US life expectancy after 65: Why so low?

Matt Yglesias cited Aaron’s post and figures on mortality after age 65 and commented,

Strong evidence of systematic underperformance in the American system. And yet since we’re talking about Medicare-eligible people here that also suggests that the issue can’t be solved by messing with who has insurance or how insurance-provision is organized. You need to actually delve down into the delivery of health care services.

That’s one conclusion, and I’m inclined to think the delivery system is part of the problem. But it could be an insurance issue too. Seeing it that way requires going deeper in another direction.

Michael McWilliams did just that in several articles that examined how previously uninsured Medicare beneficiaries fared. In his 2007 NEJM article co-authored by Ellen Meara, Alan Zaslavsky, and John Ayanian he found that such beneficiaries had “greater morbidity, requiring more intensive and costlier care over subsequent years, than they would if they had been previously insured.” The same authors found in a 2007 JAMA article that Medicare “improved trends in self-reported health for previously uninsured adults, particularly those with cardiovascular disease or diabetes.”

That is, there is evidence that Medicare improves health outcomes (no surprise there), but also that previously uninsured individuals who become beneficiaries of that program require a lot more care (not such a shock either). They’re less healthy than they would have been had they had insurance before turning 65.

Thus, another way to interpret poor post-65 U.S. mortality relative to peer nations is that we do a worse job of providing access to coverage and the care it facilitates before individuals become Medicare eligible. In short, even mortality for Medicare beneficiaries could be related to the health insurance system. This is not really surprising since many causes of death are related to life choices made and health care received over many years. It is not inconceivable that better care at an early age can prolong life even for those who make it to 65.

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