Ingrained in the American ethos is “life, liberty and the pursuit of happiness” – and, by tacit assumption, the longevity to achieve these latter two. The desire to live as long as possible is what drives people into the arms of the medical establishment when they become sick. So it is not surprising that many people, including those who comment on the quality of our health care system, often equate longevity with the quality of health care. But how related are these two things, really?
In the United States, the average life expectancy currently stands at 78.1 years. American longevity actually compares rather unfavorably with other technologically advanced countries, including Japan (82.1 years), Sweden (80.7 years) and the United Kingdom (78.8 years). Indeed, though we Americans spend a much higher portion of our GDP on health care than any of these other nations, our life expectancy does not measure up to Japan, Sweden or the UK. The comparatively inferior life expectancy of Americans often leads to charges from the commentators of poor care, wasteful spending, medical mis-management, and other evils.
Health care necessarily comprises two parts: “health” and “care”. By “health”, I mean the underlying health of a populace – how sickly or robust is the average citizen? By “care”, I mean the quality of medicine and ministrations that are conferred upon the populace. These two distinct, and relatively independent, components both impact the longevity of a population.
Consider, for example, a military battalion that is populated by young, healthy men and women. They are cared for by a state-of-the-art mobile medical team, which is highly trained and for which no expense has been spared. If this military battalion were to spend 50 years idle, with no wars to fight, then the life expectancy of these people would be quite high – perhaps higher than the 78.1 years of the average US population. However, if we put these young people into battle, their health would obviously suffer, and they might succumb to their wounds, despite outstanding care. The life expectancy of a battalion at war would surely be much lower than America’s 78.1 years, despite world-class and dedicated medical care. Hence, the life expectancy of any group of people depends on their quality of care, but also upon how sick they are.
In America, our unhealthy lifestyle is one of our biggest handicaps. The American Heart Association says that fully 67% of Americans are overweight, and 33% are actually obese. We consume large amounts of processed foods while leading sedentary lifestyles. We suffer from extraordinarily high rates of diabetes, high blood pressure, and heart disease, mostly because of our unhealthy lifestyle. But if we are unfortunate enough to develop heart disease, our chances of dying in the first year in the US are actually half of what they are in the UK. Furthermore, survival from many types of cancer is substantially greater in the US than in other countries. Indeed, for pancreatic and lung cancer, the 5-year survival rates in the US are twice what they are in the UK. How can it be that Americans survive longer from heart disease and cancer – the two biggest killers in the western world – and yet have a lower life expectancy than the Brits and other Europeans? The answer, of course, lies in the fact that we Americans are tremendously unhealthy to start with. We get sicker earlier, and more often. Even though our health care system manages to keep us alive longer after we get sick, the net effect is that we don’t live as long as many westerners.
Those who propose to revamp America’s health care system, based upon the premise that it delivers poor care, should consider the realities of how well sick people do in America as compared to elsewhere. By equating life expectancy with quality of medical care, we are making a fundamental intellectual mistake, that could very well cost us the most effective health care system in the world.
