mates for age sixty-five are generally the most rele-
vant for evaluating medical care conditions. From
1992 to 1997, it reported that the life expectancy for
males at age sixty-five in the United States rose from
15.4 to 15.9, while the number of remaining years
held steady at 19.2 for females at that age. In Canada
during this same period, the life expectancy for
males at age sixty-five rose from 16.0 to 16.3 and the
figure for females at age sixty-five increased slightly,
from 20.0 to 21.1.
Infant mortality in 1990 in the United States was
almost 1 percent, or 9.2 per thousand live births. By
2000, it had declined to 6.9 per thousand. Much of
this improvement reflected better self-care by expec-
tant mothers, particularly nutrition and the avoid-
ance of risk factors. The proportion of pregnant
women who smoked dropped from 18 percent in
1990 to 12 percent in 2000.
The four principal causes of death in the United
States during the 1990’s were heart disease, cancer,
stroke, and respiratory conditions, all of which pri-
marily affect older people. The incidence of heart-
related deaths declined significantly, however, re-
flecting both lifestyle changes and improvements in
medications, newer surgical techniques, and the
wider use of pacemakers and defibrillators. While
the overall incidence of deaths per year declined
only slightly, it is known from the improvements in
survival rates that the deaths occurred later in life.
Improved cancer treatments, for instance, were gen-
erally able to slow the advance of the disease.
The human immunodeficiency virus (HIV),
which causes acquired immunodeficiency syndrome
(AIDS), caused much alarm as it spread in the
1980’s. Between 1987 and 1994, HIV mortality in-
creased by 16 percent per year. From that point,
however, the incidence declined significantly. In
1990, HIV deaths averaged about 10 per 100,000
people, and by 2000 the incidence was only half as
large. Much of this improvement occurred as high-
risk populations such as male homosexuals and in-
travenous drug users adapted their behavior to
lower the risk of transmission.Paying for Medical Services Medical goods and
services are provided by private market suppliers in
both the United States and Canada, but the financ-
ing systems differ substantially. In the United States,
the government provides three types of financial
support: Medicare, Medicaid, and the programs for
federal prisoners, military personnel, and veterans.
Medicare, established in 1965, provided exten-
sive reimbursement of medical expenses for qualify-
ing persons aged sixty-five and older in the 1990’s.
Most people qualified by paying a Medicare tax, at a
rate of 1.45 percent, as part of their Social Security
payroll tax. This amount provided hospitalization
coverage. For doctor reimbursement, a monthly
premium was required. The number of Medicare
beneficiaries increased from 34 million in 1990 to 40
million in 2000, and the program’s expenditures
rose from $111 billion in 1990 to $222 billion in- This rapid growth in expenditures caused
alarm among many experts on government finance.
As life expectancy increased, the proportion of pop-
ulation on Medicare increased.
Medicaid is a means-tested program that covers
medical expenses for low-income persons of any
age. Each state creates its own program, but
there are federal guidelines and federal fi-
nancial support. Medicaid coverage of per-
sons under age sixty-five generally averaged
around 10 percent in the 1990’s, with no
clear trend. Only about half the people be-
low the federal poverty line qualified for
Medicaid. Medicaid was supplemented by
the creation in 1997 of the State Children’s
Health Insurance Program (SCHIP). By
2000, 3.4 million children were enrolled.
During the decade, most persons under
age sixty-five relied on private medical in-
surance, most of it arranged by employers.
Private insurance coverage declined from
76 percent in 1989 to 72 percent in 2000,
The Nineties in America Health care 409
Life Expectancy at Age 65, 1992 and 1997Country Gender 1992 1997
United States Male 15.4 15.9
Female 19.2 19.2
Canada Male 16.0 16.3
Female 20.0 20.1
Median of 27 other countries Male 14.7 15.4
Female 18.1 19.1
Source:U.S. Department of Health and Human Services,Health,
United States, 2002, p. 115.