Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

American health care: the best of times and the worst of times

Henry Buchwald, MD, PhD
Policy
August 26, 2022
Share
Tweet
Share

An excerpt from Healthcare Upside Down: A Critical Examination of Policy and Practice.

“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair.”
– Charles Dickens: A Tale of Two Cities

Setting: TV quiz show

Story participants: TV Host, Contestant, United States TV Audience

Host: Name at least two of the three NFL quarterbacks of all time with the highest career passer ratings up to 2020.

Contestant: All three have ratings over one hundred. They are Deshaun Watson, Aaron Rogers, and Russell Wilson.

Host: Correct! You got all three.

Audience: Response of millions—I knew that! I could have gotten that one!

Host: When did Dow Jones Industrials first exceed thirty thousand, month and year?

Contestant: November 2020

Host: Correct!

Audience: Response of millions—I knew that! Big day!

Host: What was Marilyn Monroe’s biggest box office hit?

Contestant: Some Like It Hot.

Host: Correct!

Audience: Response of millions—I knew that! Too easy!

Host: United States life expectancy among all nations ranks … I’ll accept an approximate answer.

Contestant: Not sure. I would say close to the top, within the top ten.

Host: Wrong! Not even close. It is 40 or lower out of 200, not even in the top quarter of all nations.

Audience: Response of millions – Wow!

With regard to health care in the USA, the quote from Dickens is twice correct. We are in the best of times for knowledge, capability, and potential. We also are in the worst of times with regard to the application of our knowledge and the outcomes achieved, especially when compared to other nations.

The USA has a proud history of medical firsts. We have the largest number of Nobel laureates in physiology or medicine, in technologic advancements, and in the highest quality of health care—for certain individuals. At the same time, we are not world leaders, not even close, when we examine the global statistics of life expectancy, mortality rate, potential life lost years, specific diseases mortality, infant mortality, derived amenable mortality to health care, health care access and quality index, and availability of health care. These are the parameters used to measure health care and in all of them, given our potential, we are failures, losers in compari­son to comparable industrial nations. Yet, we pay much more in dollars per capita and in percentage of our gross national product (GNP) for health care than any other nation.

The best way to illustrate these facts that govern our lives is to examine available statistics. In looking at the numbers, it is essential to appreciate their real-life impli­cations. Today’s newspaper articles, as well as some scientific articles, will make “statistically valid” claims—by a convention defined as the probability of being factual if something occurs 95 out of 100 times, a criterion fairly useless in the real world. In selecting the statistics for this section, I have used only meaningful real-life data where the numbers represent actual deaths, lives saved, and the quality of life experienced.

Life expectancy

One often hears the statement that life expectancy at birth in the USA in the past 160 years has almost doubled from 39.4 years in 1860 to 79.1 years in 2020. So, however, has life expectancy from birth in the rest of the world, and the USA is not in the top quarter of all nations. According to the United Nations estimates, Hong Kong, the leading country, in 2020 had an overall life expectancy of 85.29 years (88.17 females, 82.38 males). The top ten countries in life expectancy in 2020 were in order: Hong Kong, Japan, Macao, Switzerland, Singapore, Italy, Spain, Australia, Channel Islands, and Iceland. The USA was ranked below Cuba and Estonia at 46 out of 193 (the US total 79.11 years, females 81.65, males 76.61). The USA ranked six years in life expectancy below Hong Kong, about three years below our neighbor, Canada, and about two years below Great Britain. The World Health Organization (WHO) ranked the USA at 40th, and the United States Central Intelligence Agency (CIA) Factbook ranked the USA at 46th out of 227 (30th percentile).

Mortality rate

The mortality rate, or death rate, is defined as the number of deaths in a particular population during a particular period of time, usually calculated as the number of deaths per 1000 or 100,000 people per year. According to the WHO, the country with the highest mortality in 2020 was Bulgaria (15.4), and the country with the lowest mortality rate is Qatar (1.2). There are 227 nations on this list and the USA with a mortality rate of 8.7 is 150th from the bottom (the good end) and 77 from the top (the bad end); in fact, the USA is among the 35% of the nations with the highest annual mortality rate in the world. Annual overall mortality rate has declined over the past 40 years, primarily due to advances in cancer and heart dis­ease therapy, but the USA consistently lags behind comparable industrial nations

Potential life lost years

A common statistic of premature mortality is the age-specific potential life lost years (PLLY) per 100,000 population, determined by subtracting the age of death from an arbitrary life expectancy of 70 or 75 years (at the discretion of the reporting agency). This statistic can be applied to specific disease categories for comparisons among nations. According to Health System Tracker, the USA has lower PLLY for all cancers than comparable industrial countries; however, the USA has higher rates for diseases of the circulatory system (including heart disease), the respiratory system, external causes of mortality (including accidents), mental and behavioral disorders, diseases of the nervous system, and endocrine, nutritional, and metabolic diseases, as well as total PLLY.

Henry Buchwald is a surgeon and author of Healthcare Upside Down: A Critical Examination of Policy and Practice.

Image credit: Shutterstock.com

Prev

Urging patience with patient self-advocacy

August 26, 2022 Kevin 0
…
Next

Getting an appointment with primary care is the Achilles’ heel of medicine [PODCAST]

August 26, 2022 Kevin 1
…

Tagged as: Public Health & Policy

Post navigation

< Previous Post
Urging patience with patient self-advocacy
Next Post >
Getting an appointment with primary care is the Achilles’ heel of medicine [PODCAST]

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • Why health care replaced physician care

    Michael Weiss, MD
  • Health care is not a service commodity

    Peter Spence, MD, MBA
  • A week in the worst health care system in the world

    Matthew Hahn, MD
  • Melting the iron triangle: Prioritizing health equity in dynamic, innovative health care landscapes

    Nina Cloven, MHA
  • Why the health care industry must prioritize health equity

    George T. Mathew, MD, MBA

More in Policy

  • Uncovering the truth about racial health inequities in America: a book review

    John Paul Mikhaiel, MD
  • Why affirmative action is crucial for health equity and social justice in medicine

    Katrina Gipson, MD, MPH
  • The untold story of Hispanic/Latino health: Why subgroup data matters

    Matthew B. Alonso
  • Unmasking the brutal reality of gun violence in America: a call to action for unity and meaningful change

    Osmund Agbo, MD
  • Family physicians unite at the U.S. Capitol, seeking congressional support for Medicare reform and health care transformation

    Tochi Iroku-Malize, MD, MPH, MBA, Sterling N. Ransone, Jr., MD, and Steven P. Furr, MD
  • Breaking down barriers: Illinois bill calls for cultural competency training for physicians to improve health care for LGBTQ+ community

    Michael Pessman
  • Most Popular

  • Past Week

    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • Unmasking wage disparity in health care: the truth behind the Elmhurst Hospital physician strike

      Kevin Pho, MD | KevinMD
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • Emulating Michael Jordan’s winning mindset: a path to success for health care professionals and entrepreneurs

      Harvey Castro, MD, MBA | Physician
    • How electronic health records preserve patients’ legacies in the words of oncologists

      Marc Braunstein, MD, PhD | Physician
    • Unmasking the brutal reality of gun violence in America: a call to action for unity and meaningful change

      Osmund Agbo, MD | Policy
  • Past 6 Months

    • The growing threat to transgender health care: implications for patients, providers, and trainees

      Carson Hartlage | Policy
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • Uncovering the truth about racial health inequities in America: a book review

      John Paul Mikhaiel, MD | Policy
    • Why electronic health records are failing patients: the dark side of copy and paste [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • The surprising medical mystery of a “good” Hitler: How a rescued kitten revealed a rare movement disorder

      Teresella Gondolo, MD | Conditions
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • 'Medically Relevant to Saving the Life of Your Patient': What We Heard This Week
  • Want to Solve the Nurse Shortage?
  • Why Are Female Doctors Sued Nearly Half as Often as Male Doctors?
  • What Drug Did FDA Just Approve for COVID?
  • PET Scan for Alzheimer's Dx; Predicting Colon Cancer Survival

Meeting Coverage

  • No Access to Routine Healthcare Biggest Barrier to HPV Vaccination
  • Trial Results Spark Talk of Curing More Metastatic Cervical Cancers
  • Cross-Border Collaboration Improves Survival in Pediatric Leukemia Patients
  • Monoclonal Antibody Reduced Need For Transfusions in Low-Risk MDS
  • Less-Invasive Surgery for Pancreatic Cancer Proves Safe, Effective
  • Most Popular

  • Past Week

    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • Unmasking wage disparity in health care: the truth behind the Elmhurst Hospital physician strike

      Kevin Pho, MD | KevinMD
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • Emulating Michael Jordan’s winning mindset: a path to success for health care professionals and entrepreneurs

      Harvey Castro, MD, MBA | Physician
    • How electronic health records preserve patients’ legacies in the words of oncologists

      Marc Braunstein, MD, PhD | Physician
    • Unmasking the brutal reality of gun violence in America: a call to action for unity and meaningful change

      Osmund Agbo, MD | Policy
  • Past 6 Months

    • The growing threat to transgender health care: implications for patients, providers, and trainees

      Carson Hartlage | Policy
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • Uncovering the truth about racial health inequities in America: a book review

      John Paul Mikhaiel, MD | Policy
    • Why electronic health records are failing patients: the dark side of copy and paste [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • The surprising medical mystery of a “good” Hitler: How a rescued kitten revealed a rare movement disorder

      Teresella Gondolo, MD | Conditions
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...