The Washington PostDemocracy Dies in Darkness

The U.S. ranks 26th for life expectancy, right behind Slovenia

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Back in the 1970s, Americans typically lived longer than residents of other countries.

Not anymore: A new report out this morning from the OECD shows that the United States' average lifespan has fallen one year behind the international average, lower than Canada and Germany, more akin to the Czech Republic and Poland.

This isn't to say our life expectancy has gone down: Quite the opposite: you can actually expect to live about eight years longer in the United States right now than you would have in 1970. But our life expectancy is growing a lot more slowly than other countries.

This 213-page, graph-laden OECD report tells the story of why. It shows the United States as a country that is spending tons and tons on health care--but getting way less than other countries out of that investment. It exposes a country that's really great at buying fancy medical technologies, but not so fantastic at using those medical technologies to extend life. It is, in short, the story of why our health care system is so screwed up.

There are some things that the American health care system is great at and, at the top of the list, it has to be the ability to spend money. We spend more than any other country.

What do we spend that money on? Well, we're usually at the top of the list when it comes to buying fancy medical machines, like MRI and CAT scan technology. When you look at the OECD lists on who has the highest rate of medical technology per capita, the United States always cracks the top three.

We make great use of those machines, too, and do lots of screenings with our MRI and CAT Scan machines. More than one in 10 Americans get an MRI exam each year, a rate higher than any other country. In Austria, which has a life expectancy more than two years longer than the United States, the MRI exam rate is just about half of ours.

Screenings and medical scans are used a lot in American medicine, the OECD report shows. But what we don't do a lot of are regular doctor visits. The average American makes four trips to the doctor in one year, compared to an international average of six visits.

What we have, essentially, is a medical system that is heavy on screening and tests, but light on actual trips to the doctor. We're great at checking for problems, but less great at following through with treatment for any problems we do find. While the United States, for example, has the highest rate of cervical cancer screenings, it also has a below-average five-year survival rate for the disease.

This certainly isn't true for every disease. The United States, for example, has the highest rate of breast cancer screenings--and the best five-year survival rate for that disease. But, unfortunately, a lot of the time, that isn't true.

But the health system likely plays a key role, too. Yhe United States has the highest rate of uninsurance in the countries the OECD studied, right below Estonia and Mexico. It's plausible to think this can make it difficult to seek follow-up treatment when a screening does identify a problem.

And this brings us back to the start of this story, our slowing life expectancy growth. Our health care spending is like no other country--but our life expectancy is also middling. You can see that in this chart, where the United States spending on health care charted against life expectancy pretty much looks like no other country out there.

"While life expectancy in the United States used to be one year above the OECD average in 1970, it is now more than one year below the average," the authors write. "Many possible explanations have been suggested for these lower gains in life expectancy, including the highly fragmented nature of the U.S. health system, with relatively few resources devoted to public health and primary care, and a large share of the population uninsured."

We're spending a lot on health care but, when it comes to life expectancy, not getting much back in return.