Shorter lives in stingier states: Social policy shortcomings help explain the US mortality disadvantage

AbstractThe United States has a mortality disadvantage relative to its political and economic peer group of other rich democracies. Recently it has been suggested that there could be a role for social policy in explaining this disadvantage. In this paper, we test this “social policy hypothesis” by presenting a time-series cross-section analysis from 1970 to 2010 of the association between welfare state generosity (for unemployment insurance, sickness benefits, and pensions) and life expectancy, for the US and 17 other high-income countries. Fixed-effects estimation with autocorrelation-corrected standard errors (robust to unmeasured between-country differences and serial autocorrelation of repeated measures) found strong associations between welfare generosity and life expectancy. A unit increase in overall welfare generosity yields a 0.17 year increase in life expectancy at birth (p < 0.001), and a 0.07 year increase in life expectancy at age 65 (p < 0.001). The strongest effects of the welfare state are in the domain of pension benefits (b = 0.439 for life expectancy at birth, p < 0.001; b = 0.199 for life expectancy at age 65, p < 0.001). Models that lag the measures of social policy by ten years produce similar results, suggesting that the results are not driven by endogeneity bias. There is evidence that the US mortality disadvantage is, in part, a welfare-state disadvantage. We estimate that life expectancy in the US would be approximately 3.77 years longer, if it had just the average social policy generosity of the other 17 OECD nations