I'm shocked that life expectancy is falling in the US - and infant mortality is crap, too

[McEdam]

The US comes in at no. 42 in international league tables of life expectancy - because so many people don't have health insurance, apparently. Perhaps we should be thankful we have an NHS, however much we like to complain.

Also scary stats re infant mortality - US really not where it should be. I gather birth in the US is quite medicalised - perhaps this shows that Hospital Knows Best approach/high C-section rates are actually not safer at all?

US tumbles down life expectancy ratings

Doubt it, but I don't understand the point. The NHS wouldn't do that either. They won't even let you in the door if you fly yourself.

I know, I wasn't defending the NHS postcode lottery, just wondering how it works in the US.

Yes, science teacher. That is true. The system in the US is more expensive. I guess you get what you pay for.

(raises hand) I'm not an expert (never claimed to be, which is why I asked you a question, because I was interested) but I do have first hand experience of both systems. I lived in the US for a year and developed a really nasty pussy sore throat. I was insured, but with a $50 excess, and at the time I didn't have $50 to spend [cue sound of violins]. So, on that occasion, when in the UK I would have gone to the doctor and got a (would have been free under the circumstances) prescription for antibiotics, in the US I didn't and after about a month eventually fought the dratted thing off myself.

I am perfectly well aware that one incident doesn't make me an expert in any shape or form. I am interested in how easy or difficult it is to get affordable medical insurance with a specific pre-existing long-term medical condition (rather than as an averagely healthy or unhealthy member of the population) but my question was perfectly genuine.

Absolutely, Expat, both systems has their flaws.

The US system isn't as great as it's made out, and the NHS isn't as bad as it's made out.

It's also unfair to compare US private medicine with UK public medicine. Comparing everything in each place would be fairer.

There are also differences in the actual approach to healthcare. In the UK, it is more holistic whereas in the US more specialist based. The UK is far more research-focussed too, with NICE, etc.

Depends on the state, lemonaid.

Some states have passed laws disallowing insurance providers to exclude transfer or new customers due to pre-existing conditions.

Thing is, the NHS covers everyone - so you can't do a like-for-like comparison with the cost of private health insurance in the US, it's apples and pears. The NHS isn't an individual puts in x amount and gets y out of it system, it's a shared social contract. And given life expectancy in the US is falling dramatically, strikes me that the health system in the States clearly doesn't work that well for everyone. Although there will be other factors too.

The NHS was born out of a desire for a better world for everyone at the end of WW2. The upper and middle classes had been thrown into contact with the poor, had become aware of the reality of the lives of the working class, and that they were real people too, not some sort of underclass who had brought poverty on themselves and deserved to suffer. Those who could afford decent healthcare could no longer hide behind ignorance of the conditions of the working class. People actually got hold of copies of the Beveridge Report to read for themselves! Can you imagine real people actively wanting to read a government policy document today?

I think that's something of which we should be very proud, personally. Women who had been staggering around with prolapsed wombs - because even if you could pay for a doctor, you only did so if it was the wage earner at stake - were suddenly able to get treatment.

Of course it's not perfect - partly because it was starved of investment for 21 years (we were at the bottom of the European tables for health spending). But there is something precious about that history and about having a system which is there for you no matter how much or how little you have.

Agree with a lot of your points McEdam. However, my gripe is that so few people here think about the cost of the NHS.

Everyone always seems to know that US private health insurance is really really expensive yet the reality is that with a budget of over £100bn, the NHS costs an average per capita exactly what top of the range health insurance costs in the US. Obviously they aren't directly comparable as the cost of the NHS is spread in a more equitable way via the tax system and as you rightly say, they are utterly different systems. Doesn't mean though that many taxpayers on fairly average salaries aren't paying £2,000 per head and more annually though and often having to endure long waiting lists and restricted drugs etc when they need treatment.

I thought that, in GDP terms, the US spending on healthcare was roughly double the UK's. The numbers ISTR from researching this several years ago was 15pc vs 8pc.

Be that as it may, on a per capita basis, the NHS costs per head roughly what top of the range health insurance costs per head in the US. Obviously that is a straight currency calculation and there are lots of complicating factors involved.

The NHS budget isn't £100m. It is expected to hit £92bn next year.

It isn't £100bn, I meant.

I personally DON'T think about the cost of the NHS because I am grateful to have it when needed. I appreciate that it isn't perfect but neither is the American system of health insurance - in both sytems there are people who don't get ideal non-emergency treatment. At least the NHS doesn't require you to stump up a whole wadge of cash before it will treat you. Rich or poor - living off benefits or a top earner - in a crisis you will be treated. In a road accident a paramedic ambulance would arrive and you would be cared for - rich or poor. That doesn't happen in the US where they may save your life but further care may only extend to the cover you have.

Not sure where you get your figures from but as I understnad it, according to Gordon's 5 year plan it is due to surpass £100bn in fiscal 2007. According to the DoH, it was £96bn last year.

According to the OECD, who ought to know, the US spends far, far, more per head on healthcare than any other OECD country and US spending is still growing at a rate of knots. (OECD Health Data 2006.)

You are right, though, re UK spending, DH annual report for 2006 says: 'In 2006-07, the planned total expenditure of public funds by the Department is £96,581 million. This includes the NHS pension budget of £10,182 million.'

It still isn't anywhere near the US spend, though. OECD
says in 2003 the US spent nearly $6,000 per head on health - the UK spent less than $2,500. Only Finland and Japan spent less than the UK. Which suggests even with NHS budget increases since then, we still have some catching up to do.

In fact the US spends 24 per cent more on health than even their nearest rival, Luxembourg

So something must be going wrong if the US spends far, far more on health than other developed countries but has falling life expectancy.

I can't see that we can pick these statistics apart or even believe them until we lnow where they come from.

Are we talking about Americans (and I mean citizens) who have always lived in America or are we including illegal immigrants whose ill health may be due to wherever they came from? What about foreigners who suffer ill health or even die whilst in the US?

For infant mortality, does this include people who get on a raft in Cuba to escape an evil dictator and show up on florida shores so the baby can be born in the US and hence be an American citizen?

And for the financial statistics, what are the sources of this money? Does this include money donated for research purposes? What is the out of pocket expense Joe average American?

There is so much information missing that it really is difficult to draw any conclusions.

I agree with you relly, statistics tell you little and obviously private health insurance is only part of the equation in the US. It does bug me however how people here almost get upset when you talk about the cost of the NHS. Pagan says "at least you don't have to stump up a wedge of cash before the NHS treats you" but of course that's exactly what she and presumably her other half have done over the years. Unlike in the US where you pay insurance separately, here it just comes out of taxes.

I honestly feel the NHS would be improved if people were conscious of exactly how much it costs them. Perhaps people would be more careful not to miss appointments and not to dial an ambulance or even see a Doctor unless it is really neccesarry (i.e. not for common colds etc) or turn up to A&E with non-emergency ailments.

There was a piece in the news yesterday saying that one of the reasons why NHS IVF rates had a lower success rate than private clinics was that some NHS fertility clinics only operated one or two days a week thereby missing women's most fertile time. Would a private clinic operate like this given the ultimate implications for its profits? I don't think so.

My other huge bug bear is why when I want something that isn' available on the NHS (say a Nuchal scan if you are under 28) do I have to go and pay some Harley Street clinic for it rather than give the money to the NHS.

but all those categories of people would receive free health care from the nhs wouldn't they eleusis, if they were in the uk? and presumably be included in our infant mortality figures etc.

ps chocdot, i have had 2 nuchal scans on the nhs, aged 26 & 29.

At the end of the day, all countries have to ration health care resources, because we all have the capacity to use an unlimited amount. In the UK, we tend to ration via waiting lists; in the US, they ration by exclusion.

What you notice in the US is the amount of waste. Unnecessary tests, huge numbers of backroom staff, incl the insurance companies themselves. The US healthcare budget is larger than ours (probably twice as big), but remember a lot of that money is channeled ultimately into shareholder profits for the various health insurance companies. It goes via the huge bureacracy that these companies impose of healthcare - far bigger than anything the NHS could even dream of.

Ah yes Hoxtonchick - the postcode lottery, another bugbear. I wasn't entitled to one at 33. The first scan they would give me on the NHS was at 20 weeks. I would far rather have given the subsequent £200 to my fab local hospital rather than a swanky clinic.

By Definition, infant mortality and Life Expectancy are only calculated for people born in that country TODAY, immigrant background barely comes into it.

Did you know even if you have medical insurance, it costs you money out of pocket (I think about $2000) to have a baby born in hospital in the USA? Antenatal appointments and tests cost extra, too. Plus monthly checks after baby is born (you usually pay for those, too).... talk about disincentive.

Obesity is a big factor, the article points out -- true in pregnancy and adult mortality.

Causes of infant morality in USA -- I half-wondered if the strong anti-abortion stance in USA might be affecting those figures (I don't have time to find comparable figures for other OECD countries). But I also KNOW that drug addicts conceiving babies is a big problem in the USA, too.

And the most messed-up people (drug problems, messed up family origins, chaotic lives) aren't organised enough to find out how to get free medical care, and then get themselves to appointments... and the system is woefully inadequate at chasing them up. They fall thru cracks, big time. Plus the system is over-worked and sometimes they express concerns which are brushed aside.

I know someone in California who was homeless crystal meth addict when she conceived. She got antenatal care late. She had badly managed gestational diabetes. Ended up at term at hospital more or less screaming at them to admit her because she "knew" something was wrong she had been clean a few months and it was her 3rd full-term pregnancy. They tried hard to send her away, but she make them admit her and very quickly they realised the fetus was in distress born by emergency C/S with meconium in the lungs, he barely survived.

It cost me $10 oop to have my baby in the US. The overall cost was about $4000 - $2000 to the midwife for the antenatal care and delivery and $2000 to the hospital for the nurse and bed for about 16 hours.

I had expatriate insurance which meant that I should be covered to the same leve

It cost me $10 oop to have my baby in the US. The overall cost was about $4000 - $2000 to the midwife for the antenatal care and delivery and $2000 to the hospital for the nurse and bed for about 16 hours.

I had expatriate insurance which meant that I should be covered to the same leve

Good point HC - if you try to strip out non-Americans from the US figures as Eleusis suggested, then it's not a fair comparison with the NHS.

I think it's clear that whatever the quibbles, the US spends far more than any other country in the world on healthcare (assuming non-OECD countries spend less). So the NHS does seem to be better value for money than the US system, given US life expectancy is shockingly low and falling.

(Eleusis, I gave the source for my information so if you need more detail it's there...)