'd certainly want to invert the power structure.
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.
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.
This appears to be a reblog with a low-res version. The full interactive maps (in different forms) are the first three entries here: http://www.healthmetricsandevaluation.org/tools/data-visuali...
[deleted]
Probably helpful to realize that the lifespan is determined more than just one metric, such as healthcare. Cultural differences between different regions likely plays a significant effect. For instance, my guess is diet leading to obesity helps to drag down life expectancy in the regions where the life expectancy is lower:
http://www.cdc.gov/obesity/data/animated_map_slides/map26.jp...
http://www.cdc.gov/obesity/data/animated_map_slides/map26.jp...
Not just cultural differences. Things like car accidents and murders also play a disproportionate role.
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".
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".
Exactly, this is likely the most meaningful statistical correlation. Here is a map by county: http://www.americanobesity.org/obesityInAmerica.htm
Obesity has been found to take 10yrs off lifespan.
Also, smoking: http://labs.slate.com/articles/cigarette-map/ (click tab to see by county).
Obesity has been found to take 10yrs off lifespan.
Also, smoking: http://labs.slate.com/articles/cigarette-map/ (click tab to see by county).
I think this is what you're after:
http://www.healthmetricsandevaluation.org/tools/data-visuali...
http://www.healthmetricsandevaluation.org/tools/data-visuali...
"In Collier, Florida, women live 85.8 years on average. In McDowell, West Virginia, they live to be 74.1. That’s an 11.7-year gap"
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.
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.
Moving somewhere when you're old doesn't change your life expectancy.
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.
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.
> Moving somewhere when you're old doesn't change your life expectancy.
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.
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.
Exactly - at birth a man is expected to live until age 75. At age 65 he is expected to live until 81.
http://aging.senate.gov/crs/aging1.pdf (see page 8)
http://aging.senate.gov/crs/aging1.pdf (see page 8)
Fair point. Though we'd be talking moving from a place with a median age of, well, roughly median age. Greatest mortality is in infancy, again in the teens / early 20s (mostly males from violence/accidents), then gradually increases past 40 due to general mortality (disease, illness, cancer, etc.).
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.
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.
What the article doesn't seem to link is this: http://www.healthmetricsandevaluation.org/tools/data-visuali... , a nice visualisation.
Tobias wrapped up this fine post writing, the "gap [between developed and underdeveloped counties] will be, if it continues, a major fissure in a future America."
WILL be? It already is. It's pretty much in line with the so-called red / blue divide in the nation.
WILL be? It already is. It's pretty much in line with the so-called red / blue divide in the nation.
I've been living abroad for well over a year now. I always have to explain when I get the inevitable questions from people baffled by the inanity of our politics that the U.S. is really like two different countries stuffed inside one border.
s/two/fifty/
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.
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.
I love heat maps like this: they pack crucial information in an easily accessible format. However, they should always be scaled for population density, otherwise it's very misleading. Does the huge swathe of green in Alaska counterbalance the few red spots in Florida? Probably not!
The poor results on the map line up a fair bit with the cotton industry lines of the 19th century in this article http://bigthink.com/ideas/21383
Industry (dots) lined up with Obama voters from the article: http://strangemaps.files.wordpress.com/2008/11/strangemapsov...
Industry (dots) lined up with Obama voters from the article: http://strangemaps.files.wordpress.com/2008/11/strangemapsov...
I remember one year, while out skiing in West Virginia, my wife fell and broke her arm. The ambulance ride to the nearest hospital was about 1.5 hrs through some of the poorest and most ramshackle areas I've seen outside of the middle east and it ended at one of the smallest hospitals I've ever seen in the U.S. She received good care, but I can see many health choices being made in rural areas because
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.
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.
Imagine if you live in a university town, but it just gets redistricted to include a neighboring industrial town. The life expectancy of your town just dropped, drastically.
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.
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.
just proves that having the most expensive (per capita) healthcare system in the globe does not really contribute to health(y) results
I don't think I've ever met anybody who thought America's health care system was better than that of many/most Europea countries - certainly not of any fellow English/Europeans I know, but also no Americans I know and have discussed it with.
I guess it depends what you mean by "best" - if the ability to pay is not a factor (i.e. you are very wealthy) then I suspect the absolute best care is probably available in the US.
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.
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.
In my book, the fact that the US healthcare system excludes people who can't afford it automatically drops it to bottom of the list, regardless of how amazing it might be for the rich.
Excludes is an extreme view. Anybody with the wit to stand in line can get free healthcare at an emergency room or local hospital.
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 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.
> Excludes is an extreme view.
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.
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.
Countries with free health care for everybody can still offer plenty of incentives for making money, I don't think anyone would argue the UK isn't a capitalist country, and if you came to live here I'm confident that the NHS wouldn't be enough to make you stop caring about wealth.
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'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.)
The UK is not a capitalist country in the proper sense of the term, it's a mixed economy.
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.
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.
Is there any true capitalist country then? Where do you live that you don't have to pay any taxes?
Is there any true capitalist country then?
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.
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.
I would urge caution when using the terms "free" when discussing the NHS in a context like HN - I know you mean "free at the point of delivery" when you say "free" but many people won't! :-)
Obviously it has to be paid for, and I did end with the words "paying more in taxes to subsidise the NHS", but it's not as simple as paying for in advance, because people who don't make enough money to pay taxes, the unemployed, or people who need healthcare that costs more than the taxes they have paid do get it free.
> "Anybody with the wit to stand in line can get free healthcare at an emergency room or local hospital."
Spoken like someone who's never experienced illness or injury in the US without the benefit of insurance.
Spoken like someone who's never experienced illness or injury in the US without the benefit of insurance.
Of course I have.
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?
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 still don't get why you think making money is pointless if you can't spend it on healthcare. There's plenty of things you either use while paying for them in taxes (e.g. roads) or things you wouldn't be able to buy even if you wanted them (a private spacecraft, too expensive, or a child prostitute, too illegal) yet they haven't made you stop wanting to earn money.
I'm covered by the NHS, I still find plenty of reasons to cash my paycheques.
I'm covered by the NHS, I still find plenty of reasons to cash my paycheques.
A hassle? Again, I seriously doubt you've been to an ambulatory for anything worse than the flu.
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?
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?
I sometimes wonder if the high cost of healthcare is not, in part, a conspiracy from larger companies to keep people from taking jobs at startups.
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!
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!
So I would have to ask the question, "Why don't startups provide group health insurance?" If you want good employees, pay for them.
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.
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.
life expectancy at 80 is probably 5 years or so. So having a bunch of 80 year olds move to your county will probably increase it. Similarly, having successful, rich and long-lived people move out of your country at age 80, a few years before dying, will mean they don't increase your country life expectancy at all, despite the fact that they lived there for 80 years.
Not a lot of 80-yr-olds moving to the country, at least in Iowa. Mostly when folks get older, they move into the city with family or an apt or home.
It would be interesting to see the spread in life expectancy in Canada or Armenia. It's easy to shorten your life, even in a rich country but not so easy to extend it so I would expect increasing asymmetry as you go up. These comparisons should be done with distributions.
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.