lifestyle and societal factors place the U.S. at the bottom of that list for life expectancy. On average, a U.S. male can be expected to live almost four fewer years than those in the top-ranked country, though Americans who reach age 75 live longer than those who reach that age in peer nations. One consumption choice causing several of the maladies described above are cigarettes. Americans smoked 258 billion cigarettes in 2016. Cigarettes cost the United States $326billion each year in direct healthcare costs ($170billion) and lost productivity ($156billion). A comprehensive 2007 study by European doctors found the five-year cancer survival rate was significantly higher in the U.S. than in all 21 European nations studied, 66.3% for men versus the European mean of 47.3% and 62.9% versus 52.8% for women. Americans undergo cancer screenings at significantly higher rates than people in other developed countries, and access MRI and CT scans at the highest rate of any OECD nation. People in the U.S. diagnosed with high cholesterol or hypertension access pharmaceutical treatments at higher rates than those diagnosed in other developed nations, and are more likely to successfully control the conditions. Diabetics are more likely to receive treatment and meet treatment targets in the U.S. than in Canada, England, or Scotland. According to a 2018 study of 2016 data by the Institute for Health Metrics and Evaluation, the U.S. was ranked 27th in the world for healthcare and education, down from 6th in 1990. Cost U.S. healthcare costs are considerably higher than other countries as a share of GDP, among other measures. According to the OECD, U.S. healthcare costs in 2015 were 16.9% GDP, over 5% GDP higher than the next most expensive OECD country. A gap of 5% GDP represents $1trillion, about $3,000 per person or one-third higher relative to the next most expensive country. The high cost of health care in the United States is attributed variously to technological advance, administration costs, drug pricing, suppliers charging more for medical equipment, the receiving of more medical care than people in other countries, the high wages of doctors, government regulations, the impact of lawsuits, and third party payment systems insulating consumers from the full cost of treatments. The lowest prices for pharmaceuticals, medical devices, and payments to physicians are in government plans. Americans tend to receive more medical care than people do in other countries, which is a notable contributor to