Longtime readers of the blog know of my longtime love obsession hate fascination passion focus on life expectancy as a metric of quality. YES I KNOW IT HAS FLAWS. But still, at some point, we have to acknowledge that it has some uses, no?
Austin has an awesome post up on a recent paper that really digs in. If you haven’t read it yet, go read it now. I thought about it a lot, and there’s a thought I’d like to add to it.
One of my issues with the arguments people muster against life expectancy is that they are all so small. They attack some individual behavior or factor that might affect life expectancy in some minimal way, but nowhere near enough to cause the big differences we see. It’s smoking. It’s drinking. It’s accidents. It’s immigrants. It’s chemicals in the water. It’s stupidity. It’s suicide. It’s freedom.
It doesn’t matter that tons of these arguments are just plain wrong. It doesn’t matter that even after you eliminate them from the equation, our life expectancy still sucks. People hold on to them like crazy because they don’t want to believe that it could be the health care system.
What I love about this new paper is that it looks at so many aspects of health, and in so many of them it seems that we’re lagging in terms of preventing mortality. When you see something like that, you can either try and believe a million things are going on, or adopt one simpler answer – the health care system may need improving.
What I also love is that the conclusions get away from the usual arguments about access and focus on the actual delivery of care. The problem is how fragmented we are, that we “favor procedures over comprehensive longitudinal care, and absence of organizational strategy at the individual system level.”
Somehow life expectancy has become a partisan issue. It shouldn’t be. Moreover, trying to fix our system so that it provides more comprehensive and organized care would improve overall quality, not just mortality. Don’t we want that? Who doesn’t?
Sometimes admitting we have a problem is the first step towards fixing it.
