I don't think its very significant, but the adjusted numbers are probably more significant than the raw numbers.
If they didn't adjust for suicide than Japan would look better after such an adjustment, a few other countries would move up as well (but not as much) others would move down. The US would not be number 1 on that list after the adjustment (almost certainly Japan would be), but it would still do a lot better than on current comparisons. Japan is an outlier in terms of suicide. The US is more normal.
There are other factors they didn't adjust for, obesity, diet and exercise for example (diet and exercise are a very big part of determining obesity, but each factor has an effect even in isolation of the others, for example if you genetically are prone to be fat, and are fat even though you have a normal amount of diet and exercise, the extra weight still probably is negative, or if you have a normal weight, and eat healthy, but never exercise, the combination is still something of a problem).
There is also genetic factors, and they aren't well understood. Different environmental factors have to be considered. I'm sure there are a lot of factors that I, or even some expert highly focused in this field, would be unable to even identify, let alone quantify.
If you could correctly adjust for all factors other than the health care system than the adjusted longevity results would be meaningful. However I'm not sure we'd ever be able to really get the adjustments right in a very thorough and highly certain way.
Also even if you could get all the adjustments right, and the data left represented differences in the health care systems; "single payer"/"universal health care", or lack there of, or more generally differences in the way health insurance is handled, are far from the only differences in the health care system. Medical schools are different, "medical culture" is different, legal systems are different etc.
People in Japan live longer than people in the US. Is it genetic? (Japanese Americans live about the same as people in Japan), diet? (Japanese people eat more seafood, and probably more vegetables, obesity? (we tend to be fatter), health care insurance systems?, other aspects of the health care system that are part of or determined by how health insurance is handled?, accident rates? (the rates are higher in the US), homicide rates (again higher in the US, but then as Combjelly's pointed out on the other thread, and you allude to here Japan's suicide rates are higher), other more subtle cultural or behavior differences that we don't even recognize?, environmental differences?
Who knows? We can quantify some of these things (accident rate, suicide rate, homicide rate) and come up with data about others (obesity, we can measure it, but on the other hand its hard to quantify exactly how much it contributes to earlier deaths, different studies could show everything from a lot, to very little, to at least one study that seemed to indicate that being somewhat obese increased life expectancy). Other factors we can't even measure, or perhaps we can't even recognize as factors.
My overall point is that there are so many things that go in to life expectancy that it doesn't make a lot of sense to assume its mostly about how health insurance is handled in different countries.
Until those adjusted life expectancy figures became public those who argue that lower life expectancies in the US mean that the health care in the US is worse (and that its worse because we don't have "single payer" or other form of "universal health care") could at least say something like - "Well maybe our data provides a weak argument but at least we have data, you don't have data showing the opposite". Well that was true if your only considering life expectancy, but some other figures, like cancer survival rates, make the US look better; and now there is counterbalancing adjusted life expectancy data.
The problem with the data isn't that its accuracy is in doubt, the specific pieces of information are almost certainly all correct or at least close. The problem is that its relevancy is in doubt. This applies for both sides of the debate. The life expectancy differences are probably mostly due to reasons other than health insurance systems. The adjusted life expectancy figures, might properly adjust for some important other factors, but could ignore other factors.
In this debate, as in many others, there is a lot of data of questionable relevance. Some of the data supports one side, some supports another. Most people are likely to grab the data that confirms the opinion they already have. |
