JustCare

Tag: Mortality

  • Why do Americans die younger than people in other wealthy nations?

    Why do Americans die younger than people in other wealthy nations?

    Americans have shorter life expectancies than people in other wealthy nations, even though we spend more on health care than other nations. The Peterson-KFF Health System Tracker looks at why it is that Americans die younger than people outside the US.

    KFF studied mortality rates in the US as well as Austria, Belgium, Canada, France, Germany, Japan, Netherlands, Sweden, Switzerland and the United Kingdom. Americans have a premature death rate of 408 deaths for 100,000 people under 70. The other countries had 228 premature deaths, close to half as many as people in the US.

    Unlike other wealthy nations, which have seen a reduction in the number of their premature deaths, the US has faced an uptick since 2010. Americans had a similar life expectancy as people in peer nations 45 years ago. We saw some increase in life expectancy with scientific advancements, but other countries saw greater increases in life expectancy by 1990. Moreover, peer countries did not see as great a reduction in life expectancy from COVID-19 as the US.

    Heart disease and cancer are the two leading causes of death in each of the countries studied, particularly for older adults. New medicines have reduced the number of premature deaths from heart disease. But, since 2010, Americans have seen an increase in premature deaths from heart disease, while other countries have seen a decrease.

    Americans suffer more from heart disease, chronic respiratory diseases, and chronic kidney diseases, which are collectively responsible for about 105 of the 408 premature deaths. COVID-19 was responsible for 64 of the 408 premature deaths in the US, and substance abuse was responsible for 29 of the premature deaths.

    Today twice as many Americans die of heart disease before the age of 70 than people in peer countries, likely because of more substance abuse and obesity in the US. Moreover, people with chronic heart conditions need ongoing medical care to remain healthy. But, Americans face much larger barriers to care than people in other countries.

    Cancer death rates declined by 40 percent in the US since 1988 for people under 70. And, the US cancer death rates remain comparable to those in peer countries over the last 40 years. Older Americans are less likely to die of cancer than people in peer nations. Some believe that’s because more Americans have died prematurely of other conditions than people in peer nations.

    Younger Americans suffer more from chronic conditions, substance abuse, injuries and communicable diseases than people in peer nations. Fifteen to 49 year olds in the US suffer two and half times more premature deaths than 15-49 year olds in peer nations. The premature death rate for this population in the US has not changed much in the last 45 years. In peer nations, it has dropped by half!

    The US has also seen higher numbers of childhood deaths than other wealthy nations. Over the last 45 years, the number of deaths of 0 to 14 year olds in the US has declined some, but it’s still higher than peer nations, 20 more deaths per 100,000 American kids. Some attribute this difference to racial disparities leading to worse health of babies at birth, more of whom are born premature or with congenital birth defects. In addition, three to four times more American kids died from killings, travel fatalities (we drive bigger cars and have less public transportation) and choking.

    Thankfully, medical advances have reduced death rates a lot. Many fewer people die of neonatal conditions, birth defects and HIV/AIDS. Deaths resulting from heart conditions also have dropped considerably. And, because fewer people smoke, fewer people are dying of cancer and heart disease. But, we are the richest country in the world, and there’s no excuse for our continuing to have shorter life expectancies than people in ever other wealthy country.

    Here’s more from Just Care:

  • With exercise, every move you make counts

    With exercise, every move you make counts

    Just as with memory, with exercise, small bites over an extended period can generate big returns. Haley Bennett reports for BBC Science that the latest research shows that every move you make, even doing a little activity throughout the day, can improve your health and well-being.

    It’s hard to believe, but some research shows that just three minutes of intense activity periodically could reduce your risk of stroke and heart attack by about 45 percent. (Study participants were women in the United Kingdom.)

    The researchers relied on data from  tracking devices people wear on their wrists, which captures the sum total of people’s activity during the day with excellent accuracy. So, the study reflects the benefits of “vigorous gardening”  and running upstairs, which many people do throughout the day.

    Another study of middle-aged and older people who do not exercise, again based on data from tracking devices, found that just one or two minutes of vigorous activity three times a day had a 40 percent reduction in mortality within seven years relative to people who did no vigorous activity.

    Yet another study of Americans 4o and older found that inactive people who walk an extra hour add six hours to their lives. They can add as much as 11 years to their lives through additional one-hour walks.

    To be clear, many experts, along with the World Health Organization, suggest we should be exercising moderately for at least 30 minutes a day five times a week or intensely for at least 15 minutes five times a week. Such exercise levels improve both our mental and physical health. But, only about two-thirds of adults around the world do so.

    So, if you are not exercising at the moment, consider walking in place  or doing a few jumping jacks every once in a while throughout the day. Do note, though, that the benefits of classic exercising–such as lifting weights or jogging or walking quickly–are large. Engaging in “exercise bursts” does not replace the benefits of traditional exercise. Not only is traditional exercise good for your physical health, it also could strengthen your memory.

    Here’s more from Just Care:

  • 2025: Could Americans be getting healthier?

    2025: Could Americans be getting healthier?

    For as long as I can recall, Americans have ranked well below dozens of other countries on life expectancy. We are also more likely to die as a result of gun killings, drug overdoses and automobile accidents than people in other wealthy nations. And, we have a 50 percent greater rate of obesity than Europeans. In a piece for The Atlantic, Derek Thompson refers to the US as a “rich death trap.”

    Still, Thompson notes that we have seen some good news in the health department. Last year, three percent fewer people died of a drug overdose. Automobile accidents fell, even though people drove more. The US obesity rate fell one point six percent. And, murder rates across the nation fell.

    This is a first in a while. Perhaps the best data we have seen in decades. Though it’s not clear that these rates continue to decline, because the data lags by a bit, it’s also not clear why these rates are down.

    With regard to overdose death declines, declines are large and focused on the East. Were these declines the product of good policy? The explanation could simply be that more people who would have died somewhat later, died during the Covid pandemic. Or, it could be that street fentanyl is not as strong as it has been.

    Ozempic and Mounjaro could be in part responsible for the decline in the rate of obesity. One in 16 Americans reportedly are now taking one of these appetite-suppressing drugs. Or, perhaps, we have reached the limit of Americans who could be obese.

    Violent crime has also dropped for reasons that are not fully understood. Some think that public outrage at the police for their conduct reduced police activity, causing more violent crime. But, as police activity increased, violence fell.  Another theory is that as the Covid pandemic was ending, violent crime fell when the school year began.

    How could public policy have contributed to these declining rates? It’s possible that the American Rescue Plan, which delivered hundreds of billions of dollars to states and cities, enabled local governments to boost law enforcement activities, which kept violent crime and dangerous driving at bay.

    Where do we go from here? If you ask Elon Musk, counselor to the incoming president, “Nothing would do more to improve the health, lifespan and quality of life for Americans than making GLP inhibitors super low cost to the public.” RFK Jr. argues that lifestyle is what drives better health, not technology. It’s all about our behaviors–getting people to eat healthily and exercise.

    Many Republican policymakers in Congress do not support Medicare coverage of weight-loss drugs. And, the Republicans in Congress are poised to cut Medicaid significantly. It’s hard to believe that we will continue to see health improvements over the next four years.

    Here’s more from Just Care:

  • Live longer, avoid ultraprocessed foods

    Live longer, avoid ultraprocessed foods

    A few weeks ago, I took a New York Times quiz on ultraprocessed foods, sure I could identify them and complete the quiz with flying colors. I didn’t flunk, but my score was equivalent to a D+, which was unsettling. To live longer, we should avoid ultraprocessed foods.

    To help recall which answers I got wrong, I just retook the New York Times quiz; and, I got a similar score! I suppose I am struggling to accept the fact that seltzer water with “natural flavors” is an ultraprocessed food. Bottom line, once a food has natural flavors or artificial sweeteners it is ultraprocessed.

    Similarly, plant milks with artificial sweeteners or emulsifiers are ultraprocessed. I also did not appreciate that there are some frozen foods that do not have additives and are not ultraprocessed.

    What’s the trick to knowing whether something is ultraprocessed? If it contains ingredients that you don’t have in your kitchen.

    What’s the nutritional value of ultraprocessed foods? Little. They tend to have extra sugars or salt or contain saturated fats and transfats. They can have additives and usually do not have fiber.

    Why avoid ultraprocessed foods? Avoiding ultraprocessed foods reduces your risk of an early death, according to a new study published in the BMJ, reports Lauren Irwin for The Hill. The study, which took place over 32 years, looked at what 115,000 ate. Avoiding ultraprocessed foods also reduces your risk of heart disease and depression. In the study, people with different diets had different life expectancies.

    How much more likely is it you’ll die as a result of consuming ultraprocessed foods? The study found that people who ate the most ultraprocessed food had a four percent higher risk of dying.

    What are the ultraprocessed foods with strong links to greater risk of death? Consuming “ready to eat” meats and fish were tightly linked to death. Breakfast cereals, soda and ice cream also posed greater risk. Foods that have fiber, vitamins and minerals have a lower risk of death.

    Some good news: At least some experts believe that having a healthy diet should override the negative consequences of eating ultraprocessed foods.

    Here’s more from Just Care:

  • Elevance Health sues to undo changes to Medicare Advantage star-rating system

    Elevance Health sues to undo changes to Medicare Advantage star-rating system

    For years, the Centers for Medicare and Medicare Services (CMS) has been giving additional money to Medicare Advantage plans that get four and five-star ratings. The goal was to promote quality, but the reality is that the five-star rating system is a farce and needs an overhaul. CMS has taken some steps to overhaul it but Jackob Emerson reports for Becker’s that Elevance Health is suing HHS for “unlawful, and arbitrary and capricious” methodology changes to how Medicare Advantage and Part D star ratings are calculated.

    Don’t be misled by the government’s Medicare Advantage star-rating system. As of now, Medicare Advantage plans with four and five stars could have high denial rates, high mortality rates, endless prior authorization requirements and narrow networks that undermine access to care.

    CMS uses 40 quality measures to rate Medicare Advantage plans, but these measures don’t give you a good clue as to whether a Medicare Advantage plan will actually cover the care you need, when you need it from physicians and hospitals you want to use.

    CMS has gotten a bit stricter in giving out four and five-star ratings. And, Elevance says it is losing revenue because fewer of its Medicare Advantage plans are getting at least four stars.

    For reasons that are unclear to me, CMS cannot change MA plan star-rating scores more than five percent from one year to the next. Somehow, Elevance claims that CMS did not abide by this restriction. Elevance therefore asks the court to require CMS to recalculate all scores for purposes of star-ratings for 2024.

    Here’s more from Just Care:

  • Being mildly overweight in older age has its benefits

    Being mildly overweight in older age has its benefits

    Judith Graham writes for CNN on the advantages and disadvantages of being mildly overweight in older age. Surprisingly, experts report that some additional weight has its benefits. Of course, there are drawbacks to carrying extra fat as well.

    Millions of older Americans are mildly overweight–they are carrying 10 to 15 more pounds than they weighed before having kids, slowing down on physical activities, or developing chronic conditions. But, those extra pounds might not mean they should be taking Ozempic or otherwise focused on losing weight.

    Too much excess fat can jeopardize your health and promote heart disease, diabetes and other chronic conditions. And, it’s never healthy to gain weight quickly. But, there’s plenty of evidence showing that 10 to 15 pounds of added weight can protect people when they fall and provide energy to people getting debilitating medical treatment, such as chemotherapy.

    As we grow older, we naturally tend to lose muscle and gain fat. And, when we gain fat, it tends to come in our stomachs rather than under our skin. Experts say that this fat in our abdomens is unhealthy and can lead to all sorts of chronic conditions. Adding fat in your hips and rear end is much less concerning.

    Keep active: It’s important to walk quickly enough to get your heart-rate up for least half an hour five days a week.  It’s also important to lift weights at least two times a week. In fact, physical activity can be more important than losing weight if you don’t have a lot of fat around your middle.

    If you continue to eat as you always have and reduce your physical activity, you will gain weight. Yet, the vast majority of people over 65 stop physical activity when they are not working.

    If you are even somewhat overweight, it’s particularly important to exercise. Otherwise, you lose your muscle mass and strength. And, then you are likely to become disabled or otherwise physically harmed and you jeopardize your independence.

    What happens to muscle when you lose weight? You lose both muscle (25 percent) and fat (75 percent) when you lose weight. So, it’s best to exercise more, rather than eat less, if you want to lose weight.

    Carrying a few extra pounds can put you at the lowest risk of early death. Of note, some studies have found that older people who are considered to be of healthy weight are at the highest risk of early death. According to the WHO, “being overweight may be beneficial for older adults, while being notably thin can be problematic, contributing to the potential for frailty.

    It matters what you eat: Eat a plant-based diet to the extent possible, with lots of legumes, nuts, vegetables and fruits. Limit your fat intake and stick to fatty foods that have unsaturated fats, if you can.

    Here’s more from Just Care:

  • The choice between traditional Medicare and Medicare Advantage: It’s a sham

    The choice between traditional Medicare and Medicare Advantage: It’s a sham

    If all things were equal, the choice between traditional Medicare and Medicare Advantage is easier than you think, as I wrote in a previous post. But as one reader commented, there’s more to it than I could include in that post.

    Here’s part two, explaining why about half of all people with Medicare are now enrolled in the privatized Medicare option: Medicare Advantage.

    Traditional Medicare’s upfront costs are high 

    Traditional Medicare does not have an out-of-pocket cap. Unless people have supplemental coverage to pick up their out-of-pocket costs, their upfront costs in traditional Medicare are high. They easily could spend $3,000 on supplemental coverage and Part D prescription drug coverage. And, that’s on top of their Medicare Part B premium.

    Millions of people cannot afford supplemental coverage; the typical person with Medicare has an annual income of less than $30,000. So, people with lower incomes are more likely to enroll in Medicare Advantage, which has an out-of-pocket limit and few, if any, upfront costs. Not surprisingly, wealthier individuals are more likely to enroll in traditional Medicare.

    In truth: You’ll spend less out of pocket in traditional Medicare with supplemental coverage than in Medicare Advantage when you need costly care and have direct access to the care you want. Cost will not be an obstacle to care as it can be in Medicare Advantage.

    To save money, employers and unions steer retirees into Medicare Advantage

    Increasingly, companies and unions offering retiree benefits contract with Medicare Advantage plans to cover their retirees’ care. The Medicare Advantage plans are willing and able to offer companies and unions special benefits to enroll their retirees, better than what they offer people in the individual market, because the Medicare Advantage plans profit morethrough these contracts than in the individual market. And companies and unions save money on the cost of supplemental coverage.

    In truth: Millions of people with retiree benefits lose their easy access to care, choice of doctors and hospitals, and coverage anywhere in the U.S. without their consent.

    Medicare Advantage marketing misleads people about their benefits

    Medicare Advantage plans use taxpayer dollars to promote their benefits and to claim they are better than traditional Medicare. A lot of the marketing is misleading about the benefits people will get in Medicare Advantage. The government does not use taxpayer dollars to promote traditional Medicare, let alone to explain why it is better than Medicare Advantage.

    In truth: No one should trust the Medicare Advantage TV ads or mailers.

    Sales agents steer millions of people into Medicare Advantage 

    Sales agent commissions for enrolling people in Medicare Advantage are significantly higher than commissions for enrolling people in traditional Medicare. As a result, sales agents have a financial incentive to steer people into Medicare Advantage.

    In truth: No one should trust sales agents; they should use independent, unbiased advisers, such as State Health Insurance Assistance Programs.

    People aren’t told that a Medicare Advantage plan might not meet their needs

    The government suggests that people can pick the Medicare Advantage plan that’s right for them. But, the government does not make data available about key differences among Medicare Advantage plans on Medicare Compare or anywhere else. For example, people don’t know about rates of denial, disenrollment or mortality in different Medicare Advantage plans. Moreover, people do not know what their future needs will be and how the Medicare Advantage plan they choose will meet them.

    The Centers for Medicare and Medicaid Services’ “Medicare & You” handbook does not warn people that some Medicare Advantage plans engage in widespread and persistent inappropriate delays and denials of care, let alone which ones. Medicare’s five-star rating system of Medicare Advantage plans is largely a farce.

    In truth: People, who elect Medicare Advantage must gamble on whether they will get the care they need.

    Medicare Advantage plans generally cover fewer services than traditional Medicare

    While in theory, Medicare Advantage plans should cover people for the same medically reasonable and necessary services traditional Medicare covers, in practice they do not.

    People generally don’t know about high rates of inappropriate delays and denials of benefits in some Medicare Advantage plans, let alone which plans have the highest such rates. They also do not know which Medicare Advantage plans have high voluntary disenrollment rates, particularly for people with costly conditions or high mortality rates.

    In truth: Medicare Advantage plans profit from delaying and denying care, and the government does not have the tools or resources to hold them accountable when they are bad actors.

    Additional benefits in Medicare Advantage might not be valuable

    Medicare Advantage plans market their dental and vision benefits, gym memberships and other freebies not available in traditional Medicare. There’s almost no data on the value of these benefits or to show who is able to use these benefits and whether out-of-pocket costs or limited access make them less beneficial than they appear.

    In truth: Enrollees often can’t take advantage of these additional benefits; they can come with high out-of-pocket costs and limited provider networks.

    Medicare Advantage costs can be an obstacle to care

    There’s little information about typical out-of-pocket costs in Medicare Advantage plans, let alone typical out-of-pocket costs for people with different health conditions, such as diabetes or cancer. The Medicare Advantage plans do not make this information available. The government’s “Medicare & You” handbook does not include information on out-of-pocket limits in Medicare Advantage, which can be as high as $8,300 for in-network care alone this year, and significantly more for out-of-network care.

    In truth: Medicare Advantage plans impose financial barriers to care that lead some people – particularly those with low incomes and people of color — to skip or delay care when they get sick.

    Medicare Advantage prior authorization rules and networks can be an obstacle to care 

    People do not know what care they will need down the road and whether their Medicare Advantage plan has specialists and specialty hospitals in its network to meet those needs. People often face obstacles such as prior authorization from their MA plans when they need critical care.

    In truth: Medicare Advantage plans impose administrative barriers to care that keep some people from getting the care they need.

    Traditional Medicare is not always an option once people enroll in Medicare Advantage

    People are told that they can switch Medicare Advantage plans and switch to traditional Medicare each year during the Annual Open Enrollment Period. But most people don’t know that, except in Maine, Massachusetts, Connecticut and New York, they have no right to buy supplemental coverage that fills gaps in traditional Medicare after they first enroll in Medicare, with limited exceptions. They also don’t know that companies selling supplemental coverage generally can charge them much higher rates based on their health status if they switch out of Medicare Advantage.

    In truth: People are often locked into Medicare Advantage once they enroll.

  • US continues to spend more for poorer quality care than other developed countries

    US continues to spend more for poorer quality care than other developed countries

    Once again, The Commonwealth Fund is out with a report showing that we spend way more than other developed countries for our health care and yet get far less for our money. We spend more per person on health care than every other country and more as a percentage of our gross domestic product. And, unlike every other country, we don’t have guaranteed health care for everyone. 

    We live shorter lives, with average life expectancy of  77 , the lowest life expectancy at birth by three years than other wealthy nations. Black Americans live shorter lives than white Americans, averaging 74.8, as compared to 78.8. And Native Americans still shorter, averaging 71.8. Hispanic Americans have higher life expectancies at birth, 81.9. And Asian American life expectancies are higher still, 85.6.

    Our people have multiple chronic conditions at the highest rate of all nations. We also have higher death rates for conditions that are preventable or can be treated. We have the third highest suicide rates. We have the highest infant and maternal mortality rates. We have 5.4 deaths per 1,000 births and 24 maternal deaths for every 100,000 births. And, we have the highest obesity rates.

    Not surprisingly, more people in the U.S. die from assaults, including gun violence.

    While our government’s focus is on overtreatment, we have far fewer physician visits than people in other countries. We also have proportionately fewer physicians and hospital beds than other developed countries. 

    As a percentage of GDP, we spend about twice as much as the average of other developed countries on health care, at nearly 18 percent. That percentage is growing as prices continue to rise, our population ages, and new technologies for treating patients are developed. 

    On a per person basis, we spend twice as much on total healthcare costs as Germany, the next highest-spending country. And, we spend close to four times as much as most other developed countries.

    Though other developed countries guarantee health care for all, through public health insurance, they generally also offer their residents the right to buy private health insurance. In the US, more than 26 million people—8.6 percent have no insurance at all, and tens of millions more are underinsured, often unable to afford care even though they have insurance. 

    Affordable care for everyone is critical to reining in costs and addressing these terrible quality of care US rankings. Right now, even with insurance, almost half of US residents skipped or delayed getting needed care because of the cost. In addition to reining in health care costs, we must ensure well-coordinated care, including primary care, starting with investing in more primary care providers. 

    Here’s more from Just Care:

  • For people with heart disease, polypills save lives

    For people with heart disease, polypills save lives

    Heart disease is the number one killer. But, people who take their heart medicines are likely to thrive and survive. How to improve medication compliance? The New York Times reports that a polypill for people with heart disease, one pill containing three drugs instead of three separate pills, saves lives.

    Results from a randomized controlled trial of more than 2,000 people reported in the New England Journal of Medicine  found that people with heart disease who were prescribed a polypill were much more likely to take their heart drugs and reduce their likelihood of heart issues than people who were prescribed multiple pills. The polypill makes it easy to comply. One pill, once a day.

    People on the polypill also were significantly less likely to die as a result of their heart disease. In addition, the researchers report that the polypill ensures that physicians prescribe all the appropriate medicines rather than prescribing fewer medicines than appropriate.

    What’s in a polypill for people with heart disease? Blood-pressure medicine, aspirin and a drug that lowers cholesterol, reducing the likelihood of a blood clot.

    Polypills have been around for a long time because they help ensure compliance but also because drug companies can patent the combination drug and charge a fortune for it. Polypills can cost a lot more than the cost of buying the drugs separately. (The heart medicines are all generic and cost very little.) Unfortunately, insurers might not cover polypills when they cost a lot, and it’s hard to argue that they should.

    Does the FDA have to approve polypills? The answer is yes. So, they can be patented, driving up their cost.

    Who were the trial participants? People who had lived through a heart attack in the past six months. They were all 65 or over. The vast majority had high blood pressure, more than half smoked at some point and almost three in five had diabetes.

    The value of the polypill was in adherence to the medication. Though, it’s noteworthy that the difference was 70.6 percent of polypill users adhered compared to 62.7 percent of those taking multiple medicines.

    What was the difference in health outcomes between polypill users and people who took individual drugs? About 3 percent fewer people taking a polypill experience a stroke or heart attack, died of a heart issue or needed care to address a blocked artery over three years than people taking multiple medicines, 9.5 percent v. 12.7. Of note though, death rates were the same for both groups. People in the polypill group had fewer heart deaths but had deaths from other causes.

    Here’s more from Just Care:

  • Is it likely that you’ll live to 105?

    Is it likely that you’ll live to 105?

    Ferris Jabr writes for the New York Times Magazine on the possibility that human beings will have far longer life expectancies than we could ever imagine. For sure, you should not think that living to 105 is an aberration. Twenty-four years ago, one woman residing in the south of France lived until the age of 122!

    In 2015, estimates are that 450,000 people lived to be over 100 years old. That’s more than four times the 950,000 people who reached their 100th birthday in 1990. And, projections are that in the next century, 79 years from now, 25 million people will live to 100 or longer.

    There are still not a lot of people who live to 110. But, the number is definitely growing. Japan reports 146 in 2015, up from 22 in 2005. Very few people live to 115.

    Many scientists believe that human beings will never live much past 115. But, some scientists believe that people’s life expectancy could be a lot longer. We have not begun to reach our limit. According to them, the biological data does not indicate that death is inevitable.

    Yes, aging does take a toll on our bodies. Our bones harden and contract, our muscles fall away, our organs do not function as quickly or as fluidly, our immune system loses its ability to protect us. But, could we somehow change our biology to delay the aging of our bodies or even reverse it?

    Scientists are finding in studies with mice that aging is reversible, to some extent. Cells can come back to life. This finding leads to the question, if people’s life expectancy could be 105 or 115, is this what we would want? Would it be a burden? Would longer life come with well-being? What would it mean for future generations? Would it keep us from moving forward as societies? How would each of us think about our time on earth after 90 or 100?

    Here’s more from Just Care: