Tag Archives: Life Expectancy

The Social Security Filing Dilemma

19 Monday Apr 2021

Posted by in Risk, Social Security

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A 67-year-old friend told me he won’t file for Social Security (SS) benefits until he turns 70 because “it will pay off as long as I live to at least 81”. Okay, so benefit levels increase by about 8% for each year they’re deferred after your “full retirement age” (probably about 66 for him), and he has no doubt he’ll live more than the extra 11 years. Yes, his decision will “pay off” in a “break-even” sense if he lives that long: he’ll collect more incremental dollars of benefits beyond his 70th birthday than he’ll lose during the three-year deferral (but actually, he’d have to live till he’s 81.5 to break even). But that does not mean his decision is “optimal”.

Good things come to those who wait. I’ll simplify here just a bit, but let’s say an 8% increase in benefits is uniform for every year deferred beyond age 62. (It’s actually a bit more than that after full retirement age, but it’s less than 8% in some years prior to full retirement age.) 8% is a very good, “safe” return, assuming you don’t mind putting your faith in the government to make good.

The Reaper approaches: Unlike your personal savings, SS benefits end at death (a surviving spouse would continue to receive the higher of your respective benefit payments). That means the “safe” 8% return is eroded by diminishing life expectancy with each passing year. For example, average life expectancy at age 62 is 25.4 years, but it falls to 24.5 years at age 63. That’s a decline of 3.5% in the number of years one can expected to receive those higher, deferred benefits. At ages 69 and 70, remaining life expectancy is 19.6 and 18.8 years, respectively. Therefore, waiting the extra year to age 70 means a 4.1% decline in future years of benefits. So rather than a safe, 8% return, subtract about 4%. You’re looking at roughly a 4% uncertain return for deferral of benefits between age 62 and age 70. If you have health issues, it’s obviously worse.

Opportunity Cost: It would be fine to take an expected 4% annual return for deferring SS benefits if you had no immediate use for the extra funds. But you could take the early benefits and invest them! If you’re still working, you could possibly save a like amount of funds from your employment income tax-deferred. So taking the early benefits would be worthwhile if you can earn at least 4% on the funds. Sure, investment returns are uncertain, but over a few years, a 4% annualized return (which I’ll call the “hurdle” rate) should not be hard to beat.

The same logic applies to an already retired individual who would withdraw funds from savings to afford the deferral of SS benefits. Instead, if he or she takes the benefits immediately, leaving a like amount invested, any return in excess of about 4% will have made it worthwhile. But of course, all of this is beside the point if you really just want to retire and the early benefits allow you to do so. You value the benefits now!

But what about taxes? Investment income will generally be taxed, and it’s possible the incremental benefits from deferred SS benefits won’t be. That might swing the calculus in favor of waiting a few extra years to file. And taking benefits early, while still employed, might mean a larger share of the early benefits will be taxed. If 80% of your benefits are taxed at a marginal rate of 25%, state and federal, you’re out 20% of your early benefits. Also, if you expect to be in a lower tax bracket in the future (good luck!), or if you plan to move to a low-tax state at some point in the future, deferring benefits might be more advantageous.

On the other hand, if you’re subject to tax on a portion of your early benefits, you’re likely to be subject to tax on benefits you defer as well. If you’re SS benefits and investment income are both taxed, the issue might be close to a wash, but that hurdle return I mentioned above might have to be a bit higher than 4% to justify early benefits.

Optimal? So what is an “optimal” decision about when to file for SS benefits? For anyone in their 60s today who has not yet filed for SS benefits, it depends on your tolerance for market risk and your tax status.

—You can likely earn more than the rough 4% annual hurdle discussed over a few years in the market, so taking benefits as early as 62 might be a reasonable decision. That’s especially true if you already have some cash set aside to ride out market downturns.

—If you are an extremely conservative investor then you are unlikely to achieve a 4% return, so the “safe” return from deferring SS benefits is your best bet.

—If you believe your tax status will be more favorable later, that might swing the pendulum in favor of deferral, again depending on risk tolerance.

—If you are afraid that failing health and death might come prematurely, filing early is a reasonable decision.

—If you simply want to retire early and the benefits will enable you to do that, filing early is simply a matter of personal time preference.

So my friend who is deferring his SS benefits until age 70 might or might not be optimizing: 1) he is supremely confident in his long-term health, but that’s not something he should count on; 2) he might be an extremely cautious investor (okay…); and 3) he’s still working, and he might expect his tax status to improve by age 70 (I doubt it).

I plan to retire before I turn 65, and I think I’ll be happy to take the benefits and leave more of my money invested. As for Social Security generally, I’d be happy to take a steeply discounted lump sum immediately and invest it, rather than wait for retirement, but that ain’t gonna happen!

CDC Flubs COVID Impact on Life Expectancy

03 Wednesday Mar 2021

Posted by in Coronavirus, Public Health

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The CDC choked on a new analysis estimating COVID-19’s impact on U.S. life expectancy as of year-end 2020: they reported a decline of a full year, which is ridiculous on its face! As explained by Peter B. Bach in STAT News, the agency assumed that excess deaths attributed to COVID in 2020 would continue as a permanent addition to deaths going forward. Please forgive my skepticism, but isn’t this too basic to qualify as an analytical error by an agency that subjects its reports to thorough vetting? Or might this have been a deliberate manipulation intended to convince the public that COVID will be an ongoing public health crisis. Of course the media has picked it up; even Zero Hedge reported it uncritically!

Bach does a quick calculation based on 400,000 excess deaths attributed to COVID in 2020 and 12 life-years lost by the average victim. I believe the first assumption is on the high side, and I say “attributed to COVID” as a reminder that the CDC’s guidance for completing death certificates was altered in the spring of 2020 specifically for COVID and not other causes of death. Furthermore, if our objective is to assess the impact of the virus itself, under no circumstances should excess deaths induced by misguided lockdown policies enter the calculation (though Bach entertains the possibility). Bach arrives at a reduction in average life of 5.3 days! Of course, that’s not intended to be a projection, but it is a reasonable estimate of COVID’s impact on average lives in 2020.

The CDC’s projection essentially freezes death rates at each age at their 2020 values. We will certainly see more COVID deaths in 2021, and the virus is likely to become endemic. Even with higher levels of acquired immunity and widespread vaccinations, there will almost certainly be some ongoing deaths attributable to COVID, but they are likely to be at levels that will blend into a resumption of the long decline in mortality rates, especially if COVID continues to displace the flu in its “ecological niche”. I include the chart at the top to emphasize the long-term improvement in mortality (though the chart shows only a partial year for 2020, and there has been some flattening or slight backsliding over the past five years or so). As Bach says:

“Researchers have regularly demonstrated that life expectancy projections are overly sensitive to evanescent events like pandemics and wars, resulting in considerably overestimated declines. … And yet the CDC published a result that, if anything, would convey to the public an exaggerated toll that Covid-19 took on longevity in 2020. That’s a problem.”

There were excess deaths from other causes in 2020, which Bach acknowledges. Perhaps 100,000 or more could be attributed to lockdowns and their consequences like economically-induced stress, depression, suicide, overdoses, and medical care deferred or never sought. The Zero Hedge article mentioned above discusses findings that lockdowns and their consequences, such as unemployment spells and lost education, will have ongoing negative effects on health and mortality for many years. The net effect on life expectancy might be as large as 11 to 12 days. Again, however, I draw a distinction between deaths caused by the disease and deaths caused by policy mistakes.

The CDC’s estimate should not be taken seriously when, as Kyle Smith says, there is every indication that the battle against COVID is coming to a successful conclusion. Public health experts have not acquitted themselves well during the pandemic, and the CDC’s life expectancy number only reinforces that impression. Here is Smith:

“We have learned a lot about how the virus works, and how it doesn’t: Outdoor transmission, for the most part, hardly ever happens. Kids are at very low risk, especially younger children. Baseball games, barbecues, and summer camps should be fine. Some pre-COVID activities now carry a different risk profile — notably anything that packs crowds together indoors, so Broadway theater, rock concerts, and the like will be just about the last category of activity to return to normal.”

But return to normal we should, and yet the CDC seems determined to poop on the victory party!

Perspective on U.S. Health Care Spending & Outcomes

05 Sunday Aug 2018

Posted by in Health Care, Health Insurance

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The U.S. spends a lot on health care, and our health care system is frequently criticized for poor health outcomes. The chart below is an example of evidence used to buttress this argument. It shows combinations of health care spending and life expectancy over time for the OECD countries. The U.S. appears to be a severe outlier and inferior to the other countries. A variation on this chart appeared on the home page of The Wall Street Journal this week. It accompanied (but was not part of) a good article by Joseph Walker in which he used 12 other charts in an effort to explain why the U.S. spends so much on health care. (Sorry, this link is probably gated.) Walker discusses several important cost factors, including third-party payments, tax treatment, and the deployment of expensive technology in the U.S. However, the claim that the U.S. is really an outlier is worth examining on other grounds.

The chart’s construction suggests that a reliable link should exist between health care spending and life expectancy, but there are several reasons to question whether that is the case. U.S. life expectancy has been held down historically by high rates of smoking, but reduced smoking rates should help moderate the U.S. life expectancy gap in coming years. Obesity in the U.S. is a more persistent problem, especially for the poor, and an even bigger contributor to low U.S. life expectancy than smoking at present. (See this report for evidence on the contributions of smoking and obesity to shorter life expectancy for older adults.) Other contributors to low life expectancy in the U.S. include high motor-vehicle deaths and homicides, the latter attributable in large part to the war on drugs. All of these factors contribute to higher health care spending and directly reduce life expectancy.

The status of the U.S. as an outlier in terms of health care spending is questioned on the Random Critical Analysis blog (RCA). The author’s detailed analysis includes the following points among many others of interest:

  • Health care is a superior good: as income rises, spending on health care rises faster;
  • The U.S. has a much higher standard of living than any of its peer nations;
  • U.S. consumption spending relative to GDP is an “outlier”, like health care spending relative to GDP;
  • Consumption is a stronger predictor of health care spending than income;
  • Relative to consumption, health care spending in the U.S. is not an outlier, nor is spending on pharmaceuticals, physician/nursing compensation, and the levels of health price indices.

Take a look at the following sequence from the RCA blog linked above (the animation might not be visible on a phone):

So the argument that the U.S. health care system is inferior to peer countries based on cross-county spending comparisons and life expectancy, to the extent that it holds up at all, is subject to strong qualifications. Inferior lifestyle choices, diets, and lack of exercise might be problematic in the U.S., but the healthcare system cannot be faulted based on spending levels relative to other OECD countries.

In fact, the superiority of the U.S. health care system in many areas is not even in dispute. As Mahdi Barakat points out, wait times for care, cancer survival rates, and stroke mortality are all clearly better in the U.S. than in many peer countries:

“Lives are indeed saved by the many types of superior medical outcomes that are often unique to the US. This is not to mention the innumerable lives saved each year around the world due to medical innovations that are made possible through vibrant US markets.”

Barakat compares dubious progressive claims that up to 45,000 American lives are lost each year due to a lack of insurance with the likely incremental lives lost if various performance measures in the U.S. were equivalent to those in other countries:

  • 25,000 additional female deaths per year with Canada’a wait times for care (no estimate for additional male deaths is given by Mahdi’s source);
  • 64,000 additional stroke deaths each year with the UK’s overall stroke mortality;
  • 72,000 additional cancer deaths each year with the UKs survival rates.

Theoretically, the national spending figures could be adjusted for the cost of queuing, i.e. wait times. While Obamacare certainly increased wait times in the U.S., the adjustment would likely reduce or eliminate the spending advantages that several OECD countries appear to have over the U.S.

The performance of health care systems in many countries with single-payer systems or universal care is subject to challenge, as some of the statistics offered by Barakat demonstrate. In “The Truth About SwedenCare“, Klaus Bernpaintner expresses his dismay at the romanticized view of health care in Sweden among so many Americans. His effort to convey the truth about Sweden’s stultifying health care bureaucracy is illuminating. There are few private physician practices in Sweden. Care is generally rationed and waits are lengthy, and it is delivered by disinterested, centrally-assigned providers.

“For non-emergency cases in Sweden, you must go to the public ‘Healthcare Central.’ This is always the starting point for anything from the common flu to brain tumors. You must go to your assigned Central, according to your healthcare district. Admission is by appointment only. Usually they have a 30-minute window every morning, when you call to claim one of the budgeted slots. Make sure to call early or they run out. Rarely will you get an appointment for the same day. You will be assigned a general practitioner, probably one you have never met before; likely one who does not speak fluent Swedish; and very likely one who hates his job. If you have a serious condition, you will be started on a path of referrals to experts. This process can take months.”

Bernpaintner calls this Sweden’s health care “bread line”, where people go to die. He mentions several other nightmarish features of health care in Sweden that Americans should hope to avoid. In particular, we should resist calls for a single-payer system, like Bernie Sanders’ Medicare-For-All proposal. An analysis by Charles Blahous of the Mercatus Center at George Mason University has shown that it would increase federal spending by $32.6 trillion over ten years. This estimate is basically in-line with others mentioned by Blahous. Much of the additional federal spending would represent a transition away from private spending, a process that would be massively disruptive. However, the study gives the plan the benefit of several doubts by accepting the assumptions made by Sanders: 1) a huge saving in prescription drug costs; 2) a huge saving in administrative costs; 3) providers will happily accept Medicare reimbursement levels; and 4) new immigrants will not be attracted by an essentially free health care program. Fat chance. But given all of these questionable assumptions, total health care spending would fall even as the government takes on the massive new outlays. Take away just fantasy #3 and total national health care spending would rise, a swing of $700 billion by 2031.

John Cochrane makes a useful distinction between two conceptions of universally-accessible coverage: one that all must use vs. one that all can use. (He calls them both forms of single-payer systems, though that usage sounds a bit awkward to me.) The voluntary form is preferable for several reasons: it can preserve choice in terms of coverage and providers; while the public-payer’s share must be funded, it demands little or nothing in the way of cross-subsidized pricing; and it does not imply that government must act as a single “price setter”. Cochrane warns of the possible consequences of a universally-mandated single payer:

“Not only is there some sort of single easy to access health care and insurance scheme for poor or unfortunate people, but you and I are forbidden to escape it, to have private doctors, private hospitals, or private insurance outside the scheme. Doctors are forbidden to have private cash paying customers. That truly is a nightmare, and it will mean the allocation of good medical care by connections and bribes.”

The presumption that universal health care will improve quality and save lives is unsupported by any real evidence. Its proponents incorrectly assume that the uninsured do not get care at all. Providers might go uncompensated, but the uninsured can often get needed care with more immediacy than they could with the lengthy wait times typical of many single-payer systems. The quality of care is likely to deteriorate under a single-payer system given the stresses placed on providers, the highly regulated conditions under which they would be forced to operate, and restricted treatment options. And of course a single-payer system would suspend the price mechanism and any semblance of competition in the health care marketplace.

The health care system in the U.S. has massive problems, but they were created and exacerbated by a series of governmental intrusions on the marketplace over many years. A flourishing market requires choice for consumers and competition between providers—in both health care delivery and insurance coverage. It also requires a roll-back of regulation on providers and insurers. But as Cochrane emphasizes, such a marketplace can exist apart from a voluntary, tax-funded payer-of-last-resort.