We Could Be Doing So Much Better

I have been on Medicare for over a month now, and I am grateful for it. Sure, I’ve encountered its inscrutability and limitations, but I know that it provides good access, good coverage, and comprehensiveness that will continue from now until the end of my life. I retired from full employment (with benefits) at age 60, so I’ve been purchasing my health insurance from the market for the past several years, and I am thrilled that my premiums dropped by about 80% when Medicare kicked in.

In America, we treat our health care system as if it were the best in the world; we are proud of our technology, and embrace the idea that medicine can treat, can cure virtually any disease. Since we pay far more for health care than any other nation on the planet, we should expect miracles. But that fantastic idea is just that, a fantasy. Our exorbitantly expensive system produces only mediocre results when measures of population health are compared with other countries. One clear example are maternal mortality rates, that is, deaths due to pregnancy or childbirth. UNICEF reports that, between the years 2000 and 2017, maternal mortality rates decreased worldwide by 38%, but during that same period, the rate in the United States increased by 58%. Yes, our rate remains low when compared to the less developed parts of the world, but our 2017 ranking puts us tied for 63rd place, tied with Latvia, Oman, Moldova, Romania, and Ukraine, and trailing many nations not known for progressive health policy, like Iran, Albania, Uruguay, and Tajikistan.1

An equally disturbing report was published in November in the Journal of the American Medical Association.2 This demonstrated that, not only are we not becoming healthier, we are dying younger. American life expectancy, that is, the projected survival of a baby born in the United States, gradually increased, as we would expect, from 1959 until 2014, but then it started to slip. Some of the increase in recent deaths are from social tragedies like opioid overdoses and suicides, but there were also increases in deaths from various types of organ failure. Much of the nuance of cause and effect is yet to be elucidated, but one clue I notice is the geographic distribution of the worst loss of life expectancy, which was in New England and the Ohio valley, especially areas hit by economic downturn and substance abuse. Other data showed that adjacent states, like Alabama and Georgia, in which one expanded Medicaid access under the Affordable Care Act and the other did not, showed divergent trends. And, though it is politically unpopular to mention, states with stronger firearms restrictions, like California, did not join the rest of the nation in the increases in gun-related deaths.

These and other data scream that access to affordable health care results in improved survival, yes, but also improved ability to work, go to school, raise a family, all the things we say are part of the American dream; but even modest expansion of benefits is resisted because of the partisan dysfunction rampant in the country. The opioid epidemic got major public attention after affluent kids started dying from overdoses. We pay exorbitant prices for new miracle drugs without cogent social debate. Pharmaceutical companies must be profitable, I get it, I have drug company stocks in my portfolio, but where is the demonstration of value?

I don’t have answers for all these disturbing trends, but I do know that if the American population saw this as the crisis it is, change could happen. Third-world type outcomes in the economically and socially disadvantaged segments of the country don’t get our attention. Maybe the fact that we are getting ripped off will.

1UNICEF, https://data.unicef.org/topic/maternal-health/maternal-mortality/ , posted Sept. 2019, accessed 12/11/19.

2Woolf & Schoomaker, “Life Expectancy and Mortality Rates in the United States, 1959-2017,” JAMA 322(20), 1996-2016, 2019. doi:10.1001/jama.2019.16932
Coffin photo by Rhodi Lopez on Unsplash