It is as difficult to sink a business without debt as it is sink a ship without holes.
- Manlobbi
Stocks A to Z / Stocks S / State Street Corporation (STT)
No. of Recommendations: 4
No. of Recommendations: 7
https://www.visualcapitalist.com/ranked-top-25-cou...Now do countries without single-payer health insurance. I went into the World Databank on healthcare as percentage of GDP for the countries in that visualization and simplistically, they pay mostly between 7-12% of (mostly, considerably smaller GDP/capita) for much better outcomes than the US at 16.5% of GDP, which is no surprise. I am curious how Qatar and Monaco get on there at 2.2 and 3.4% respectively but maybe it's because they have very *high* GDP/capita? (collected data at end).
BTW after my first 6 weeks in Portugal and a few encounters with the private medical system to check on an eye problem, I'm pretty happy with how that's going. They definitely lack the frills of US hospitals - pretty carpets, nice paintings, plants, restful colors - but the actual quality of care feels very high and the doctors and nurses, very approachable. And the prices - full fare for someone with no applicable PT health insurance, yet - are cheaper than the after-insurance copays at Kaiser Permanente for similar appointments and tests. KP does have a nice integrated electronic records system going for it which is not to sneeze at, and waiting times are somewhat less, but that's all I can count in its favor thus far.
As an amusing side note when getting the second and third round of eye dilation drops before my tests, the PA just came out into the hallway and gave it to me in the waiting area with other people sitting on either side.
-- Healthcare as % of GDP for countries in visualization + US, in decreasing percentage --
United States 16.5
France 11.9
Switzerland 11.7
Japan 11.4
Canada 11.2
Sweden 10.9
Portugal 10
South Korea 9.9
Australia 9.9
Spain 9.7
Malta 9.5
Iceland 9
Italy 8.5
Norway 8
Andorra 7.9
San Marino 7.4
Israel 7.3
Ireland 6.1
Luxembourg 5.8
Hong Kong 5.4 (proxy data for China used which is probably wildly inapplicable to HK)
Singapore 4.9
UAE 4.7
Monaco 3.4
Qatar 2.2
Vatican City no data
Liechtenstein no data
No. of Recommendations: 1
In 2022, the average life expectancy in the U.S. was 77.4 years, with a rank of 49th globally, according to U.S. News & World Report. Men's life expectancy was 76.4 years, and women's was 81.2 years.
Jeff
No. of Recommendations: 2
Most (not all) of the countries with a higher life expectancy at birth have a fairly homogeneous population, unlike the U.S.
No. of Recommendations: 16
Most countries with higher life expectancy than the US have gun control laws and much lower road fatalities.
Aussi
No. of Recommendations: 5
Most countries with higher life expectancy than the US have gun control laws and much lower road fatalities.
I saw a bunch of expats complaining about terrible Portuguese drivers, then looked it up and found their road fatality rate was something like half that of the US. They honk a lot but stop instantly when a pedestrian enters a crosswalk.
No. of Recommendations: 0
Where is the USA?
No. of Recommendations: 2
Most (not all) of the countries with a higher life expectancy at birth have a fairly homogeneous population, unlike the U.S.
You think that's the big factor?
Or might it be extreme wealth disparity? Maybe the lack of universal healthcare?
I'd be interested in your reasoning.
No. of Recommendations: 19
No. of Recommendations: 4
In the list, Australia has one of the lower (better) numbers. A real benefit of the Australian system is that medical coverage is not an employment concern. When considering a job change or perhaps starting a business, or being a contractor, medical coverage is not even on the list of factors that are considered.
Aussi
No. of Recommendations: 5
No. of Recommendations: 16
Where is the USA?
Big country. Mostly South of Canada.
Jim
No. of Recommendations: 6
The very small countries at the top may be statistical artefacts.
For example, I imagine a lot of expats in Monaco (who make up over half the population) move back to their home countries when they get seriously old, so their deaths wouldn't show up. Health care spending would be tough to track...only households with locally employed or citizen breadwinners are covered, and there is a lot of cross border health care, both ways, between Monaco and France.
I don't know the situations for the other small fry, but stats get skewed very easily for city states.
Jim
No. of Recommendations: 5
There are just far too many confounding factors affecting life expectancy to derive explanatory causes from a simple country ranking like this.
Differences in lifestyle choices (e.g., smoking, alcohol, exercise, diet), environmental factors like pollution, regional genetic differences affecting lifespan, differences in healthcare outcomes, just to name a few.
It's fun to look at and wonder/speculate, and even more fun to pin high or low life expectancy in certain countries on our own pet theories, but it's nothing more than speculation without heavy research to try to quantify and account for all those differences.
No. of Recommendations: 2
Keep in mind too that some of the countries with the "oldest" people also tend to have the worst recordkeeping of births and deaths.
No. of Recommendations: 2
I wouldn't say Japanese record keeping is bad, but there are incentives for keeping aging relatives "officially" alive
No. of Recommendations: 3
Keep in mind too that some of the countries with the "oldest" people also tend to have the worst record keeping of births and deaths.
True, but this will mainly affect studies of extreme longevity dependent axiomatically on a few extrema. It but won't materially affect overall life expectancy figures which are based much more on averages across hundreds of thousands of observations. In big countries, anyway.
If you have a small motivation to say you are older than you really are, say to cross over the maximum age for a military draft, a few fibbers won't affect their cohort much at that time, but they will come to dominate their apparent peer cohort as it gets very old. A few 75 year olds hidden among a group of 90 year olds will have anomalously good survival rates. The true average age of that "claimed" cohort will be off by more and more over time.
Jim
No. of Recommendations: 0
Differences in lifestyle choices (e.g., smoking, alcohol, exercise, diet), environmental factors like pollution, regional genetic differences affecting lifespan, differences in healthcare outcomes, just to name a few.
When wandering aimlessly around the world, there are demographic groups found "everywhere" who are instantly recognizable from a great distance. While these are, of course, stereotypes, they are accurate enough to frequently be obvious. They include Chinese tourists (who travel in impolite packs), Mormon missionaries (who are blond, wearing white shirts, black pants and badges - which, when you get close, introduce their rank as "Elder"), Hasidic Jews (men in black with beards and long "dread locks").
And, of course, Americans - recognizable not only by their loud voices and impolite manor, but by their tendency to be large and overweight. If there is a genotype for someone with diabetes, a large proportion of Americans exhibit it. A lifetime of eating junk food and processed "stuff" is taken for granted in an environment where the art of advertising (and lobbying) has trumped common sense when it comes to diet.
I don’t think it is BECAUSE we spend more on healthcare, but DESPITE our spending more that many of our countrymen/women are destined to die prematurely.
Jeff
No. of Recommendations: 2
I don’t think it is BECAUSE we spend more on healthcare, but DESPITE our spending more that many of our countrymen/women are destined to die prematurely.
Don't overlook that we just pay more as well. In the US, drug prices are controlled by pharmacy benefit managers (PBMs). In theory, PBMs negotiate drug prices for insurance companies. And they do. They also get rebates from the drug manufacturers in order for favorable place on insurance companies formularies. To offset the cost of these rebates, manufacturers raise the "list price" of their drugs. This practice is encouraged by PBMs because their profits are tied to the size of the rebates, which are larger for higher-priced drugs.
The industry is becoming integrated where the largest pharmacies have their own PBMs. This leads to odd effects for example, your co-pay for a particular drug with insurance costs you more at say, CVS, than than paying 100% out of pocket at an independent pharmacy.
No. of Recommendations: 9
The industry is becoming integrated where the largest pharmacies have their own PBMs. This leads to odd effects for example, your co-pay for a particular drug with insurance costs you more at say, CVS, than than paying 100% out of pocket at an independent pharmacy.
The US PBM's are definitely a head-shaking phenomenon. It's an interesting thought experiment: what would happen if there were a law requiring every drug to be sold at a single price to all, without volume discounts or rebates? (other than knocking the stuffing out of the budgets non-US drug buyers)
But all the middlemen, in aggregate, could probably use a rethink (not that I expect anyone can or will). Insurers, drug distributors and pharmacies take their pound of flesh too. They probably deserve more ire than the drug companies who seem to take all the heat.
The four gatekeeper industries combined had revenues equal to 25% of total US health care spending in 2013, and 45% in 2022. In aggregate their "rent", estimated return on invested capital above estimated WACC (not my fave), is 2.3%/year higher than the rest of the SP 500, 5.9% vs 3.6%.
Jim
No. of Recommendations: 0
If you have a small motivation to say you are older than you really are, say to cross over the maximum age for a military draft
There's also sometimes motivation at the other end ... to not declare a death. There were a few stories out of Japan and out of Italy over the years about family members not reporting deaths because they wanted to continue collecting the national pension funds that were deposited each month.
But none of this is material anyway because the numbers are tiny compared to the overall population.
No. of Recommendations: 1
If there is a genotype for someone with diabetes, a large proportion of Americans exhibit it. A lifetime of eating junk food and processed "stuff" is taken for granted in an environment where the art of advertising (and lobbying) has trumped common sense when it comes to diet.
It's not likely to be genetic because it only changed over the last 30-40 years. In the 50s and 60s there were way fewer overweight folks in the USA. Even in the 70s and early 80s it was much less common.
