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Going Dutch

PH2009051702175.jpgOne of the real virtues of the blogosphere is that when someone has a question or an insight about economics, plenty of economists are around to comment on it. But the long-term impact of that has been that economists are sort of dominant in the blogosphere, and so when you have a question or an insight about something that's not economics, economists are still around to answer it, and have a tendency to pretend it's actually about economics. Over at the economics blog Marginal Revolution, for instance, a commenter contributes this gem:

At birth, someone living in the Netherlands can expect to live 2.35 years longer than someone born in the US, but at age 65, the difference is reversed, and someone living in the US can expect to live 0.4 years longer than someone living in the Netherlands. This difference can be explained by assuming that semi-socialized health care is better for young and worse for old people, or, at least as likely, different policies are not the main cause of the difference.

In other words, the difference in life expectancies is about the economics of how we finance health care. Matt Yglesias and Paul Krugman agree, but they see the economics differently: American seniors are covered by Medicare, which is single-payer, while the Dutch health-care system is fully private, and thus this is a win for government-funding of health care.

But ask public health people, and they'll tell you that health care is a fairly minor contributor in explaining aggregate life expectancies among different groups of people. I think they'd explain the data like this:

What's happening before age 65 and after age 65 are not unrelated. America's bad health risks are dying off in high numbers. That's not only people killed in car accidents and violent crimes, (people who, incidentally, come from the portion of the population that's least healthy) but also people with chronic diseases and bad genes and unhealthy lifestyles. In the Netherlands, most of those people don't die before age 65, in part because there are fewer car accidents and violent crimes, and in part because lifestyles are generally healthier, and in part because they have access to basic health care all their lives instead of only after age 65. The end result of that is that post-65 America has shaved off its worst health risks by letting them die, while the Netherlands hasn't.

Photo credit: Peter Dejong -- Associated Press Photo.

By Ezra Klein  |  August 3, 2009; 7:10 AM ET
Categories:  Health of Nations  
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Next: Why Don't We Just Expand Medicare?


Good point, Ezra! Yes, the simplistic way economists often are thinking, ceteris paribus, is totally unsuitable for such complex problems. You can't boil such questions down to only one factor being decisive. If you try to do that, your answer will simply be wrong. So, we need more economists being able and willing to look beyond their own nose in order to find real solutions.

Posted by: Gray62 | August 3, 2009 7:30 AM | Report abuse

Plus, it's hard to get worked up over these small differences of a couple of years. If people lived 10 years longer in one country rather than another, it would be worth finding out why.

Posted by: mdfarmer | August 3, 2009 8:06 AM | Report abuse

Isn't it sad (or impressive) to think just how much this 25 year old young man does to keep the health care debate honest these days?

I see so much flawed and simplistic reasoning, and Ezra is one of the few, and on some days, the only person I see out there injecting anything that resembles thoughtful, researched, and well-reasoned responses to the debate of the day.

Posted by: nylund | August 3, 2009 8:27 AM | Report abuse

Sounds like my rural county. Around here we have more obits for 50-year olds than for 68-year olds.

The older I get, the less value I place on adding a few years at the very end.

Posted by: serialcatowner | August 3, 2009 8:35 AM | Report abuse

It might help to have a graph showing the distribution of age of death for the US and for the Netherlands. A graph of this sort would likely be far more helpful than life expectancy of people at two different ages. For instance does the US have a longer tail than the Netherlands? Is the distribution more bimodal signifying people who die in accidents and people who don't? Does the US distribution show powerful effects of Medicare?

Posted by: CraigMcGillivary1 | August 3, 2009 9:26 AM | Report abuse

Perhaps we need an 'entrance exam' for getting into seniorhood. Fail the exam and you go to the soylent green factory immediately (not passing Go). This would save lots of money, and provide a stable protein supply.


Posted by: JimPortlandOR | August 3, 2009 9:59 AM | Report abuse


Car accidents and violent crimes are not health risks in the sense that you're talking about. There's no reason to believe that the people who die young in car crashes are more sickly than the rest of the population.

Also, do you have some support for the idea that a higher percentage of Dutch live to 65 than do Americans?

Posted by: tomtildrum | August 3, 2009 10:10 AM | Report abuse

I expect that public health people would be more likely to note that there are 40% more smokers in the Netherlands than the U.S. Many smoking related diseases are dose-dependent so you see excess smoking deaths in later years. In fact, I suspect that one habit has more contribution to the difference in longevity than the structure of health insurance in either country.

Posted by: J_Bean | August 3, 2009 10:12 AM | Report abuse

You can find the data on life expectency afetr 60 at

The US ranks 30th for men and 26th for women.


Posted by: lensch | August 3, 2009 10:56 AM | Report abuse

The commenter above is correct in that the differences are small and useless other than for political fodder.

Given all other things equal, I would choose the system that afforded me the most liberty.

Posted by: WrongfulDeath | August 3, 2009 11:10 AM | Report abuse

"Given all other things equal, I would choose the system that afforded me the most liberty"

Does that include the freedom to go bankrupt or die if you can't get health insurance?

Posted by: lensch | August 3, 2009 12:14 PM | Report abuse

The great thing about having non-economists in the blogosphere is that whenever you have a non-economics question, you have plenty of people to answer it! The downside is, when you have a question that deals with economics, the non-economists have a tendency to believe it doesn't have to do with economics...

Posted by: goinupnup | August 3, 2009 12:32 PM | Report abuse

Re tomtildrum's:
""Car accidents and violent crimes are not health risks in the sense that you're talking about. There's no reason to believe that the people who die young in car crashes are more sickly than the rest of the population.""

Well, violent crimes are definitely more common among the poor and disadvantaged, who are also at higher risk for getting insufficient medical care.

Car crashes, I'm less sure of - but certainly the stereotype is that poor people are more likely to drive drunk or drugged, more likely to drive unsafe cars, and more likely to have to drive when they really shouldn't be on the road, because they have fewer options and less power.

In any case, "tomtildrum" and myself are giving our opinions, while I am sure actual data exist - and I wouldn't be surprised if Ezra had looked it up at some point.

Posted by: WarrenTerra | August 3, 2009 2:48 PM | Report abuse

"It might help to have a graph showing the distribution of age of death for the US and for the Netherlands. "

I can help with the Dutch info according to our Central Bureau of Statistics (link =,101-120&D3=0&D4=0,5,10,15,20,25,30,35,40,45,l&HDR=G3,T&STB=G1,G2&VW=T)

I made groups of 15 years, and calculated the percentage of deaths in that age group for 2008. In the link you see the numbers per 5 year group of age and per year since 1950 if you want to expand ;)

0-15 : 0.75% of deaths in 2008
15-30: 0.67% of deaths in 2008
30-45: 2.07%
45-60: 8.68%
60-75: 22.46%
>75 years: 65.38 % of deaths in 2008.

Posted by: dutchmarbel | August 3, 2009 5:11 PM | Report abuse

More time today, so I did a little search myself. The ony data I could find was the CDC data over 2006 but I assume that's close enough to 2008 to see whether there is a significant difference.


Figures (I grouped them the same way, for convenience sake)

0-15 years: 1.62% of deaths in USA in 2006
15-30: 2.23% of deaths in USA in 2006
30-45: 4.33%
45-60: 13.11%
60-75: 22.19%
>75 years: 56.47% if deaths in USA in 2006

So in the Netherlands 12.17% of deaths in 2008 were younger than 60.
In the USA 21.29% of deaths occured before people are 60.

Posted by: dutchmarbel | August 4, 2009 12:57 PM | Report abuse

Whilst I hold the calculator, I thought I'd look at the percentage of people 60-65 year old that dies in both countries. In the Netherlands that's 6.19% of the population, in the USA that's 6.11% of the population.

So in the Netherlands 18.36% of the deaths occur bevore peope are 65 and in the USA 27.4% of deaths occure before peope are eligible for medicare.

Posted by: dutchmarbel | August 4, 2009 1:09 PM | Report abuse

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