This is a masterpiece of succinct communication showing clearly how extravagantly ineffective the US healthcare system really is. There are 14 single payer universal government plans that are not only one half the cost, but support a healthier population.

It is a shame this graphic is buried in the front pages of the January issue. It needs much greater exposure. Every member of congress should receive a copy and, to make sure they study it, it should be reproduced in some highly visible media, like full page add in the NY Times, Washington Post, etc. Perhaps Move ON would sponsor it. If NGS would make it available as a poster it could be displayed more readily and more widely.

A technical issue: It does not print well on a laser jet due to the low contrast tones. It would be good to have more printer friendly version available.

I know that there are risks in publishing material with political associations even if it is the facts. The presentation is highly illuminating, and I congratulate Mr. Uberti on the graphic and thank NGS for publishing it.
RGR 122009

This graph is dramatic, and I do not doubt its message. But, what about the countries missing from the graph, including Germany, The Netherlands, Belgium, Norway, and Italy, all of whom have some sort of universal care? Why are they not on this graph?

I also question the comments attributing the costs and results to our fee-for-service system. This is opinion, not data. Maybe the problem is our terrible diet and obesity? Maybe violent death in our ghettos is a big contributor? Maybe we have too many bad doctors? Maybe costs are high because of too many regulations on hospitals leading to $2000/day or more for a hospital stay, or the outrageous cost of drugs in the U.S. vs. any of these countries?

I don't know the cause and neither does the creator of the graph. Just present the data, all of it.

I wish this message could get to everyone, but most people belive that most of those countries with universal health care do not get as good of care as we do in the US. If that were true we would have a longer life expectancy. I am ashamed of the US for letting the money people spew such lies. Senators who voted against public option should be voted out. Maybe we should not allow the physicians & pharmacy companys to put so much money in the politicians pockets. I'm 59 with no health care and I work full time. Our company had to drop our coverage because it was costing too much. I have 5 years before I can get medicare and now is when I need it to catch anything before it is life threatening. Excuse the spelling etc I am just upset about all this. I have been insured all my life and now at 59 I have no benefits and havent for over a year now.

Debra Rauch

This graphic is a clear illustration of not only a broken health care system, but of a broken political system as well.

To entertain such a high level of partisanship and vitriol over this issue, in the face of data like this, is a sign that Americans are a lot worse off than we want to believe.

We are a country in denial.

REB,

As the graphic indicates, all 30 OECD countries were not shown. Because many countries like Germany and Italy had similar numbers that overlapped on the chart, I left some off to make the graphic easier to read. Also, a few countries did not have data for annual doctor visits. Here's how the nine omitted countries measure up:

HEALTH CARE SPENDING (per person in U.S. dollars)
Norway: $4,763
Netherlands: 3,837
Belgium: 3,595
Germany: 3,588
Ireland: 3,424
Iceland: 3,319
-------------(OECD average: $2,986)
Greece: 2,727
Italy: 2,686
Turkey: 618

LIFE EXPECTANCY
Italy: 81.2
Iceland: 81.2
Norway: 80.6
Netherlands: 80.2
Germany: 79.8
Ireland: 79.7
Belgium: 79.5
Greece: 79.5
-------------(OECD average: 79.2)
Turkey: 72.1

DOCTOR VISITS A YEAR
Belgium: 7.6
Germany: 7.5
Iceland: 6.5
Netherlands: 5.7
Turkey: 5.6
Italy: no data
Norway: no data
Ireland: no data
Greece: no data

Hope this answers your questions,
Oliver

This graph must be correct, and the health care systems must be better in those other countries. This is because we see so many people leaving the United States to get better health care in other countries and we never see anyone come to the United States for better Health Care. Most of the best doctors in the world obviously do not work in the United States, they work in all those other countries. Most of the doctors say they want to contiune practicing medicine here in the U.S. after this health care reform passes. Certainly not 50% of them will consider retiring if this health care passes -- that would be crazy. So we need not worry at all about a massive shortage of doctors in the future. Most current medical students embrace this new reform that we are talking about, they are not discourgage by it. Clearly, this graph shows that we need to embrace this new reform. Or do we?

I'm 58 and can't remember a time when our system, our government, wasn't 99% about allowing those with obscene amounts of wealth and power to keep what they had and acquire more. As events have unfolded over the past couple of years, this is becoming more obvious than ever. Look at banks, insurance companies, auto makers, (at least they actually make something). To quote a famous line from a tee-shirt, "I used to be disgusted, but now I'm just amused."

A few observations.

Fact (to Scott V. above)
1. The US has some excellent Doctors / facilities and some Canadians seek American medical solutions for procedures/treatments not available here.

Opinion
2. The lifestyle of overweight / fast food / too little exercise / toxic habits seems to be so negative that it takes many $$ to try to overcome it.

Opinion
3. Could it be that life expectancy at birth has little correlation to medical spending because of so many other factors.
for example - if traffic accidents and other violent deaths were removed from this equation might it give a truer picture?

Gordon,
Most of the western countries listed have very similar lifestyles to the US, they do have sane gun laws, but all in all the comparison is reasonable.

No sane person could possible think that American health care is 2.5 times greater than the UK's, no matter how much violent crime or how many automobile deaths occur. Does this chart explain it all? No, but it explains enough--Americans spend way way way too much for health care than every other country. Consider how much better the health care system in the UK would be if they spent half as much on care as the US.

Interesting that Mr. Van Dyken can only argue with his own strawmen here. This is a very clean presentation of astonishing numbers, especially now that it's been clarified why certain countries were omitted. These are the facts...and they are undisputed.

Hilarious, Scott V. Apparently you were unaware that many, many Americans DO leave the country (mostly to Canada) because they can't afford the outrageous costs of health care.

"Most of the best doctors in the world obviously do not work in the United States,"

The best-paid doctors, certainly. But the best doctors in the world don't do you any good if you can't afford it, obviously.

I don't see the point of the graph. Is there some provision in the current reform measures that will decrease insurance cost? Since big insurance companies uniformly back Obama's reforms, I think the cost will increase instead. So how will reform flatten the line for the US? Does anyone expect us to live to 300?

The chart is wonderful.

It captures so many of the flawed assumptions underlying the reform debate.

There is no correlation between higher rates of spending and life expectancies.

There is no correlation between having a "universal" system and life expectancies.

Nor is there a correlation between number of doctor visits and life expectancy, or, for that matter cost.

You know what else?

The "United States" is the wrong entity to look at. Health care is a local issue in America. Some states, like Massachusetts, already have universal coverage. It has a high life expectancy....but very high costs. New York does not have universal coverage, but it also has high life expectancies and costs.

The chart also suggests that the "universal" systems of these diverse countries are somehow equivalent, when in fact they are as different as the countries themselves.

In this sense, the chart shows far more than its authors intended.

More here: http://bit.ly/8fdZfc

Evan Falchuk

People do not understand the OECD international health cost data. It has led to so many wrong statements about US health care costs and to ineffectual policy proposals and legislative solutions.

OECD converts international medical costs into US dollars using a concept called 'Comparative Price Level', which is 'Purchasing Power Parity' divided by foreign currency exchange rates. Most people assume the foreign medical costs are the actual foreign medical costs converted into US dollars using foreign exchange rates, but that is not what happens when Purchasing Power Parity is involved.

For example, the current exchange rate for UK pound to US dollars is about US$1.60 for 1 Pound. If going to the doctor in England cost 50 pounds, it should become US$80 for comparison purposes of US medical costs.

The OECD and others use 'Comparative Price Level' instead of exchange rates to convert foreign currencies into US dollars for medical cost comparisons. The Purchasing Power Parity for converting UK pounds to dollars is about 1.1 and not 1.6. (See, http://www.oecd.org/dataoecd/48/18/18598721.pdf)

It means that in the OECD charts and statistics, the 50 pounds spent in the UK for doctors is converted to US$55 and not to US$80 as currency exchange rates dictate. In effect, the UK medical costs are reduced by 31 percent or must be increased by 46 percent to reflect what they really cost just using currency exchange rates. In other words, if the US suddenly took over all of the UK health care system, it would have to pay 46 percent more than all the OECD UK medical costs charts and data indicate.

Some of the reasons, US medical costs look so high in international comparisons is that "Purchasing Power Parity' is affected by the fact that the US has the largest GDP in the world, the most productive labor force, one of the highest standards of living in the world and is a big importer of low cost goods.

The foreign medical costs are not as low as they are cited in comparisons. If the foreign costs were compared to US medical costs just using foreign currency exchange rates, the US would still look higher than other countries, but the gap would start to shrink drastically.

Other factors unfairly statistically inflate US costs. The US has a better handle on reporting costs in a timely fashion. When the US reports a cost for a given year, it most likely occurred in that year. Other countries have a slower data gathering system and a cost reflected in a given year is more likely to occur in the previous year. When costs are rising by 15 percent or more in a year, it means that some countries are underreporting their true medical costs by that cost increase factor of 15 percent or more.

The US also includes more costs as medical costs than other countries, which raise our per capital medical cost numbers. Other countries also do not include the government's costs for the medical education of doctors, nurses and other medical staff. Other countries do not include some nursing home, rehabilitation, therapy and convalescing costs for patients.

Numerous other factors make the OECD numbers useless for policy decisions. The US is penalized in OECD numbers for better and more inclusive reporting, and for having a better standard of living than many other countries. Too bad these positive factors have turned OECD health care cost numbers about the US into a negative. Remember, the OECD is an international group that has no incentive to make the US look good. If anything, its incentive is to make other developed countries look better to justify their high taxes and social programs. Unfortunately, the OECD numbers have come to dominate the discussions in the US about comparative medical costs.

I'm not sure life expectancy is a great metric. I'd rather live 75 good years than 78 less good years.

Available is misspelled on the graphic, but I'm certain the rest of it is accurate.

Milton,

UK's Purchasing Power Parity (PPP) looks indeed strange. However, correction using PPP is absolutely essential for comparative purposes. A dollar does not buy you the same goods in the US or in Portugal, as cleverly demonstrated by the Big Mac Index (which is nothing more than a product-specific PPP index). The numbers for Portugal look correct by anecdotal estimate.

Correcting using PPP allows the health cost to be offset by the cost of all other goods. If surgery costs one year salary both in the US and in Portugal, then the value in the OECD charts will be the same, no matter how much a year's salary differs in both countries.

Your link for OECD's PPP document is 404. Here's the one I used: http://www.oecd.org/dataoecd/61/54/18598754.pdf

Someone needs to send this graphic to Glenn Beck and rest of the teabaggers in the right wingnut brigade. Well, fix the spelling error -- no doubt the wingnuts will exploit that somehow.

pwb - Health is a good factor in determining the quality of life... it's inherently obvious that a longer life means you are healthy.

This is a cool graph. But I want to know why everything is compared with respect to the UK, i.e., the straightline.

We should make all our senators read this article and I will they were more responsible to the people of this country than to the big corporations.

Milton,

In your long comment, you have mentioned a lot of factors affecting US badly in the comparison. But How did you assume that none of these factors have any effect on other countries? Most of them are developed countries with equally good (or better?) governance and facilities. Also, it was too poor an assumption to say that OECD will always against US and will support other countries!

PPP is an important factor in any comparison. Even with PPP, it wont be apples to apples comparison, but PPP will surely make better sense.

I agree that PPP-adjusted figures are correct for this comparison. However, for exchange-rate computed figures please see http://www.who.int/whosis/whostat/2009/en/index.html in table 7.

Even with exchange-rate figures the disparity remains, to a lesser but still compelling degree.

I appreciated seeing the graph. I agree with a number of the comments already made and it's apparent that the readership really thinks about these issues. The graph tends to lead the reader if they are not versed in statistical analysis to a particular conclusion. Our health care has too high of a cost-benefit (life expentancy). Not necessarily true.
I would also like to see other graphs produced that consider "infrastructure costs", legal fees and malpractice insurance and payments, prescription drugs and time of diagnosis to treatment. Also the fees actually paid to medical professionals should be shown as well.

If this information is availabel to NGM and the researcher please share.

thanks,

Why is this a line chart? Having two Y axes and no X axis is very confusing. This data would be better represented with 2D scatter plot.

How about Cuba? Life expectancy there is amongst longist in the world and I am sure that health care spending is quite low?
Why has it been omitted from the graph?

An interesting alternative representation of this data was presented at the following site and I thought it was a clearer representation of the data with the added benefit of showing the clusters of countries with similar spending and life expectancies:

http://peltiertech.com/WordPress/graphing-the-cost-of-health-care/

It would be very interesting to see further breakdown of the data based on use of public and private insurers as well as spending on prevention programs versus treatment efforts.

"Lies, damn lies, and statistics."
- Mark Twain

Its pretty obvious that our spending and life expectancy are *simplify* a matter of our universality of coverage. overly simple associations, overly simple logic, simply wrong.

if you look at the state of hawaii - a climate and ethnicity more similar to japan you will find that hawaii has a long life expectancy as does Utah, Idaho, and Minnesota and others, all which have lower per capita spending, lower primary care per capita, and nothing outstanding as to coverage. worse place for life expectancy: washington DC, with high cost plans federal employee plans. from there the southern state rank at the bottom of life expectancy. universal coverage is not going to fix obesity, diet, education.

Several years ago I heard a Canadian health economist discussing data similar to this. In his analysis of US healthcare cost, he subtracted care costs associated with the last few weeks/months (I don't remember exact period) of life and found that the US costs were more aligned with those of the rest of the world. Seems we have an eagerness to spend what it takes to prolong life when other countries may not be doing so. Without starting the "death panel" debate, there may be a need for a dose of better expectation management at the end of life.

What's the saying, Figures don't lie, but liars sure can figure!!

Making raw comparisons of dollars on charts like these is why our healthcare debate never seems to rise above ideology and emotion from either left or right.

It's ironic that in the same issue is an article about the bionic age. I'll bet very little of that technology originates in so called low cost countries nor is it spent on the citizens of those countries.

A Toyota Corolla and Mercedes S65 AMG are both automobiles but vastly different in costs and vastly different in features and performance. So lets discuss the system intelligently and look for improvements, but don't try to tell me you can still drive a Mercedes while paying for a Toyota!

"As the graphic indicates, all 30 OECD countries were not shown"

Aren't Poland, Hungary and Czech Republic members of OECD?

if health insurance premiums (mine are nearly 25% of my income) were called taxes the whole of the country would be in revolt. instead we meekly send off outrageous sums to be used by insurance companies to find ways to deny coverage and increase their own bottom lines to the detriment of real people.

I'd love to see a similar graph comparing health care spending and insurance company profits in those countries with private insurance.

There's a real problem with this chart, aside from what's already mentioned. First, the computation seems horribly misleading as mentioned, but more important is the scale.

The left axis covers from 823-7290 and the right covers just 72-83, or 7 inches to 2.5 inches. If you put the age range into a similar scale you'd look at ages 10 to 89, but the space seperating the data would be a scant .8 inches.

I realize that does not clearly support the conclusion that spending correlates with life expectancy, but it'd be a more honest depiction.

The graph is nice, but only partially useful.

Are Britain, France, Australia, or Japan nearly as diverse as the USA? No way. A more homogenous population should be cheaper to treat than a diverse one.

I don't see Russia, South Africa, China, India, Pakistan, Brazil, etc that make up the other 5/6's of the world's population - why not? Because many of their life expectancies are horrible. Our 78 years is still in the top tier of the globe BY FAR!!!

I'm all for health reform - our costs shouldn't be as high as they are - BUT, we don't need to replace the entire system in order to bring costs down.

If moderate changes don't have the desired effects in the next 5-10 years, then maybe more invasive changes should be implemented later. Don't throw the baby out with the bathwater!!! We've got a globally TOP-TIER health system that needs to get a bit cheaper and broader in coverage.

What we are really talking about is the opportunity for all Americans to see the MD of thier choice, an recieve the best medical treatment available in this country. No one is mentioning defensive medicine, where the md needs to run battieries of tests to cover themselves from the always present medical malpractice attornies. Medicine is an ART and not entirely an exact science. I wonder how many of the countries MD'S on this chart can be sued, or have high malpracticed insurance premiums?

Nifty chart, but where is this data coming from? The average cost of health insurance for an individual in the U.S. is about $4,800 in 2009. See here:

http://www.usatoday.com/money/industries/health/2009-09-15-insurance-costs_N.htm

The "average" person is healthy so that would likely be about the total annual cost as well.

Now let's talk about access. Are Americans travelling to Canada for knee surgery, hip replacements, and open heart surgery or are Canadians travelling to the U.S.? We all know it's the latter. But Canada has better access? Yeah, to a GP who tells you to a wait six months for these therapies.

Accurate figures put the U.S. squarely back "on the chart".

We have a fairly wide disparity of cost among the 50 U.S. states. About 2/3 of the states would appear to be very competitive on this chart. See U.S. state by state data here: http://www.ahipresearch.org/

Three states are truly off the chart. These are New York (my state), New Jersey, and Massachussetts (the Obamacare model). Legislatures in these states have loaded policies with so many coverage manadates and banned underwriting, the most basic practice of insurance. Unfortunately, the other 47 states are about to pulled into this morass.

Looks like I missed the fun but I have to comment on Edward Stevenson's post.
"if you look at the state of hawaii - a climate and ethnicity more similar to japan you will find that hawaii has a long life expectancy as does Utah, Idaho, and Minnesota and others..."

If you look at insurance coverage and the States with high life expectancy... Surprise! High coverage, low levels of uninsured for the most part! Hawaii, in particular, has an employer mandate to force high insurance coverage. (Idaho, by the way, doesn't have particularly high life expectancy on the stats I have.) States with longest life expectancy are HI, 2nd lowest uninsured. MN, 3rd in uninsured. UT, 25th in uninsured. CT, 7th in uninsured. MA, 1st in uninsured. NH, 11th in uninsured. IA, 5th in uninsured.

The southern states have high poverty and low levels of insurance coverage. And low life expectancy. Poverty, life expectancy and insurance coverage are unsurprisingly highly correlated. And if you look at the data in the graph on life expectancy, with the exception of Denmark and the USA, all the the countries with life expectancies below the OECD average are relatively poor and frequently former Soviet bloc countries.

Life expectancy at birth is highly affected by the high US rates of violent death in the young. But when you look at life expectancy at age 65 or Disability-adjusted life expectancy (DALE), the US still comes out as mediocre or poor which is surprising given the high level of medical spending here.

You do realize that the countries with lower costs and better outcomes, the Civilized world, has taken the PROFIT out of basic health care financing? They've also told the drug pushers in Big PhRMA what they'll pay rather than let them rape them.

USAmerica is the only country that allows the leeches in the "health insurance" mafia and Big PhRMA set the costs and payments for USAmerican "sick care"...

It's been amusing watching those of you who live in the land of denial, those of you who still believe that USAmerica represents the best of everything and can do no wrong, madly examining the gnats in order to ignore the elephants...

All this kerfuffle about fostering competition, yet the bill currently in the works preserves the antitrust exemption of insurers, and may also leave insurance regulation at the state level, a sure fire recipe for price fixing and market carve-ups!

Also a reply to Sean Harley: "Now let's talk about access. Are Americans travelling to Canada for knee surgery, hip replacements, and open heart surgery or are Canadians travelling to the U.S.? We all know it's the latter."

“There is an image of Canadians flooding across the border to get care,” said Donald Berwick, a Harvard University health- policy specialist and pediatrician who heads the Boston-based nonprofit Institute for Healthcare Improvement. “That’s just not the case. The public in Canada is far more satisfied with the system than they are in the U.S. and health care is at least as good, with much more contained costs.”
http://www.bloomberg.com/apps/news?pid=20601082&sid=aNkLyH2VecGM

Americans are seeking to leave the US and get health care elsewhere, including Canada.

"It was reported in The Globe and Mail on September 30 that "Ailing Americans will soon be able to buy surgery at bargain prices in Canadian hospitals through a medical tourism company founded by two physicians" (by Lisa Priest, "Ontario MDs to Launch Medical Tourism Firm," - the firm is Canadian Healthcare International Corp. ). It is noted in the article that the idea of using the revenue from operations on tourists to increase hospital budgets for the benefit of domestic patients is not new. For another Canadian article on the subject see: "Surgery in Canada Marketed to U.S. Patients," by Larry Kusch, Winnipeg Free Press, Dec. 6, 2007. The company in this case is Choice Medical Services and they are also involved in arranging medical trips to Cuba. Back in 1992 we also found an example of a Canadian hotel chain that had entered into a medical tourism venture with a Hungarian firm ("Canadian Carlton to Set Up Joint Ventures, Buy into Resorts," Agence France-Presse, July 13, 1992. "
http://www.lib.uwo.ca/programs/generalbusiness/medicaltourism.html

"ONE consequence of the high cost of medical care in the United States has been the rise of medical tourism. Every year, thousands of Americans undergo surgery in other countries because the allure of good care at half the price is too good to pass up."
http://www.nytimes.com/2009/06/10/opinion/10milstein.html?_r=1

There's also that small matter of Americans ordering drugs from Canada to save money.

Can you please provide a similar chart listing $$ spent and some metric of quality of life or days lost to illness/injury? I'm sure the US can maintain its current life expectancy rate at a fraction of its current cost, but what we'd lose is the ability to fix bad hips, knees, and deal with minor inconveniences. That is what we spend our money on, not keeping people alive (because frankly, thats the easiest part)

Part of the cost associated with American health insurance plans is the potential to visit a doctor. What is the maximum potential number of visits covered by the average health insurance plan? Compare that with how often people actually go to the doctor.

In the USA, we have a culture that tells you not to go to the doctor. It tells you to go to work even if you are sick. It tells you to work long hours so that you don't have the extra time to exercise. We tough it out because we are Americans.

The point I am trying to make, is that the majority of Americans with health insurance don't use all of the benefits they are paying for. If Americans went to the doctor as many times a year as they were allowed under their insurance plans, how would that look on the graph? Or even using some actuarial numbers on what liabilities insurance companies plan to cover because that would be less than the maximum usage and more than actual visits.

An interesting graph would be medical services paid for every year in comparison to what is actually used.

It is interesting to note that some people in congress have noticed this and plan to tax some insurance plans because they provide more benefits than people are using.

This graph simply shows everybody lives about the same length of time. Big whoop. If it included the "percentage of household income spent on healthcare" or "healthcare cost as a percentage of cost of living" it would be worth it.

It's ridiculous how we have some of the best doctors and advanced treatments for illness in the world, and yet our life expectancy is lower than other countries with universal healthcare. One of my family members slipped on the ice and sprained his wrist, but he refused to go to urgent care because we don't have health insurance and can't afford another medical bill. What good is having amazing heathcare if nobody can afford to use it?

Unfortunately the "life expectancy" charts aren't very realistic when use as above.

Ours (US) includes traumatic deaths, high rates of premature births (not necessarily due to lack of health care, but in many cases due to lifestyle choices like drugs, smoking,etc).

To examine in a more realistic manner...

Examine the REMAINING life expectancy of a person hitting 45 or 50 years old (when they are much less likely to be shot in a gangland shooting, or killed while driving drunk). This is the stage in life when people need MORE health care than in their earlier lives. That is a more realistic study of how health care effects life expectancy.

Or...

Look at people who are freshly diagnosed with a disease (Breast Ca, Prostate Ca, Lung Ca, etc.)...and compare their life expectancy across the countries above.

When you do studies like those--studies that actually factor out lifestyle issues...the US comes in at or near the top.

The US has more obese people than other developed countries, which accounts for more than 10% of our country's medical expenditures and a high number of early deaths. We also have many more deaths due to traffic accidents than other developed countries. Your skewed statistics prove that NGM has become a leftist propaganda publication.

You guys should really just stick to taking pretty pictures.

I have a degree in Mathematics and work as an analyst by trade. I can tell you from experience that this chart and data is potentially flawed. The chart simply shows cost data but may or may not completely ignore many relevant variables that would skew the real cost numbers. For example the chart does not take into account life style differences between nations. Scientific data that I have reviewed shows Americans poor diet, love of alcohol etc may play a part in higher health care costs. Life expectancy numbers have been skewed for years because Americans count infant mortality in their average life span while most other European countries do not. Cost is also greatly affected by legal policies. Does this chart's producer assume that the legal costs to practice medicine is the same in the U.S and all of its European counterparts?. Certainly this would skew the comparison. The current health care Reform bills do not address this issue at all. This chart is a good beginning but it raises more questions than it provides answers

John wrote: "Examine the REMAINING life expectancy of a person hitting 45 or 50 years old (when they are much less likely to be shot in a gangland shooting, or killed while driving drunk). This is the stage in life when people need MORE health care than in their earlier lives. That is a more realistic study of how health care effects life expectancy."

OECD gathers that kind of data too. Google "OECD Health Data 2009," it's downloadable.

Life expectancy at 65 years old, females and males.

For males, the US still trails Switzerland, the UK, France, Japan, Spain, Italy, Norway and others.

For females, the same, the US is middle of the pack but there's a bigger difference in life expectancy with Japanese living 3 years longer. With males the difference is about a year.

I don't see the USA expenditures on the graph or anywhere else.
What are US expenditures?
The other data comparisons do not include the US.