A cancer care laboratory in Marseille, France | Gerard Julien/AFP via Getty Images Why you’re more likely to die of cancer in Europe than America Turns out the US is actually doing something right when it comes to health care — at a high cost, of course.

Europeans are way, way more likely to die of cancer than Americans.

It's a fact that many people find surprising. Given all the (true) stories we hear about the ranks of uninsured Americans facing bankruptcy when they get sick, and reams of stats about higher health care costs for worse results than other rich countries, how can it be possibly true? And yet, in 2018, there were an estimated 280 deaths per 100,000 in Europe, compared to 189 per 100,000 in the United States, according to the International Agency for Research on Cancer.

The mortality gap between the U.S. and Europe is one of the central questions we've been trying to answer in the POLITICO Global Policy Lab: Decoding Cancer, our exploration of this growing public health crisis.

One of the difficulties: People had trouble believing the numbers. "The difference is probably based on some statistical trick," one expert at a policy brainstorming session in Rome declared.

To some extent, the expert is right. Depending on which statistic you use, the gap can appear less dramatic.

But there are some real ways the U.S.'s health system makes up for its many flaws. And, when it comes to cancer, that translates into saved lives.

Here are four reasons why Americans are less likely than Europeans to die of cancer.

Age

The first reason is somewhat of a statistical trick. Cancer is a disease of the elderly. An estimated 60 percent of cancer cases are diagnosed in people over 65; that age group accounts for 70 percent of cancer deaths. Put another way, the incidence of cancer in people above 65 is 11 times higher than in those below that age. Europe’s elderly population is considerably bigger as a proportion of the population: About 19 percent of the EU population is over 65, compared to around 15 percent in the U.S. That’s the top explanation for why the so-called crude mortality rate is so much lower in the U.S.

But it doesn’t tell the whole story. Even using a process called age standardization, where you imagine every country has the same distribution of ages, the mortality rate in the U.S. — 91 per 100,000 — is better than all but a few EU countries: Sweden, Luxembourg and Finland. How on earth is the U.S. performing at the same level as those relatively homogenous, rich, famously socialized health systems?

Medicare covers cancer drugs “generously — vastly more generously than Europeans do,” said Amitabh Chandra.

Socialized medicine à l'américaine

Part of the reason again comes down to age.

The reason the U.S.’s strong performance on cancer comes as a shock is because access to care in the country is notoriously unequal. But, it turns out, that's far less true of the elderly.

Age 65 is when virtually everyone in the U.S. qualifies for Medicare — America’s national, taxpayer-subsidized, government-run (dare we say socialized), comprehensive health insurance program.

The public insurance scheme, which has an extra layer of financial help for the poor, has a huge influence on how hospitals and other health care providers do their work. In contrast to another high-performing EU country, Italy — where regional administration of health systems means quality of care varies depending on where you live — the U.S. can use Medicare to enforce nationwide standards.

While it's far from perfect and can still involve some significant out-of-pocket costs, Medicare coverage makes it easier for people to actually pay for their care, boosting the likelihood that they'll go to the doctor both for preventive checkups and when something seems wrong. Free screenings for some of the most common cancers are a perk.

More than a quarter of EU respondents in a 2017 poll said they smoke tobacco, compared with just 14 percent of U.S. adults.

Medicare also covers cancer drugs “generously — vastly more generously than Europeans do,” said Amitabh Chandra, a health economist at Harvard. "It’s fashionable to beat up on U.S. health care, and while there are many reasons to do that, we should also remember that it covers medical innovation liberally,” he added in an email. Indeed, Medicare covers things like immunotherapy and clinical trials. "This increases health care spending, but will also improve outcomes if the innovations that we’re covering are good,” Chandra said.

High costs, first served

And indeed, new cancer cures go to U.S. patients faster than those in the EU. The reasons why include market factors, public research funding and data-sharing (or lack thereof in Europe’s case).

Speedy access to cutting-edge treatments cuts deep into America's national purse. One study, summarized in the New York Times, determined that the U.S. averted 265,000 more deaths of colorectal cancer compared to Western Europe between 1982 and 2010. Each year of healthy life gained cost $110,000. The costs for gains in prostate and breast cancers were even more dramatic.

Smoking

Finally, there's an important reason related to health practices in Europe that contributes to the disparity. Cigarettes are the leading cause of lung cancer — the world’s deadliest — and boost the risk of cancers of the "voice box, mouth, esophagus, throat, bladder, kidney, liver, stomach, pancreas, colon and rectum, and cervix, as well as acute myeloid leukemia,” according to the U.S. National Cancer Institute.

More than a quarter of EU respondents in a 2017 poll said they smoke tobacco, compared with just 14 percent of U.S. adults. Yes, there are some variations in ages sampled and types of tobacco considered, but the difference is clear. More smoking means more cancer, making Europeans more likely to die of the disease.