January has turned out to be a banner month for fans of American exceptionalism. As documented in voluminous detail in a 404-page report released this month by the National Research Council and the Institute of Medicine, Americans lead shorter lives than Western Europeans, Australians, Japanese and Canadians. Of the 17countries measured, the United States placed dead last in life expectancy, even though we lead the planet in the amount we spend on health care (17.6percent of gross domestic product in 2010 vs. 11.6 percent each for France and Germany). We get radically less bang for the buck than comparable nations. If that's not exceptionalism, I don't know what is.
Americans die young. The death rate for Americans younger than 50, the report showed, is almost off the comparative charts. A range of exceptionally American factors — car usage and lack of exercise, junk-food diets, violent deaths from guns, high numbers of uninsured and a concomitant lack of treatment, the high rate of poverty — all contribute to this grim distinction. The United States ranks first among the 17 nations in violent deaths, at roughly three times the level of second-ranking Finland and 15times that of Japan, which ranked last. This list includes violent deaths by all means, not just gunshots, so it's a pretty fair measure either of different people's inherent propensity toward violence or of the access people have to deadly weapons when they get violent. (To look at this list and conclude that guns have nothing to do with the rate of violent deaths, you have to believe that Americans are just much more murderous than anybody else.)
The study enumerates other key, if unsurprising, factors in our shortness of life. "Americans are more likely to find their health care inaccessible or unaffordable," it concludes. "Americans benefit less from safety net programs that can buffer the negative health effects of poverty and other social disadvantages." But a funny thing happens to Americans' life expectancy when they age. The U.S. mortality rate is the highest of the 17 nations until Americans hit 50 and the second-highest until they hit 70. Then our mortality ranking precipitously shifts: By the time American seniors hit 80, they have some of the longest life expectancies in the world.
What gives? Have seniors discovered the Fountain of Youth? Do U.S. geriatricians outpace all our other physicians? Part of the answer is Darwinian: Those Americans who have been less able to access reliable medical care, maintain good diets and live in neighborhoods that are not prey to gun violence have disproportionately died off before age 80. That isn't natural selection but social selection — the survival of the economically fittest in a nation that rations longevity by wealth.
But the larger part of the answer is that at age 65, Americans enter a health care system that ceases to be exceptional when compared with the systems in the other 16 nations studied. They leave behind the private provision of medical coverage, forsake the genius of the market and avail themselves of universal medical insurance. For the first time, they are beneficiaries of the same kind of social policy that their counterparts in other lands enjoy. And presto, change-o: Their life expectancy catches up with and eventually surpasses those of the French, Germans, Britons and Canadians.
This puts defenders of the U.S. system of private health insurance in a bit of a bind. To gain some empirical credibility, they probably need to shift their entire line of argument — say, to affirming that our system of health care uniquely guarantees shorter lives and then employing talented spin doctors to convince us that this is a good thing.