January has turned out to be a banner month for fans of American exceptionalism. As documented in voluminous detail in a 404-page report released last week by the National Research Council and the Institute of Medicine, Americans lead shorter lives than Western Europeans, Australians, Japanese and Canadians. Of the 17 countries measured, the United States placed dead last in life expectancy, even though we lead the planet in the amount we spend on health care (17.6 percent of gross domestic product in 2010 vs. 11.6 percent each for France and Germany). We get radically less bang for the buck than comparable nations. If that’s not exceptionalism, I don’t know what is.
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But a funny thing happens to Americans’ life expectancy when they age. The U.S. mortality rate is the highest of the 17 nations until Americans hit 50 and the second-highest until they hit 70. Then our mortality ranking precipitously shifts: By the time American seniors hit 80, they have some of the longest life expectancies in the world.
What gives? Have seniors discovered the Fountain of Youth? Do U.S. geriatricians outpace all our other physicians?
Part of the answer is Darwinian: Those Americans who have been less able to access reliable medical care, maintain good diets and live in neighborhoods that are not prey to gun violence have disproportionately died off before age 80. That isn’t natural selection but social selection — the survival of the economically fittest in a nation that rations longevity by wealth.
But the larger part of the answer is that at age 65, Americans enter a health-care system that ceases to be exceptional when compared with the systems in the other 16 nations studied. They leave behind the private provision of medical coverage, forsake the genius of the market and avail themselves of universal medical insurance. For the first time, they are beneficiaries of the same kind of social policy that their counterparts in other lands enjoy. And presto, change-o: Their life expectancy catches up with and eventually surpasses those of the French, Germans, Britons and Canadians.
It’s funny how quite a few of the people who whine and complain about healthcare for all happen to be in the elderly bracket. Another case if IGMFY.