Medicare and Life Expectancy Misconceptions

Some intriguing commentary emerged over the weekend, from the venerable Paul Krugman, via his appropriately titled blog "The Conscience of a Liberal". As we all know, a nascent health care reform bill is struggling to make it out of committee in both the House and the Senate, vaulting all things health care into the position of Contentious Issue #1. Mr. Krugman plays his part in the debate, arguing that the "success" of Medicare reasonably justifies supporter's claims that socialized medical care can in fact work for this country. As evidence for his assertion that the US Government is an efficient manager/administrator of health care for the elderly, Krugman cites life-expectancy statistics in both the US and Netherlands. These stats indicate that at birth, a resident of the Netherlands can expect to live longer than his American counterpart; however, once the age of 65 is reached, it is the American who can expect to live a bit longer (by about 0.4 of a year). From this discrepancy, Mr. Krugman and others conclude that Medicare is socialized medicine at it's best, and that if we could just sign the entire population up for Medicare (or some derivative thereof) then everything would be fine. Basically: If Medicare works for the most medically needy portion of the population, then it should certainly suffice for the (usually) healthier young. To list the first several issues that come to mind when presented with Krugman's logic:

1. Older people are much more likely to vote; 63% of those older than 55 vote v. 22% for those between the ages of 18 and 24. This is why Social Security and Medicare are not tampered with by the politicians. Lawmakers are scared by old people because the elderly both pay attention and vote.
2. You're telling me that our country spends more - per capita - on health care than any other country in the world? And all we get out of it is a fraction of an additional year of life, likely spent institutionalized?
3. The statistics concerning US v Dutch life expectancy could simply mean that the American elderly are more risk averse, i.e less prone to engaging in "dangerous" behavior. Or perhaps, the data shows that American youth are so at risk, that many simply die before ever reaching the statistical pool of 65 years olds; they have in effect "Weeded" themselves out of the sample.
4. At what point does life-expectancy cease to function as a gold-standard? Spend some time in a nursing home and you'll quickly decide that, while you can "buy" life-expectancy, it doesn't come with a free sample of happiness or quality of life.
   

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