That shows a very inefficient use of USA's wealth and a very poor healthcare policy.
US states may be very different from each other, but their difference is far less that the ones between European states. You speak a single language, you have a single president, a federal senate, a federal army, a federal police, a powerful federal intelligence agency, and many institutions at the federal level. You have 200 years of common history as a single country, if we except the Secession period. Actually, I could understand that you could say that US is an union of two countries because of this episode, but a union of 50, no way.
Europe on the other hand is a territory that is divided in several countries with different languages, different religions, different history, several wars between them (the list is really really long). Being generous, you could say that we began a common history 50 years ago, but this was in fact only an economic union on a small set of goods (steel and coal IIRC) between 5 countries.
Apple to oranges, really.
It's like how if you took Canada, with our pretty good (I like to think so) health care and general infrastructure, and more or less respectable indicators of health and safety.... and then decided to just look at our reserves. Huge WTF.
Natives are 1/30th of the Canadian population (so significant, but not huge), and their average life expectancy is ~10 years less than the national average. How does this happen?
Situations like this shows that it IS important to consider internal divisions like this. If the native population in Canada happened to be doubled or something, then you would run in all sorts of problems trying to improve out overall health care without addressing specific issues regarding why the native population appears to have such poor outcomes.
Also low-density population means smaller sample sizes thus larger error. Again, surprise.
Let me address your points one by one:
1. Comparing us to Japan is really a poor choice. Japan is a highly uniform society and very xenophobic. They have an almost uniform cultural, religious, and genetic makeup.
2. We don't have a single language, a single president, a federal police, or any of the other things you are mentioning in the same manner of which you think of them in your country. The authority of those particular institutions is VERY limited in some very crucial ways. We are more like a strong union of 50 separate states, each with its own government (and president, called a governor here) with its own particular political challenges. There have been SEVERAL fights between the state and federal government over things like national policy and states rights that run counter to your argument. For example, Arizona is fighting with the federal government over immigration enforcement. California is fighting with the federal government over marijuana. Nevada fights with the federal government over online gambling. etc etc etc. During the civil rights era, some southern states mounted what almost became an armed rebellion against the federal government.
We also dont have a single language. LARGE parts of this country speak ONLY Spanish, or ONLY Haitian, or ONLY Russian. There is no requirement for someone living here to speak English and it's been a HUGE problem politically in places like California, Texas, and Florida. In California and Washington State, there are large Chinese and Japanese populations that only speak their mother tongue.
Furthermore, the country itself is changing constantly. Dearborn, Michigan is home to the largest concentration of Muslims in the USA, and that is having an interesting effect on the political and social dynamic of what was once a very very white/european part of the country.
It's easy here to understand how we can identify a Southerner or a Californian by their manner, diet, and dialect. I feel like the rest of the world is often confused by the idea that the USA acts and thinks alike as a uniform country. We're not.
I'm French, my wife is Japanese. We have experience of both immigration procedure. Let me tell you that Japan's xenophobism is a myth that dates from WWII. France is far more tough for foreigners.
It is true that they are basically more uniform culturally and probably genetically and religiously than US. But you missed an important point : I did not compare US's healthcare to Japan's. I compared US' best county to Japan's average. That makes the uniformity of the country quite irrelevant, don't you think ?
2. You exaggerate the differences. 96% of Americans speak English. 87% as their primary language. Of course institutions are limited ! That's how it works in a democracy ! I agree that states are different, have some freedom (but probably not much more than a German Land or a Swiss canton, these are federal countries too) but my point is that stating that these differences are as big as the ones between EU countries is ridiculous.
Examples where it is not true: Russia, India, China, Germany, Spain, Italy.
We're one big family who've been all over each other for thousands of years.
What used to be the Duchy of Savoy is now split between Italy and France.
EDIT: A map of Savoy in the 16th century: https://en.wikipedia.org/wiki/File:Savoy2.png
Actually it doesn't.
Suppose we compare the lifespans of Japanese-Americans to Japanese in Japan. Your theory predicts that Japanese-Americans will have a shorter-lifespan. Reality says otherwise.
The populations are different. The US is incredibly diverse, and much of that diversity is correlated with geography. Japan, not so much.
I think in America you also have to account for socio-economic status more than in other first world countries. Also where do Japanese-Americans tend to live? I find it hard to imagine that immigration is as high in the poorest regions.
How many, and which, states have you lived in?
Heck - if you live in CA, how much time have you spent outside LA/SF Bay area? The central valley (where I grew up) is very different, as are the sierra folk.
And no, ski trips or summers at Tahoe don't count.
The greatest factor in longevity is genetics, not wealth expenditure. Ever consider that the average genetic makeup of someone in Japan may be quite different from the average in the US?
Now, compare those of Japanese ancestry living in the US with those in Japan and I might be interested in your theories.
Lots of people say if you remove the US, the greatest correlation (not causation and all that, yes yes) to longevity is health care spending. Picking the first result off google, here: http://andrewgelman.com/2009/12/healthcare_spen/
Japan is a clear outlier but so is the US.
http://www.sciencedaily.com/releases/2011/02/110207112539.ht...
Don't smoke, drink coffee moderately, have low cholesterol, and be wealthy.
That's actually not true...even remotely. California and Texas for example have been part of at least three different countries. Texas for example has had six different national owners, including a stint as an independent country. Alaska wasn't a state in the U.S. till 1959!
Something like half of the land territory of the U.S. was added in the 20th century. And territories like Virginia have around 400 years of history, only half of which is with the U.S.
Oklahoma (a non-European word) held out till 1907 and has at least 25 Native tongues and presently is home to 39 recognized nations protected by treaty!
This one sentence does an excellent job of summing up our failures as a nation over the last 236 years. One, gargantuan government can never hope to meet the vastly different needs of 300 million people living in highly diverse geographies, population densities, and climates.
So while the US should be treated like one country for all those reasons, those reasons should also be blamed for most of her failures.
One monolithic government is a myth. It could even be argued that the fractured nature of US govt is responsible for wide variation is schools, infrastructure, moral laws etc.
However, in the UK we went for the option of having pretty good, but perhaps not the absolute best, available to everyone, free at the point of delivery, regardless of wealth. With the option to pay for private care if you want it - either in the UK or abroad. Personally, I think this is a pretty good compromise.
Edit: (To my many silent downvoters..) Healthcare being tied to your employer is a competitive advantage of larger companies, isn't it? Either way, speak up!
In most states, if you have 2 employees you are eligible for a group plan. In a few states even a single founder is eligible.
You aren't just computing with large companies either. At my last job I worked for a small business. Less than 25 employees. We had group health insurance. Talk to an insurance agent. It is not as hard as it seems and if you go with a high deductible plan, it is not as expensive as it seems either.
http://www.cdc.gov/obesity/data/animated_map_slides/map26.jp...
If nation A has 60 people living to 79, and nation B has 59 people living to 80 and 1 person being murdered at 20, A and B have the same mean life expectancy (of 79).
Though I suppose you could call things like murders and road safety "cultural".
Obesity has been found to take 10yrs off lifespan.
Also, smoking: http://labs.slate.com/articles/cigarette-map/ (click tab to see by county).
I would guess most of that difference is due to migration of elderly persons to Florida, not due to Florida being healthier or health care being better there.
You're confusing something else, possibly average age, with life expectancy.
If the elderly populations of long-lived Florida counties still largely come from migration, longevity may say much more about living and healthcare conditions elsewhere. As well as wealth effects reflected by the ability to retire to Florida.
It may increase the average life expectancy of the area you are moving to, though.
In other words, while the people who were born and raised in the area may have a low life expectancy, an influx of wealthy retirees will drag up the average life expectancy. In some cases the people moving to these areas may already be older than the average life expectancy.
WILL be? It already is. It's pretty much in line with the so-called red / blue divide in the nation.
There's a reason it's referred to as the united states.
In most of the world, "state" == nation. The US is an exception, but it's because the initial concept, pre-pivot, was of a confederated union of independent states.
http://www.healthmetricsandevaluation.org/tools/data-visuali...
Industry (dots) lined up with Obama voters from the article: http://strangemaps.files.wordpress.com/2008/11/strangemapsov...
a) Too poor
b) Too far
If a resident of that area can even get their hands on a car, a 3-4 hour round trip to visit the medical center (not counting time at the center) vs. putting in another day on the job would certainly give me pause.
But does that change your life at all? No, your life is exactly the same as before.
Same with these stats. Just because people who have lower life expectancies move or happen to live near you, it doesn't change anything about your life.
If canada and the US merged, the average life expectancy of the new country would go up, but that number itself wouldn't change anyone's life.
It's the same with arbitrary county groupings. If you live in a county with lots of poor people, they will have a lower life expectancy. That doesn't mean anything about you, though. If the border was different, you might live in a county with lots of rich people.
