When Is a Dog Not a Dog?

EVERYBODY WANTS TO GO TO HEAVEN, BUT NOBODY WANTS TO DIE: The cheap and easy way for people in my line to sound erudite yet folksy is to steal a quote from either Mark Twain or Winston Churchill. I don’t go there. To do so would require actually reading. Instead, I like to strip-mine the wit and wisdom of Homer Simpson. He rarely disappoints. “If Jesus had a gun,” Homer told us last week, “he’d still be alive.” Bringing Homer to mind was the jaw-dropping report — Shorter Lives, Poorer Health — also issued last week by the National Research Council (NRC), an offshoot of the National Academy of Sciences, detailing how the United States spends twice as much money per citizen on health care than any of its peers among 16 relatively affluent, educated, first-world nations, yet still has the lowest life expectancy at birth of any. Boiling down a report 378 pages long, the authors concluded, “On nearly all indicators of mortality, survival, and life-expectancy, the United States performs at or near the bottom of any high-income countries.” Given the white-heat rage — and I do mean white — generated by President Barack Obama’s health-care reform, some of the details might be worth belaboring. And given the intense public-health consequences the report’s authors ascribe to America’s love affair with firearms, it deserves far more attention than the flickering coverage it received.

When the aforementioned Jesus was nailed to the cross, he was only 33 years old. That’s not as young as it sounds, considering how only 100 years ago, the average life expectancy throughout the Western world was 40 to 50. Today in the United States, it’s 78.2 years. But the average among the 16 peer nations studied by the NRC is 79.5. In Switzerland, it’s higher still, and in Japan, it’s 83. There are a few anomalous bright spots; males in Minnesota, it turns out, live longer than the NRC average, and Hawaiian women, for some reason, live on average to the age of 84.8 years old. But mostly, the news is grim. A 15-year-old girl in the United States is twice as likely to die before reaching the age of 50 than her counterparts in the 16 other nations. No doubt it’s just coincidental that she’ll also underperform all her peers in terms of math, science, and reading ability.

When Obamacare was first unveiled, its critics insisted America’s health-care system was already the best in the world. We spend nearly 18 percent of our gross domestic product on health care. That translates to $8,000 a person, which is more than twice the $3,200 spent per capita by our peers. But when you tally up what all that money buys, it’s not that much. We spend about twice as much on pharmaceutical drugs per capita than any other nation, and we’re tested more for blood pressure and cholesterol counts than anyone else. And, it should be noted, we do an impressive job keeping people diagnosed with cancer alive. After that, it pretty much blows, according to the NRC. We boast the lowest life expectancy at birth of anyone else. That’s in part because the U.S. has the second fewest number of physicians per capita and only 12 percent of them practice primary care. Our health system is dangerously fragmented, the NRC reported, overspecialized, and fixated on fancy, expensive, high-tech gadgets. And yes, 50 million people lack health insurance.

Even if 98,000 Americans die every year because of medical error, our health-care system can’t be blamed for everything. Lack of insurance does not explain why, for example, America has the highest rate of obesity, drug- and alcohol-related deaths, and car-crash fatalities of any of its peers. The acute lack of primary-care doctors does not explain why the average American spends 157 minutes a day absorbing electronic media or consumes far more calories per day than anyone else. Nor does it explain why Americans, on average, are 300 percent more likely to be murdered than their counterparts and why American males between the ages of 15-19 are five times more likely to be killed than their peers. Not to beat a dead horse, but the NRC report strongly suggests that the easy availability of firearms compounds the problem. Nearly 70 percent of America’s homicides involve some form of firearm. Gun ownership in the United States is such a fact of life that civilians, it turns out, own four times the number of automatic and semiautomatic weapons as the Army does. The vast majority of gun owners are, in fact, responsible, law-abiding, and conscientious. Still, the NRC report did not document a single instance in which anyone was beaten to death with a violent video game. I mention this because 919 people have been killed by firearms in this country since the Newtown Massacre of December 14. By the time you read this, that number will be higher still.

Naturally, I assumed that if we excluded black people, other minorities, poor people, and the obese from the NRC report, the United States would be sitting pretty in terms of overall health performance. Blacks, after all, are more apt to die prematurely via any number of ways. But even when you compare upper-income, educated, nonsmoking, nondrinking American white people with their counterparts in the other 16 nations, we don’t stack up well. Equally counterintuitively, the NRC report concluded that recent immigrant arrivals to the United States — who make up 12 percent of the population — generally and consistently outperformed the native born.

The good news is Americans were far more inclined to rate their own health as good. The other good news is that once we hit the age of 75, we tend to kick ass, either holding our own or surpassing our peers. To steal a line from another profound wellspring of pop-punditry — the movie Caddy­shack — “So I got that going for me, which is nice.”