Yesterday, I threw up a chart that graphed life expectancy and health care spending. I didn’t put in any context, nor did I spend a lot of time explaining that life expectancy is an imperfect metric, because I’ve done that many times before.
My point is this. As a number of people pointed out to me on Twitter and in emails, life expectancy may not be a good metric of public health, but as a friend put it, “it seems like one of the central goals of health care is to keep people not dead longer. Not the ONLY goal..but a big one.”
Plus, this. Our system has to have some impact on life expectancy. Anyway, here are a few of the many thoughts I had reading your comments and tweets yesterday:
-Even if you dispute that life expectancy is a good metric of the quality of a health care system, can we agree that the life expectancy in the richest, most resourced country in the history of the world is a problem? Even if you don’t think it’s “the health care system”, do you think it’s OK? How can you defend this, period?
-Please stop with the “we define life differently at 24 weeks” thing. That’s been tested, and found not to be the cause of the infant mortality differences. Plus, we give the OECD this data. They don’t steal it in the middle of the night. If we really thought we were being measured unfairly, we could fix it.
-Please stop with the whole “it’s all violence thing”. I don’t care how big a blog said it. I already went through that one, in detail, and everyone who keeps saying it has never once acknowledged the arguments made in that post.
-Please stop telling me that we should spend this much because we’re so rich. All I hear about is how we’re spending too much as a country, and can’t afford things like SNAP and infrastructure.
What bothers me most is not that we’re all the way on the right, or even that we are lower than we should be. It’s that we are all alone. We are spending so, so, so much more than everyone else. It’s not an even spread. I don’t want to get into arguments about the fit of the line, or about the fact that there’s a cutoff. It’s that those countries – representing lots more people than the US, by the way – are all in a reasonable relationship of more spending correlated with more life, to a point. Then there’s us. The difference is so large, it must be defended. It must be justified. What are we spending the money on, if not extending life?
This question is especially important given the fact that we have so many people uninsured and barely able to access the system at all. We have so many people who don’t feel like they spend enough time with their doctors, or feel like they have to avoid care because of the cost.
What are we doing?
You want to spend this much money, fine. But I would love to see some similar charts showing the United States in a class by themselves, on some metric of actual quality.** Then, this might all make sense. Until then, this seems like a lot of waste.
**Don’t you dare show me survival rates.