Curiously, however, for a system apparently stultified by the dead hand of government, Australia’s health system far outperforms the free market-based US healthcare system, which spends nearly twice as much per capita as Australia to deliver far worse outcomes — including Americans dying five years younger than us.
The shocking truth: Australia has a world-leading health system — because of governments
Overall, we now have the fourth-highest life expectancy in the world.
This is contrary to the narrative that pervades the media about our health system — one in which our “frontline” health workers heroically battle to overcome government neglect and inadequate spending, while the population is beset by various “epidemics” — obesity, alcohol, illicit drugs.
In fact, Australian longevity is so remarkable that in August The Economist published a piece simply titled “Why do Australians live so long?”
It's not a very free market when there is such a large power differential between the buyer and the seller. You can't exactly shop around for the ambulance or the hospital when you need it, nor can you realistically circumvent the artificially constrained supply [1] of doctors to get cheaper healthcare (unless you live next to the border).
When the alternative is a one-sided market like this, government becomes rather more appealing.
There's also a lot of regulation and lots of subsidies (the US has similar per capita public spending to Canada - old people on Medicare are not cheap). If something is so heavily regulated and subsidised that the private sector is only there to outsmart the government to line their pockets, it's inferior to even a public system.
To me that is the funny thing today if you look at markets Chinese markets under it's communist system are actually freer than US. China is not interested any 1 company getting a monopoly and becoming more powerful than the government so they promote finance multiple companies resulting in a truer capitalist market than the US.
Always when I read this I think they are comparing too very different societies where healthcare is just one factor. Americans are so much less healthy than Australians due to lack of exercise, poor diets, stress, no holidays, guns and crime. Its a miracle that if the US health is nearly as good as Australians it shows how great the US healthcare system really is.
Part of the Australian national, state, and local health care system is policy to encourage healthy life styles and to discourage, limit, or ban food additives, tobacco, etc.
Back in the 1970s the AU Government was running campaigns such as Life. Be In It: https://www.youtube.com/watch?v=GNjEge3Awl8 (many short segments airing with commercials on TV).
Planning requirements typically require open spaces, walking paths, sporting facilities, etc.
A "healthcare system" needs to be more than simply "immediate care for the injured, sick, and|or dying".
>Its a miracle that if the US health is nearly as good as Australians it shows how great the US healthcare system really is.
Or its a ticking time bomb: 39.6% of Americans are Obese(BMI 30 or higher). Fast forward 15 years and this will probably collapse the country. It certainly will be the No 1 issue in the country bar none. Ozempic may actually give the country a chance of some sort of future.
"Free market" is one of the best examples of a technical term people use with complete confidence despite not knowing what it really means. Furthermore, even if you do know what it means you probably remember it as something you learnt on day 1 of economics class before learning all the reasons they never really exist and what governments try to do about that.
Australians (and other outsiders) use that term when talking about aspects of the US because that is the Hollywood picture of how the US functions.
That is the lie that is sold, and people outside have no way to know it’s not true. Even today there are hundreds of millions of Americans who say they live in a free market and that it’s the best thing ever.
Is the US health system free market? The government provides healthcare via Medicare and Medicaid for seniors, the people for whom life expectancy and healthcare quality have the highest correlation.
It’s a mixed bag, but the funding source doesn’t necessarily make it a controlled market, to the degree that Medicare and Medicaid pay non-government providers and allow competition (which again, is mixed). Medicare and Medicaid coverage make up one third of the US population. The other two thirds are on group/employer insurance, private insurance, or no insurance at all.
For non-seniors, the medical insurance system certainly sometimes doesn’t feel like a free market from the consumer perspective, but the insurance companies are private for-profit institutions, and the medical providers are too, so it may well fit the definition.
> the people for whom life expectancy and healthcare quality have the highest correlation.
What do you mean by this? Fatalities among the young will have a much larger impact on lowering nationwide life expectancy than fatalities among the elderly.
The quote is from a Crikey reporter, I (an Australian) wouldn't agree that the US health system is classic free market .. but it appears to have more regulatory capture by vested commercial non government profit orientated interests than by social policy best outcome for the masses civil authorities.
( Describing various systems in various countries as either communist of free market capitalist is pretty simplistic, it's not much as a linear spectrum either )
I'd also argue that the foundation for a high life expectancy doesn't start with good health care for seniors .. unless the metric is "life support via artificial means" .. life expectancy is grounded in healthy living and excerise from an early age well maintained with good health programs.
AFAIK Australian healthcare system is mixed public private with a heavy lean on private. The healthcare market is open to market forces as the government works through subsidies. Plus I think many of the hospitals are religiously run institutions which helps protect from private equity influence.
The US has massive government regulation and dysfunctional state intervention in healthcare if not directly then vicariously with rules around Medicare. The US government helps make the dysfunction that private equity later exploits.
So I’m not sure that it would be correct to use Aus and the US as examples of the either end of the private / public continuum.
I would use UK or France as an example of a public system and Singapore as a light touch private, and perhaps India or Turkey as a laissez-faire system.
The UK and France systems appear to be degrading and do not appear long term affordable and I think they will soon be adopting Canadian style Maid systems to cut cost.
Germany is a weird one because it seems like half the doctors there are homeopaths and the Germans love their insurance but I’m not sure if they get value for it.
Personally I’d prefer the Australian or Singaporean style systems but I’d classify those as mostly private.
Australia absolutely has a hybrid health care industry with layers; health, medical, surgery, pharmacy and mostly outcomes based regulation rather than much assistance to maximise financial profits.
The current system grew out of a more fully public system under a many years past Whitlam government, people like the universal health for all aspects and wanted additional private services in the mix. It's evolved from there, with government oversight directed towards keeping things accessable and fair.
The US appears to have "massive government regulation and dysfunctional state intervention" as the end result of a lot of fingers in the pie bending regulation toward "middlecare" providers that don't apply splints or save lives, just diddle about with insurance schemes. (Admittedly that's just an impression from afar).
> The US government helps make the dysfunction that private equity later exploits.
My feeling is the US government is largely an arm of private interests in many matters.
Health Care in Australia embraces public policy such as Food Regulation to ban and limit additives, parks and sports grounds to encourage exercise, limiting access to tobacco, and some interesting national level drug acquisition deals to keep pharmacy costs low.
These cause a flow on of less per capita input into the medical side; lower heart disease, less smoking related issues, etc.
I had private health insurance in Germany. It was quite expensive and had a very high deductible — so pretty bad incentives around routine health care, I never made a claim in 13 years.
The upside was that if you needed, say, a brain transplant for ten million Euros, as long as it was medically necessary they would pay for it.
Now I have a policy elsewhere that is cheaper, still covers me when I go to Europe, and has a much better copay structure while being 100% private. Downside is I can’t afford that brain transplant, but I’ll probably be OK for everything else.
Next to the USA, Australia provides some of the highest earning opportunities for medical specialists thanks to its very well-developed private sector. A doctor might clock AU$300/400k for a 0.5FTE role at a public hospital, and then bring in another AU$500/600k+ from their private practice (and that's a very low figure for a lot of specialities). As a result, Australia can attract and retain extremely high-quality doctors with the public sector essentially riding the back of the earning potential provided by the private sector. Interestingly, I think the reason you don't often see full private specialists is that due to lack of market forces applying to public healthcare, the public system crowds out the private system on complex/innovative care -- so as a specialist you need to retain a public presence to get access to the high-profile work that you use to support your private billings.
"less likely to die from drug overdoses. Older age groups are also less likely to die from chronic diseases such as circulatory problems and heart disease. Cancer mortality rates are lower in Australia than they are in all other Anglophone countries, except among American men aged over 65. And Australians are also less likely to die in road accidents than other countries"
So what does this have anything to do with healthcare system ( govt or free market) .
The issue with most of these is that they have better health outcomes overall but when it comes down to the uncommon cancer your mom has, she will have a much higher chance of survival in the US. The difference is a lot of poor folk without adequate healthcare die of relatively straightforward conditions like diabetes while if you do have healthcare you end up getting the state of the art though it might bankrupt you.
There's nothing in the Australian health care system that precludes people with uncommon conditions seeking specialist treatments either in Australia or abroad.
> she will have a much higher chance of survival in the US.
Without a deep dive it looks ballpark the same, to be honest.
AU Cancer Survival Rates:
The 5-year survival for cancer in 1991–1995 was 55% and by 2016–2020, the rate had increased to 71%. Even with decreasing mortality rates and increasing survival, the number of deaths from cancer has been increasing.
Five-year survival rates have also been increasing for an even longer period of time. The overall cancer survival rate was 49 percent in the mid-1970s. It currently sits at 68 percent
> when it comes down to the uncommon cancer your mom has, she will have a much higher chance of survival in the US.
A few years back my Mum in Australia was diagnosed with stage 4 lung cancer, given 12 months to live.
For just shy of 3 years she had radiation, chemo, trial drugs worth nearly a million a pop all in a brand new cancer Center. Because she lived a couple of hours away she got free transport to and from and free hotel. Not pay and claim it back, fully free.
She was on an enormous cocktail of drugs that dad would get at the pharmacy that raised a lot of eyebrows for the strength of the opiates among other things.
For three years they never paid a cent. They never paid a cent of health insurance, never had private cover, never had a deductible. That would all be the same if they had never worked or took a decade off to pursue some hobby.
Trust me when I say it was stressful and emotional enough without adding money or paperwork or insurance into the equation
The comparison to my friends in the US who couldn’t get a separated shoulder fixed because it was “out of network” or had to move hospitals the day after a C section because the insurance didn’t want to pay anymore is downright disgusting.
For real people living their lives the two systems are vastly different.
Obesity's definitely a factor, but other developed countries haven't seen the same level of stagnation despite their own skyrocketing obesity rates. For that matter, Americans also smoke less compared to most of Europe.
There's likely at least one other major factor, and I would assume that it's some variation of "inability to access high-quality care for financial reasons" given how much of a wealth disparity there is in various healthcare outcomes.
yep exactly. 'healthcare' should be called 'disease care' . Most ppl are too far gone to recover from their illness by the time they go to the doctor.
All the medicines they prescribe are merely to manage symptoms. I have GERD and reflux. I was given PPI after many many tests. How does taking PPI extend my lifespan. Whatever has gone wrong with my body is still there.
How is this not obvious to ppl making this absurd correlation between hospital care and lifespan.
Medicine doesn't have shit of new breed of diseases and disorders ppl are dying from. Doctors don't have answers to any of modern illnesses so how does it matter if access to a useless person is govt funded or 'free market'.
Bernard is well across many aspects of US, UK, and AU political views, government systems, media etc. with his own particular views as we all have.
In context he's writing for an Australian audience about a conservative Australian trope that the Australian health system is weighed down with government meddling and would do better with, for example, a "US free market" approach.
I think we all appreciate that's an illusion, a myth spun for children.
Depends on what you mean by health care. Medicare is insurance, not care, and while insurance is part of the system, Medicare often pays private healthcare providers for service. Medicare only insures ~14% of the US, less than one sixth and is only available for people 65 and older. For those reasons, your example maybe doesn’t demonstrate what you imply.
The healthcare system in the US is far, far from a free market. Most people would describe it as a crony capitalist market. There's a lack of transparency, lack of competition, and lobbyists of established players have too much say in the lawmaking process.
I assume you are referring to a larger amount of people living in poverty in the US?
Could this also (partially) be explained by the cost of healthcare? Something like a downwards spiral where average people end up poor either due to direct costs of healthcare or neglecting their own healthcare due to cost?
Demographics (I assume you mean race?) can't be the reason. West Virgina is IIRC almost exclusively white and has a lower live expectancy than North Korea.
Our organization (the American Federation for Aging Research) is hosting a webinar with Jay Olshansky (author of the paper) and Andrew Scott, a leading economist in longevity to discuss Jay's results on 10/22.
The gist is that this isn't quite as cut and dry as it may seem.
We also paid to make the Nature Aging paper open access.
> We also paid to make the Nature Aging paper open access.
That’s awesome! Did you make a deal with the authors to pay for the fee during publication or is this something anyone can do by approaching the journal itself?
Thanks! I wasn't directly involved in that discussion, but I imagine anyone can do it. It is a requirement for some grants and for some research funders.
Edit: if you need to know I would just ask the editor if it's an option
> We also paid to make the Nature Aging paper open access.
Why not just use a preprint server like Medrxiv?
Arxiv is now the default place to publish papers in physics -- and, with that established, it seems to me that it would be for the best if more institutions, researchers, and organizations in biology, medicine, chemistry, and other areas also use preprint servers.
Just let it sink a second, they speak about how many baby born after 2000 will reach 100 years old, how we are reaching the absolute limit of human survival.
75% overweight... Everyone know fat people don't live long. I bet all the studies done in the 90's that predicted we would easily be able to reach 100 years old didn't take that into account.
Both are also largely meaningless because they're based on BMI, which is literally just mass/height^2. No measure of percent body fat, no measure of any other aspect of health, just mass by the square of height.
If you're comparing the BMI of two countries with very similar gene pools it's not a bad point of comparison (though the raw number still doesn't tell you much without more context about build types), but when you're comparing Australia to the US the gene pools of the non-European minority groups are sufficiently different to make BMI pretty worthless as a point of comparison for public health.
To be fair BMI is based on Belgians from the 1850s with all the implications it has. Modern people are much taller (+15 cm for males) and eat a lot more protein.
So the line between normal and overweight is somewhat blurry. e.g. someone who is 6'3" and weighs 200 pounds is overweight. Which might or might not be the case (but you certainly don’t need to a body builder or invest a lot of time to maintain at least reasonably healthy 18-20% body fat ratio).
I'm thinking that ozempic and zepbound will have something to say about this. When ozempic becomes available as a generic (2032) it's going to be available for $10 a dose and a huge amount of people will be taking it.
studies estimate that moderate obesity takes about 2-3 years of life expectancy (defined as having a BMI of 30-35), only people with severe obesity (BMI of 40-45+) lose on average 6-13 years, comparable to smoking.
Given that severe obesity is still uncommon even in the rich world it only has a small impact on life expectancy overall.
Being slightly overweight is associated with longer lifespan. Really look it up, the longest lifespan is slightly overweight and top of normal bmi. Lifespan gets down when you move toward obese, somewhere in the middle of overweight segment.
The worst life expectations are in underweight category.
You should be suspicious of definitions where the average is abnormal. If 75% of people are over weight, maybe the definition of overweight is wrong.
These definitions are arbitrary anyway. In india they define a bmi of 25 as obese. The same indian after moving to America is not obese until a bmi of 30.
Meanwhile, the average height is also going up, which also correlates with lower life expectancy.
Cardiologists already had to back off their blood pressure guidelines when they defined the average middle aged man as hypertensive in the past.
Well, the average wasn't abnormal, and now it is, without the definition changing. That's telling us something. We're becoming fatter. That doesn't make being fatter "normal". It makes it average, but that's not the same thing. Historically, we know this is abnormal.
I remember a paper that said optimal weight to reduce mortality is just below overweight. slightly overweight people were living as long as "normal" weight people and being very low "healthy" weight really wasn't that great.
I don't know what they based "normal" bmi weight on, but it's not by setting the middle of the range to max longevity.
That’s a bizarre hill to die on, I see all kinds of larger people survive into their 90s when I was living near and volunteering at a nursing home as a teenager
I see all kinds of larger people survive into their 90s
So dangerous to extrapolate from anecdotal observation like this. If I see old people smoking, doesn't mean smoking is safe. It just means it doesn't kill at 100% effectiveness.
That’s the funny thing: at homes and nursing homes all around America you will find WW2 veterans. One could conclude that WW2 wasn’t dangerous from that, I suppose.
> The decline in the United States is driven by increasing numbers of deaths because of conditions such as diabetes and heart disease in people aged roughly 40 to 60.
People are asking if we should be surprised by the headline but are missing this. As suggested in the article by the researchers, there is something dragging down the average since the 2010s. Not even hitting the general expectation of ~75 years. We don’t have solid answers yet, only theories.
So yes, generally while going up against the process of aging is going to create barriers (eg can we get to 130 years old), we are also failing to raise the baseline which is the bigger issue that people might not grasp when it comes to “life expectancy rates”.
That's not what I meant. A solid answer as to why those conditions are happening, not the fact that they are happening at all.
We have research on what can affect heart health, like what things might be linked to it, such as smoking and alcohol. We also know genetics plays a huge role.
So we don't actually have solid answers, actionable answers as to the rise of heart health issues. Look at this analysis[1] regarding how dietary guidelines specifically for fats (saturated, trans) have very little substantial evidence supporting it. Yet this gets repeated by the average person, that fats are the ultimate evil you must avoid. In another study[2] we find that reducing your fat intake still resulted in the same rates of mortality as those who ate more. This is also why more in the space are shifting away from these sort of claims ("only eat x amount of saturated fat per day") and more to general food composition (eg who cares if a fish has saturated fats, eat the fish with vegetables).
It's quite challenging to figure out, everyone has their theories. All I'm saying is we don't actually have the answers yet.
I think the distinction there is between immediate cause and root cause. Heart disease and diabetes (or complications thereof) is the immediate cause of death, but what is causing an increase in those diseases is theory at this point.
I'm actually a little surprised at the framing here. I didn't realize anyone thought we could overcome aging. I thought the goal was to live longer, but not to completely overcome aging. That sounds somewhat foreign to me. Is that a commonly reasonable goal for folks?
That is to say, I'm not clear that "beating aging" is what is required for "long life." Is that definitionally required and I'm just being dense?
I'm assuming this is a tiered discussion? In that nobody thinks we should freeze aging at baby stages for someone. Such that we would still want some aging, but would then try and fix a point where all aging can be stopped?
> That is to say, I'm not clear that "beating aging" is what is required for "long life."
Ageing is not a perfectly understood process, so what it would mean to overcome aging wasn’t clear, and there was some hope decades ago that maximum human lifespans would just keep going up indefinitely as medicine slowly eliminated the various causes of death.
But now this research concludes what has been suspected for a while - that even under perfect conditions the average human lifespan isn’t going to hit 100. Even if you eat and exercise well and have the best medical treatment, and avoid all the other things that might kill you, ageing will get you.
The medical term for this is “mortality compression”, the idea that as we remove all the ways people die early, the ages of death for everyone end up being squashed up against a limit.
It will take significant breakthroughs in technology (probably some combination of gene therapy, cancer treatments and nanotechnology) to actually stop, or reverse aging.
I think this somewhat makes sense. Just going on the discussion, I was missing that this is using "aging" as shorthand for "the degenerate effects of aging." I'm assuming the growth effects of aging would be more "maturing" or some such.
I still think calling this "defeating aging" is an odd framing. But it makes sense in the standard context here.
It's the bit of life where you can dress yourself and control your bowels that most people would like to extend. I think nobody gets into longevity research hoping they'll be able to dodder around a nursing home with a walker for 25 years instead of 15.
But you could do that by extending the bit of your life where you can do those things. Not necessarily turning off aging?
As I said down thread, this could just be a potato/potahto thing? If this is just definitionally beating getting frail, then that makes sense. But I don't know that I could pin down an age that I would want to freeze progress at. Nor do I think I expected that there would be a general age to freeze aging at. Let me keep my strength longer, but I expect I will be/look/appear older and older the older I get.
Now, granted, I'd be delighted if I have the same strength my 90 year old grandfather in law did. In his 70s, I'm pretty sure the only thing I could beat him at was a race. Lifting things or doing manual work outside, and he was far beyond what I was in my 30s.
I think it is just a difference in how you view it? I'd expect ancient person to be noticeably ancient. Not necessarily frail, but just as an old tree has signs of aging that younger trees don't necessarily have. Not that they stopped aging entirely.
So, if you limit aging to "getting frail," I am fully there. But there are other things that happen as you age.
I honestly thought the whole point was beating aging. Whether that's longer life or cancer or whatever. The point is to stay 20-40 forever, from what I can tell.
But, by the time you hit 20-40, you have already done a ton of aging?
Fair that I don't expect to be as strong in my 60s as I am now. Or when I hit 70+. If I get that far. Light weight training is plenty to get to be in good physical shape, though? Get to where you can do 10-30 pushups and run a continuous mile, and you are probably doing fine?
I always wondered why I personally know almost nobody who has managed to exceed average age. With the only exception of my previous landlady, she became 95. In my family, the average age is roughly 60, with three siblings on my fathers side dying before 50. Both my grandpas died around 50. My best friend died with 18. Many of the fellow blind people I know died below 50. And I am from a relatively rich country, with classical western standards. It is almost as if I was thrown into a local minimum while the simulation was set up. I would understand if the phenomenon was largely limited to my family, call it genes then. But it doesn't end there. I guess the personal statistics becomes only meaningful after your own death and beyond. But really, looking at how many people had to pass away early, I am beginning to get spooked.
> I would understand if the phenomenon was largely limited to my family, call it genes then
Perhaps there are other shared variables besides genes? For one thing, blindness is associated with higher mortality [1]. And even within a country, life expectancy can vary dramatically by region, city, and even neighborhood. Or perhaps the people you know happen to be more likely to share certain occupations, mindsets, levels of physical activity, or diets?
I wonder how much impact there will be on average life expectancy uncovering that a lot of the super-long-lived population examples have been pension fraud.
Probably not much because you can find long-lived populations that don't follow the administrative boundaries of pensions.
King County in Washington State, which contains the Seattle metro area, has a life expectancy of 86.3 years. This is higher than any country in the world. If you move one county south (Pierce), it is 75.7 years, slightly worse than the US average currently. Not surprisingly, there are many obvious factors that may contribute to this e.g. the obesity rate in Pierce County is 50% higher and the obesity rate in King County is roughly half the US obesity rate. The Seattle metro is a relatively walkable city and people do, Pierce County is not. As a matter of demographics, King County is significantly more Asian than Pierce County. And so on.
Both counties are geographically large and contain many municipalities. It is difficult to come up with a theory where pension fraud in King County is so high relative to Pierce County that it explains a >10 year difference in life expectancy.
For every pension fraud that went on that long and took such an obvious risk with continuing to a notable age, I imagine there were hundreds or thousands of shorter frauds.
Readit News
Source: https://www.crikey.com.au/2024/10/16/pubic-private-healthcar...
Bypass: https://clearthis.page/?u=https%3A%2F%2Fwww.crikey.com.au%2F...
Other references:The Economist: https://www.economist.com/graphic-detail/2024/08/23/why-do-a...
AU Gov Report: Advances in measuring healthcare productivity https://www.pc.gov.au/research/completed/measuring-healthcar...
market, maybe, "free" market? I doubt it.
It's not a very free market when there is such a large power differential between the buyer and the seller. You can't exactly shop around for the ambulance or the hospital when you need it, nor can you realistically circumvent the artificially constrained supply [1] of doctors to get cheaper healthcare (unless you live next to the border).
When the alternative is a one-sided market like this, government becomes rather more appealing.
1. https://en.wikipedia.org/wiki/American_Medical_Association#R...
>market, maybe, "free" market? I doubt it.
The consumer of healthcare is doubly removed from the price of healthcare. This is the opposite of a free market.
The patient did not pay the doctor, the insurance company does. In most cases the patient does not pay for insurance their employer does.
So the normal pricing forces of a free market are removed.
Then we need to talk about certificate of need laws which restrict the supply...
The vast bulk of health care is by appointment, not a dash in the ambulance.
When I am psychotic I cannot exactly choose which psychiatric hospital I want to check into and ponder about the price to put it off for another day.
And this is what the free market did to psychiatric hospitals: https://www.wral.com/holly-hill-hospital/21507953/
Back in the 1970s the AU Government was running campaigns such as Life. Be In It: https://www.youtube.com/watch?v=GNjEge3Awl8 (many short segments airing with commercials on TV).
Planning requirements typically require open spaces, walking paths, sporting facilities, etc.
A "healthcare system" needs to be more than simply "immediate care for the injured, sick, and|or dying".
Or its a ticking time bomb: 39.6% of Americans are Obese(BMI 30 or higher). Fast forward 15 years and this will probably collapse the country. It certainly will be the No 1 issue in the country bar none. Ozempic may actually give the country a chance of some sort of future.
You think paying vastly more for much worse outcomes is a good thing??
Boy do I have a GREAT used car for you!
For non-seniors, the medical insurance system certainly sometimes doesn’t feel like a free market from the consumer perspective, but the insurance companies are private for-profit institutions, and the medical providers are too, so it may well fit the definition.
What do you mean by this? Fatalities among the young will have a much larger impact on lowering nationwide life expectancy than fatalities among the elderly.
( Describing various systems in various countries as either communist of free market capitalist is pretty simplistic, it's not much as a linear spectrum either )
I'd also argue that the foundation for a high life expectancy doesn't start with good health care for seniors .. unless the metric is "life support via artificial means" .. life expectancy is grounded in healthy living and excerise from an early age well maintained with good health programs.
The US has massive government regulation and dysfunctional state intervention in healthcare if not directly then vicariously with rules around Medicare. The US government helps make the dysfunction that private equity later exploits.
So I’m not sure that it would be correct to use Aus and the US as examples of the either end of the private / public continuum.
I would use UK or France as an example of a public system and Singapore as a light touch private, and perhaps India or Turkey as a laissez-faire system.
The UK and France systems appear to be degrading and do not appear long term affordable and I think they will soon be adopting Canadian style Maid systems to cut cost.
Germany is a weird one because it seems like half the doctors there are homeopaths and the Germans love their insurance but I’m not sure if they get value for it.
Personally I’d prefer the Australian or Singaporean style systems but I’d classify those as mostly private.
The current system grew out of a more fully public system under a many years past Whitlam government, people like the universal health for all aspects and wanted additional private services in the mix. It's evolved from there, with government oversight directed towards keeping things accessable and fair.
The US appears to have "massive government regulation and dysfunctional state intervention" as the end result of a lot of fingers in the pie bending regulation toward "middlecare" providers that don't apply splints or save lives, just diddle about with insurance schemes. (Admittedly that's just an impression from afar).
> The US government helps make the dysfunction that private equity later exploits.
My feeling is the US government is largely an arm of private interests in many matters.
Health Care in Australia embraces public policy such as Food Regulation to ban and limit additives, parks and sports grounds to encourage exercise, limiting access to tobacco, and some interesting national level drug acquisition deals to keep pharmacy costs low.
These cause a flow on of less per capita input into the medical side; lower heart disease, less smoking related issues, etc.
The upside was that if you needed, say, a brain transplant for ten million Euros, as long as it was medically necessary they would pay for it.
Now I have a policy elsewhere that is cheaper, still covers me when I go to Europe, and has a much better copay structure while being 100% private. Downside is I can’t afford that brain transplant, but I’ll probably be OK for everything else.
Looks like you conflated two unrelated things ?
> she will have a much higher chance of survival in the US.
Without a deep dive it looks ballpark the same, to be honest.
AU Cancer Survival Rates:
15 Aug 2024 - https://www.aihw.gov.au/reports/cancer/cancer-data-in-austra...US Cancer Survival Rates:
2023: https://www.cancercenter.com/community/blog/2023/01/cancer-s...A few years back my Mum in Australia was diagnosed with stage 4 lung cancer, given 12 months to live.
For just shy of 3 years she had radiation, chemo, trial drugs worth nearly a million a pop all in a brand new cancer Center. Because she lived a couple of hours away she got free transport to and from and free hotel. Not pay and claim it back, fully free.
She was on an enormous cocktail of drugs that dad would get at the pharmacy that raised a lot of eyebrows for the strength of the opiates among other things.
For three years they never paid a cent. They never paid a cent of health insurance, never had private cover, never had a deductible. That would all be the same if they had never worked or took a decade off to pursue some hobby.
Trust me when I say it was stressful and emotional enough without adding money or paperwork or insurance into the equation
The comparison to my friends in the US who couldn’t get a separated shoulder fixed because it was “out of network” or had to move hospitals the day after a C section because the insurance didn’t want to pay anymore is downright disgusting.
For real people living their lives the two systems are vastly different.
There's likely at least one other major factor, and I would assume that it's some variation of "inability to access high-quality care for financial reasons" given how much of a wealth disparity there is in various healthcare outcomes.
The figure I see thrown around is America has a 40% rate of obesity.
Australia looks like it's 32%.
European countries look like 20-30%.
I think these rates alone could explain life expetancy regardless of health care system.
All the medicines they prescribe are merely to manage symptoms. I have GERD and reflux. I was given PPI after many many tests. How does taking PPI extend my lifespan. Whatever has gone wrong with my body is still there.
How is this not obvious to ppl making this absurd correlation between hospital care and lifespan.
Medicine doesn't have shit of new breed of diseases and disorders ppl are dying from. Doctors don't have answers to any of modern illnesses so how does it matter if access to a useless person is govt funded or 'free market'.
In the US, government is elected by people. You can't blame a gvt for not doing what it hasn't been mandated to do.
Are you touring with this material, or is it off the cuff standup?
For example, Medicare.
https://www.crikey.com.au/author/bernard-keane/
Bernard is well across many aspects of US, UK, and AU political views, government systems, media etc. with his own particular views as we all have.
In context he's writing for an Australian audience about a conservative Australian trope that the Australian health system is weighed down with government meddling and would do better with, for example, a "US free market" approach.
I think we all appreciate that's an illusion, a myth spun for children.
The healthcare system in the US is far, far from a free market. Most people would describe it as a crony capitalist market. There's a lack of transparency, lack of competition, and lobbyists of established players have too much say in the lawmaking process.
Could this also (partially) be explained by the cost of healthcare? Something like a downwards spiral where average people end up poor either due to direct costs of healthcare or neglecting their own healthcare due to cost?
The gist is that this isn't quite as cut and dry as it may seem.
We also paid to make the Nature Aging paper open access.
Event: https://www.afar.org/events/webinar-lifeexpectancy-1
That’s awesome! Did you make a deal with the authors to pay for the fee during publication or is this something anyone can do by approaching the journal itself?
Edit: if you need to know I would just ask the editor if it's an option
What a world to live in.
Why not just use a preprint server like Medrxiv?
Arxiv is now the default place to publish papers in physics -- and, with that established, it seems to me that it would be for the best if more institutions, researchers, and organizations in biology, medicine, chemistry, and other areas also use preprint servers.
75% American are overweight..
Just let it sink a second, they speak about how many baby born after 2000 will reach 100 years old, how we are reaching the absolute limit of human survival.
75% overweight... Everyone know fat people don't live long. I bet all the studies done in the 90's that predicted we would easily be able to reach 100 years old didn't take that into account.
Quick Google search:
First hit: Source: https://www.abs.gov.au/statistics/health/health-conditions-a....US NIH says: 73.1% are overweight (includes obese). Ref: https://www.niddk.nih.gov/health-information/health-statisti...
Sure, 73.1% > 65.8%, but Australia is still plenty overweight. Both are appalling.
Both are also largely meaningless because they're based on BMI, which is literally just mass/height^2. No measure of percent body fat, no measure of any other aspect of health, just mass by the square of height.
If you're comparing the BMI of two countries with very similar gene pools it's not a bad point of comparison (though the raw number still doesn't tell you much without more context about build types), but when you're comparing Australia to the US the gene pools of the non-European minority groups are sufficiently different to make BMI pretty worthless as a point of comparison for public health.
So the line between normal and overweight is somewhat blurry. e.g. someone who is 6'3" and weighs 200 pounds is overweight. Which might or might not be the case (but you certainly don’t need to a body builder or invest a lot of time to maintain at least reasonably healthy 18-20% body fat ratio).
studies estimate that moderate obesity takes about 2-3 years of life expectancy (defined as having a BMI of 30-35), only people with severe obesity (BMI of 40-45+) lose on average 6-13 years, comparable to smoking.
Given that severe obesity is still uncommon even in the rich world it only has a small impact on life expectancy overall.
This is really hard to believe. Moderate obesity has to shave at least 10 years off life expectancy.
A 70 year old man 6' tall with a BMI of ~35 weighs 260 lbs. That is pretty overweight.
Anecdotally, I just don't see many people that overweight or heavier making it into their 80s.
The worst life expectations are in underweight category.
It's hard to take seriously the aversion especially Americans seem to have against overweight and obesity
Funny the land of the free is so incredibly intolerant on this one point
These definitions are arbitrary anyway. In india they define a bmi of 25 as obese. The same indian after moving to America is not obese until a bmi of 30.
Meanwhile, the average height is also going up, which also correlates with lower life expectancy.
Cardiologists already had to back off their blood pressure guidelines when they defined the average middle aged man as hypertensive in the past.
"here is the theoretical limit given adherence to modern recommendations on cardiovascular health, exercise, etc."
and
"you all didn't listen and got fat instead"
I don't know what they based "normal" bmi weight on, but it's not by setting the middle of the range to max longevity.
So dangerous to extrapolate from anecdotal observation like this. If I see old people smoking, doesn't mean smoking is safe. It just means it doesn't kill at 100% effectiveness.
People are asking if we should be surprised by the headline but are missing this. As suggested in the article by the researchers, there is something dragging down the average since the 2010s. Not even hitting the general expectation of ~75 years. We don’t have solid answers yet, only theories.
So yes, generally while going up against the process of aging is going to create barriers (eg can we get to 130 years old), we are also failing to raise the baseline which is the bigger issue that people might not grasp when it comes to “life expectancy rates”.
The exact quote you gave had a pretty solid answer, certainly not just "theories".
We have research on what can affect heart health, like what things might be linked to it, such as smoking and alcohol. We also know genetics plays a huge role.
So we don't actually have solid answers, actionable answers as to the rise of heart health issues. Look at this analysis[1] regarding how dietary guidelines specifically for fats (saturated, trans) have very little substantial evidence supporting it. Yet this gets repeated by the average person, that fats are the ultimate evil you must avoid. In another study[2] we find that reducing your fat intake still resulted in the same rates of mortality as those who ate more. This is also why more in the space are shifting away from these sort of claims ("only eat x amount of saturated fat per day") and more to general food composition (eg who cares if a fish has saturated fats, eat the fish with vegetables).
It's quite challenging to figure out, everyone has their theories. All I'm saying is we don't actually have the answers yet.
[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9794145/ [2]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092457/
Dead Comment
That is to say, I'm not clear that "beating aging" is what is required for "long life." Is that definitionally required and I'm just being dense?
I'm assuming this is a tiered discussion? In that nobody thinks we should freeze aging at baby stages for someone. Such that we would still want some aging, but would then try and fix a point where all aging can be stopped?
Ageing is not a perfectly understood process, so what it would mean to overcome aging wasn’t clear, and there was some hope decades ago that maximum human lifespans would just keep going up indefinitely as medicine slowly eliminated the various causes of death.
But now this research concludes what has been suspected for a while - that even under perfect conditions the average human lifespan isn’t going to hit 100. Even if you eat and exercise well and have the best medical treatment, and avoid all the other things that might kill you, ageing will get you.
The medical term for this is “mortality compression”, the idea that as we remove all the ways people die early, the ages of death for everyone end up being squashed up against a limit.
It will take significant breakthroughs in technology (probably some combination of gene therapy, cancer treatments and nanotechnology) to actually stop, or reverse aging.
I still think calling this "defeating aging" is an odd framing. But it makes sense in the standard context here.
As I said down thread, this could just be a potato/potahto thing? If this is just definitionally beating getting frail, then that makes sense. But I don't know that I could pin down an age that I would want to freeze progress at. Nor do I think I expected that there would be a general age to freeze aging at. Let me keep my strength longer, but I expect I will be/look/appear older and older the older I get.
Now, granted, I'd be delighted if I have the same strength my 90 year old grandfather in law did. In his 70s, I'm pretty sure the only thing I could beat him at was a race. Lifting things or doing manual work outside, and he was far beyond what I was in my 30s.
Why not? Humans have been pursuing immortality for time immemorial. "The Epic of Gilgamesh", one of the first known stories, features such a pursuit.
So, if you limit aging to "getting frail," I am fully there. But there are other things that happen as you age.
Fair that I don't expect to be as strong in my 60s as I am now. Or when I hit 70+. If I get that far. Light weight training is plenty to get to be in good physical shape, though? Get to where you can do 10-30 pushups and run a continuous mile, and you are probably doing fine?
Perhaps there are other shared variables besides genes? For one thing, blindness is associated with higher mortality [1]. And even within a country, life expectancy can vary dramatically by region, city, and even neighborhood. Or perhaps the people you know happen to be more likely to share certain occupations, mindsets, levels of physical activity, or diets?
Or maybe it's just coincidence.
[1] https://www.thelancet.com/journals/langlo/article/PIIS2214-1...
King County in Washington State, which contains the Seattle metro area, has a life expectancy of 86.3 years. This is higher than any country in the world. If you move one county south (Pierce), it is 75.7 years, slightly worse than the US average currently. Not surprisingly, there are many obvious factors that may contribute to this e.g. the obesity rate in Pierce County is 50% higher and the obesity rate in King County is roughly half the US obesity rate. The Seattle metro is a relatively walkable city and people do, Pierce County is not. As a matter of demographics, King County is significantly more Asian than Pierce County. And so on.
Both counties are geographically large and contain many municipalities. It is difficult to come up with a theory where pension fraud in King County is so high relative to Pierce County that it explains a >10 year difference in life expectancy.