Two interpretations of US health care cost vs. life expectancy

On the other day, Andrew Gelman posted this chart illustrating the high cost of US health care:

He did so to correct a “somewhat misleading (in my opinion) presentation of these numbers [that] has been floating around on the web recently.” The misleading graph, which appeared on a National Geographic blog, was — I agree — a confusing way to show information better represented in a scatterplot.

But I’ve seen this data before, and there’s more to the story. Neither the National Geographic nor FiveThirtyEight has anything to say about which numbers they’re charting.

Back in 2005, in a review of John Abramson’s excellent book Overdo$ed America, I noted that he had used a different source to reach a slightly different conclusion.

His chart, based on OECD health-expenditure data (link now 404) and WHO healthy life expectancy data (link still alive), looked like this:

He used it to make the oft-cited point that US healthcare isn’t just wildly expensive, but that it also correlates with worse life expectancy than in many countries that spend less.

I wondered what the chart would look like if based on the same OECD expenditure data but on the OECD’s rather than the WHO’s definition of life expectancy. The result looked like this:

The U.S. is the clear cost outlier on both charts. The first chart, however, places us near the low end of the life expectancy range, justifying Abramson’s assertion that we combine “poor health and high costs.” The second chart places us near the high end of the life expectancy range, suggesting that while value still isn’t proportional to cost, we’re at least buying more value than the first chart indicates.

Although based on older data, this second chart closely resembles the ones recently shown and discussed by the National Geographic and FiveThirtyEight.

My review of Abramson’s book concluded:

Has Abramson spun the data to make his point, just as he accuses the pharmaceutical industry of doing? Of course. Everybody spins the data. What matters is that:

  • Everybody can access the source data, as we can in the case of Abramson’s book but cannot (he argues) in the case of much medical research
  • The interpretation used to drive policy expresses the values shared by the citizenry

Would we generally agree that we should measure the value of our health care in terms of healthy life expectancy, not raw life expectancy? That the WHO’s way of assessing healthy life expectancy is valid? These are kinds of questions that citizens have not been able to address easily or effectively. Pushing the data and surrounding discussion into the blogosphere is the best way — arguably the only way — to change that.

That was five years ago. The data was, and is, out there. So it’s disheartening to see the same chart pop up again without any further discussion of the sources of its data, or of the definitions underlying those sources.