I found the article Americans Outlive English, Study Finds on webMD. The sub headline was “Despite Being Less Healthy, Americans Live Longer Than U.K. Residents”.

Older Americans are not quite as healthy as their English counterparts, but do live just as long, if not longer, according to a new study in Demographics.

In the new study, Americans aged 55 to 64 and 70 to 80 had higher rates of chronic diseases than same-aged English people, but they died at about the same rate. And Americans aged 65 and older — while still sicker than their English peers — actually lived longer than similar-aged people in England.

The article concluded with:

The researchers speculate that this may be because these same illnesses are more likely to be fatal in England than in America, or that English people may be diagnosed at later stages in their disease, which would result in a higher mortality rate.

“Both of these explanations imply that there is higher-quality medical care in the United States than in England, at least in the sense that these chronic illnesses are less likely to cause death among people living in the United States,” Smith says.

I think it was Nicholas Taleb who said it is one thing to present data, but quite another thing to think you know the explanation for the data.

I kept thinking that there must be other possible explanations.  Then it hit me.

Perhaps the English health care system focuses on preventing disease while the US system focuses on prolonging life at the end.  This very focus in the US is where a large amount of our costs for health care are spent.  So the English may be getting about the same longevity for far less cost. Moreover, is it better to be healthy as long as you can and then go quickly when your time comes, or is it better to be sickly all your life and prolong your last agonizing days as long as possible with heroic but degrading mechanical efforts to keep you “alive”?

Upon further thought, I came up with the possibility that our fee for service model makes it financially better for the health care provider to administer expensive end-of-life care procedures than it does for maintaining good health up to that end stage.

In following Nicholas Taleb’s warning, all I said was that perhaps my explanation could be an alternative.

After coming up with these thoughts, I decided to write this post. While trying to retrieve the link to the WebMD article for this posting, I stumbled across another article.

U.S. Life Expectancy Falls Behind Major Countries, Despite Highest Health Spending

The researchers say that the failure of the U.S. to make greater gains in survival rates with its greater spending on health care may be attributable to flaws in the overall health care system. Specifically, they point to the role of unregulated fee-for-service payments and our reliance on specialty care as possible drivers of high spending without commensurate gains in life expectancy.

“It was shocking to see the U.S. falling behind other countries even as costs soared ahead of them,” said lead author Peter Muennig, MD, MPH, assistant professor of Health Policy and Management at the Mailman School of Public Health.

More than conjecturing an explanation similar to mine, this study seems to even contradict the raw findings of the story I alluded to first.

Today the Worcester T & G carried Clive McFarlane’s column, Reversing Course To Disaster.

The only significant disagreement that I have with the column is his closing paragraph:

If this reversing of course is what the Republicans plan to do for the next two years, the president can only hope that the country in two years speaks the way Massachusetts voters spoke in this midterm election — that they may be afraid of the present and concerned about the future, but they are not stupid.

My response tried to show that stupidity on the part of the electorate is not the issue. The issue is the idea that the only thing President Obama can do is to hope for a sudden awakening.  Here is what I wrote:

The President said that the Republicans have been politicking for the last two years while he has been trying to govern.

For Barack Obama, that shows an unusually bad understanding of something so basic.

What the Republicans know that Obama doesn’t seem to grasp is that part of the job of governing is to get the electorate to be enthusiastic about your governing agenda.  Not only do you have to get them there, you have to keep them there.

For two years the Republicans have been aggressively selling their point of view, while Obama quietly went about his business.  With his lack of salesmanship, the following that he established in 2008 started slipping away.

For the majority of citizens who do not follow politics closely, the only message they get is the one that is most loudly thrust upon them.  If the message is one sided, you cannot blame them for succumbing to it.

I used to blame the media for not providing the balance.  All they seem to do is report what the various sides say.  Now I realize that the Republicans have figured out how to play in that environment while the Democrats have not.  So the blame really does have to fall on the Democrats for not knowing how the political world works.

If you want the media to represent your side of the issues, you have to say something about your side so that the media has something to report.  If you don’t say it, the media aren’t going to dig it up and feature it all by themselves.

Oh sure, the media might run the occasional story to set the record straight.  However the opposition is out there on a daily if not hourly basis trying to tilt the record in their favor.

This reversal in fortune shows how tenuous political accomplishments can be if you don’t foster enthusiastic backing from the electorate for the programs you put in place.