La Dolce Vita

Did you know that Hispanic Americans live longer than non-Hispanic whites? If that doesn’t knock your socks off, consider this: American Hispanics are three times as likely to be uninsured as non-Hispanic whites.

If you’re still not blown away, maybe you haven’t been following the twists and turns of the health policy debate. The Centers for Disease Control (CDC) discovery that Hispanics (one-third of whom are uninsured) have a life expectancy that is 2 1/2 years longer than whites (90% of whom have health insurance) makes mincemeat out of the oft-repeated argument for health reform. To wit: the uninsured get less health care and die earlier than everyone else.

Nothing helps, neither threat nor prayer

In support of the conventional wisdom, for example, the Physicians for a National Health Care Program (PNHCP) went so far as to claim that a whopping 45,000 people die every year because they are uninsured. That figure, repeated as though it were unquestioned fact by President Obama and most of the health care media, is almost as large as the number of American soldiers killed in the entire Vietnam War!

Families USA went so far as to make the astounding claim that 6 people die every day in Florida because they are uninsured. Eight die every day in California; and 25 die in New York. In Texas, the report implies that more people die every two months from lack of health insurance than the number killed at the battle of the Alamo (counting only losses on our side, that is). Nationwide, says the PNHCP, an uninsured person dies every 12 minutes.

With all this carnage, you might wonder whether there are any uninsured people left alive.

All of this nonsense is critiqued here. But don’t get me wrong. One of the joys of health economics is that you just don’t get this kind of entertainment in other economic fields. For sheer comedic amusement, health economics is sui generis.

The latest government report also completely blows out of the water a whole slew of international comparisons that cause a lot of commentators to froth at the mouth. Take the 1,000 or so U.S.-health-care-system-bashing studies, essays and opinion pieces (or is it 10,000? I can’t remember) that claim we’re getting short-changed because we spend more and die earlier. Turns out, these comparisons were mainly focused on insured people. Had they looked instead at the U.S. ethnic group most likely to be uninsured they would have had to eat their words. American Hispanics probably spend less on health care than people in other developed countries and they live longer!

American Hispanics outlive Canadians and the British, to say nothing of Germans, the Irish, the Finns and the Belgians. Overall, Hispanics in the United States live a year and a half longer than the OECD average life expectancy. (All numbers are from 2006, to conform to the CDC study.)

It is not known why so many Hispanics are uninsured, but the phenomenon is not explained by lower incomes. Census Bureau statistics show that at every level of income, Hispanics are two to three times as likely to be uninsured as the population as a whole, and the higher the income level, the greater the discrepancy.

Now if we did research at the NCPA the way Families USA does research, we would be claiming that lack of insurance actually makes people live longer! I can see the press release now…..”90,000 People Alive Today because They Didn’t Insure, Says Study”….. An estimated million, billion, trillion extra life years, all because of….. 12 extra people walk the streets of Florida every day….. That’s XXX people who didn’t die every minute…..YYY every second…..ZZZ every nanosecond…..

Comments (25)

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  1. Larry C. says:

    Nice post. Also very funny.

  2. Larry C. says:

    Thanks for posting the video. I’d never seen Maria Callas before.

  3. Ken says:

    Great post. One of your best.

  4. Devon Herrick says:

    I read one article that suggested Hispanic Americans live longer because many are immigrants. Only the most healthy among the Spanish-speaking populations of Mexico, Latin America and South America (those with the ability to work) are in good enough health to immigrate. But if that were truly the explanation, then why do Spaniards also outlive most Americans?

  5. Neil H. says:

    I’ve never understood why the left is so fixated on health insurance, instead of focusing on health care.

  6. Brian Williams. says:

    So you are saying we passed Obamacare for nothing?

  7. Maureen says:

    I think part of the problem with American’s life expectancy is our diet (or lack of healthy foods) combined with a sedentary lifestyle.

  8. Jane L. Delgado, PhD, MS says:

    Yes…and even though we have a higher rate of excess weight and diabetes we also have lower rates of heart disease, strokes, breast cancer, and lung disease when compared to non-Hispanic whites. There are many reasons for this (Hispanics smoke less, eat healthier, do work which is more physically active, and maintain family networks). We need to have a model for health that focuses on individual strengths and characteristics. Moreover, since health factors do not form a neat normal distribution the use of “average” is a meaningless and distorting concept for understanding health. With health insurance our outcomes would be even better.

    Jane L. Delgado, PhD, MS
    President and CEO
    National Alliance for Hispanic Health

  9. ralph says:

    Very Interesting, and it proves to me that defensive medicine is bad medicine. Since we pay less that 14% of medical costs out of pocket in the US, (less than in Canada), we over-consume. Too much of even a good thing is bad for oyu.

  10. Tom, DrPH, MD, PhD, JD says:

    Doctor master Jane is wrong.

  11. Jack Rudolph says:

    Right on!!!!
    Keep up the good work and writing!!!

  12. Erik says:

    Viva La Raza! This is our great revenge. You treat us badly, we outlive you. Divine intervention…

  13. Tom Miller says:

    The Hispanic (now “Latino”) paradox has been around the literature for several decades (first coined in 1986). It started to draw mainstream national media attention in the NYT and LAT in 2006. What drove the latest study to the headlines was the broader availability of quantitative survey data on hispanic longevity in the U.S. The initial story rains on the parade on the “health insurance is everything” policy advocates, who deliberately ignore the many OTHER non-health-care factors that shape long-term health and health outcomes. But do not underestimate the resilience of like-minded health policy “researchers” to pick apart and slide and dice the data differently to retell their story or re-explain discordant facts on the ground. For examples of studies that try to minimize or change the basic numbers, and present alternative “acculturation” and “ethnic enclave” community support causes or knock down “salmon bias” and “healthy migrant” theories, see:

    Am J Public Health. 1999 October; 89(10): 1543–1548.
    “The Latino mortality paradox: a test of the “salmon bias” and healthy migrant hypotheses.”
    American Journal of Public Health 919-925 May 2007, Vol 97, No. 5
    “The Latino Paradox in Neighborhood Context: The Case of Asthma and Other Respiratory Conditions”
    The Tomas Rivera Policy Institute, August 2007, “Revisiting the Latino Health Paradox”
    And there’s more on the way, based on a quick survey of more recent literature.
    By the way, there is less-well-documented data that indicates a great difference in mortality between legal immigrants and undocumented (aka illegal) ones, with an arguable case that overall U.S. life expectancy would look better if the latter cohort was pulled out of current aggregated estimates.

  14. Lacey says:

    Hamanera is such a great song!

    What I want to know is if this factors in age related death only, or life expectancy for all death types? I would think that would make a difference in the stats, especially when you are trying to use the stats to talk about health insurance.

  15. Larry says:

    John, what do you make of this report?
    A study of surgical operations from 2003 to 2007 found that unadjusted mortality for Medicare (4.4%), Medicaid (3.7%), and Uninsured (3.2%) patient groups were higher compared to Private Insurance groups (1.3%); mortality was lowest for Private Insurance patients independent of operation.

    Source: “Primary Payer Status Affects Mortality for Major Surgical Operations, Annals of Surgery,” abstract only, Volume 252, Issue 3, September 2010,

    http://journals.lww.com/annalsofsurgery/Abstract/2010/09000/Primary_Payer_Status_Affects_Mortality_for_Major.16.aspx

  16. Philip Weintraub says:

    John,

    This is probably the most baseless argument you have made to date against PPACA. I can only surmise your constant stream of negative public health articles shows either an unimaginable level of insensitivity towards your fellow man, outright ignorance of public health issues in the US, a purposeful attempt to de-legitimatize the President of the US or all three.

    Before sharing your views on a study you should have considered the reported study results could just be another version of the ‘healthy worker syndrome’ found in epidemiological studies performed in many countries. That is, the healthiest Hispanics were able to overcome the obstacles and travails of entering the US as alluded to by another commenter. Another explanation of the study is uninsured Hispanics live longer because when faced with a catastrophic disease they return to their country of origin to receive quality free healthcare. Whatever the reason for Hispanics outliving the general US population, if true, the results of the study deserve further investigation, but it is not an argument against access to heathcare. As a test of your theory, I would suggest you go without healthcare coverage for yourself for a five year period and then report back to us how you fare.

  17. Tom says:

    Phil,

    I can only surmise your constant stream of positive public health comments shows either an unimaginable level of sensitivity towards your fellow man, perfect knowledge of public health issues in the US, a purposeful attempt to legitimatize the President of the US or all three.

    I do agree though: another explanation of the study is that uninsured Hispanics live longer because when faced with a catastrophic disease they return to their country of origin to receive quality free healthcare as they dodge bullets the whole way. Wait—is that bad for health? Phil we may have a bit of a problem here.

  18. Frank Timmins says:

    Oh good grief Philip, I cannot believe I am reading what you wrote. Are you suggesting that the report is skewed by selection of “healthy workers”. That is certainly a fresh interpretation of Darwin’s law of “natural selection”. Healthy worker syndrome huh? You may get an argument on that premise from some of the state unemployment claim administrators in Calfornia, Arizona and Texas. And we can only assume you are giving us a bit of tongue in cheek with your suggestion that illegals return to their native countries to be treated for “catastrophic disease”. As you probably know, the desire for medical care is one of the reasons we have illegals in this country.

  19. Joe S. says:

    I don’t see the PPACA mentioned or criticized any where in this Health Alert. Am I missing something?

  20. steve says:

    This is great news. Please let us know when you turn in your health insurance John and that for your family. I would also like to see the list of other health care pundits who go without.

    Steve

  21. John Seater says:

    Isn’t the implication obvious? We need a federal law outlawing health insurance. Sure, that would eliminate risk-sharing, which people seem to want, but so what? Since when do the citizens get to decide how to spend their own money? What the people want is none of their business. We know what’s best for them. Down with the blood-sucking profit-seekers of the insurance industry who have bamboozled 85% of the public into buying a harmful product! Up with longer lifespans! Stamp out health insurance now! (Hmm. This is not the President’s point of view. Does that make it racist?)

  22. Dr. Bob Kramer says:

    Just when you think all your marbles are in a row, suddenly a new stat jumps up and hits you right in the gut. If this is all true, then we can proceed knowing that they are a cost neutral part of the scene. Notwithstanding that, there should be no free ride or sense of entitlement. If they can have cell phones, smoke cigaretts, and drive fairly new pickups, getting a free ride for healthcare demeans the profession, causes lack of continuity, and serves to only worsen the scene.

  23. Nancy says:

    Tom Miller’s post implies that the difference in life expectancy between Hispanics and whites has been known for some time. If so, why wasn’t more made of it when Families USA and the Physicians for a National Health Care Program were running all over the country claiming so many people were dying because they didn’t have health insurance?

    It seems like such an obvious counter point to make: if uninsurance causes premature death, why is the group with the highest uninsurance rate living the longest?

  24. Linda Gorman says:

    Not to be too much of a wet blanket here, but how, exactly, does Census know someone is Hispanic? Smith and Bradshaw (Am J Public Health, 2006) note that the “paradox” concided with “a change from the classification of deaths and population by Spanish surname to the use of Hispanic-origin questions in the census and vital statistics.”

    For Texas between 1980 (surname calculation) and 1990 (origin calculation) “the change in Hsipanic deaths in persons aged 65 years or older was only half as great as the change in population size, implying a relative omission of 15% to 20% of deaths.”

    Angel et al. found that Mexican immigrant mortality varies by age at migration.

    Looking forward to further discussion of this in the literature, not ready to say it has much to do with health insurance or the lack thereof.

  25. Tom Miller says:

    Not to warm up that “web blanket” too much, but the challenge of determining how many Hispanic angels can dance on the head of a life expectancy table pin depends on how you choose to calculate the data and from where you sample. For example, a subsequent short article in the March 2007 American Journal of Public Health, by Ho, Shih, and Simon pointed out that Smith and Bradshaw had overlooked some earlier large nationally representative studies using linked data files that eliminated the Census question problem (which partly started right after the 1980 Census) and still found a Hispanic mortality advantage. And the very first Public Health Reports article back in 1986 to raise the “epidemiological paradox” involving the health of hispanic subpopulations in the southwestern U.S.,
    by Markides and Coreil, did not seem to rely on Census data per se and it even made note of some of the surname/country of origin confusion back then.
    Of course, the recurring problem in batting around most health policy factoids and facile theories on both the left and right is that they first identify some crude correlation, leap ahead to simplistic causation, and then the next round of Ph.D’s get published in nibbling away at them. It usually turns out that the entire issue is much more complex, nuanced, and subject to other complicating factors (like age, location, and choice of dependent variable — such as morbidity vs. mortality).
    But it’s probably okay to use one less than perfect theory to limit the reach of even more overreaching ones that are being applied too liberally (both literally and figuratively) in practice these days.