There are a number of points of view that argue that life expectancy is not the best total outcome to measure effectiveness. While I agree in principle, I disagree with the arguments presented. Generally, the argument against using life expectancy (or infant mortality) comes down to the fact that they don’t measure outcomes when interacting directly with the care system. In other words, if I mortally injure myself shooting off fireworks on July 4th and die before paramedics can treat me, they argue that my premature death should not be counted against the healthcare system.
Avik Roy’s piece “The Myth of Americans’ Poor Life Expectancy” expands upon this point, and even includes a counterpoint – that the US has the highest cancer 5-year survival rate in the world.
In certain situations, they have a point. Dangerous irresponsibility or absurd misfortune are not the responsibility of care providers to mitigate. And looking from purely a talent perspective, the US is hard to beat when it comes to surviving an exotic or life-threatening condition.
Conversely, what the data tells us is something that is already widely discussed – that the US healthcare system is a misnomer. It is a reactive, “sickcare” system that is rather ineffective at preventive screening and intervention, and relies heavily on surgery and expensive invasive therapy to stop issues after they have become huge problems.
As a consumer of healthcare, it is not a reassuring argument to say that my stroke or heart attack survival rate is much higher in the US than anywhere else. Congenital heart problems aside, a heart attack for a young person represents a massive failure of the primary care system. That I can pay exorbitant healthcare insurance premiums for decades, only seeing a care provider maybe once every one or two years while cardiovascular disease slowly kills me from the inside, should be a signal that the reactive way of practicing medicine that dominates care delivery in the US is broken. As a consumer of healthcare, I would rather have a system that is effective at early detection and intervention of preventable diseases than one that relies on the heroics of clinicians to save my life at the brink.
Instead of measuring by life expectancy, we can measure by Type 2 Diabetes prevalence, Hyptertension prevalence, Cardiovascular Disease deaths, or Obesity Rate. All of these issues generally result in increased contact with the medical system over time.
Next to other OECD nations, the US obesity rate compares even worse than its relative life expectancy rate. Even going back to the cancer survival rate argument, studies have shown that certain types of cancers such as esophagus, colorectal, gall bladder, pancreatic, prostate, post menopausal breast, non-Hodgkin’s lymphoma, and leukemia all have significant positive associations with obesity.
Looking at Cuba – a nominally poor country that nonetheless has an average life expectancy just one year less than that of the US – we can see to what extent our approach to healthcare is poorly designed.
Recognizing that it could not afford to be reactive in health management, Cuba focused over the past four decades on building out infrastructure for multi-specialty community based clinics in order to deliver proactive preventive care services to the entire population. There are focused efforts on gathering population health data for responsive deployment of preventive care resources around issues such as smoking cessation, hypertension, or allergies.
Perhaps the resistance to acknowledging our systemic failures comes from a fear that the only answer is socialized medicine. But a debate on socialized medicine focuses too much on the wrong issue – the political philosophy – and not enough on maximizing the overall quality of the healthcare product. In reality, we need to focus on identifying the best way to reduce the cost and prevalence of preventable conditions. The answer should have nothing to do with ideology.