This commentary was originally featured in The Hill on January 10, 2018.
When David Blumenthal speaks, people listen. Unfortunately, when the president of the Commonwealth Fund, a distinguished foundation specializing in health care analysis and reform, contends that a “drop in U.S. life expectancy is an indictment of the American health care system,’” he misspeaks.
His indictment was based on a recent report from the Centers for Disease Control and Prevention that life expectancy for the U.S. population had decreased 0.1 year, from 78.7 years in 2015 to 78.6 years in 2016. He described it as “abysmal new life expectancy data.”
Really? When I was born in 1943, my life expectancy was 62 years. That was 74 years ago. Things appear to be looking up, not down.
The Commonwealth Fund is not the first, merely the latest, organization to assign responsibility for Americans’ life expectancy incorrectly to the health care system. It seems to be common wisdom with the National Center for Biotechnology Information, Our World In Data, and the Washington Post all coming to the same incorrect conclusion. They blame health care when the fault lies elsewhere.
Without doubt, the U.S. health-care system has huge problems. We are spending twice what others are spending, can’t afford it, and not getting value for what we spend. There is both fraud and abuse as well as massive bureaucratic diversion that takes funds away from care services. Worst of all, many Americans don’t get the care they need when they need it.
Despite all these problems within the U.S. health-care system, the fact that Americans “only” live on average 78.6 years and Japanese life expectancy is 83.7 years cannot be laid at health care’s doorstep.
National longevity is much more affected by genetics, lifestyle, culture, exercise, diet, and illicit drugs than by anything doctors do. For individual patients and some groups of patients, medicine can make a huge difference. For the general population, the statistical effect of health care on longevity is minimal.
When I was in medical school, essentially all children with congenital heart disease or who contracted leukemia died. Now, more than 90 percent of them live full, productive lives. While this is intensely gratifying for those who are saved as well as the doctors and nurses who save them, the number of these triumphs doesn’t move the needle much when we evaluate longevity statistics about 320 million people.
Deaths from the opioid epidemic certainly contributes to the U.S. death rate. The increase in deaths is related to more potent illicit drug combinations such as adding fentanyl to heroin rather than an increase in the number of improper prescriptions written by doctors. How does the flood of fentanyl-heroin glassine packets from China “indict” the U.S. healthcare system?
The reality is that national longevity is in control of the people, not the physicians. Medicine cannot change our genetic code (yet), but people can decide what they eat and how they live. If U.S. longevity declines, blame ourselves, not healthcare.
The concern is that policymakers will take the wrong lesson from statistics like these and use them to push for more unnecessary control over the daily lives of Americans.
For instance, under the guise of improving health, ObamaCare mandated all Americans purchase health insurance, heavily regulated what plans had to offer and what people had to pay for, and prevented many from choosing their own health care providers.
The result, of course, has been skyrocketing health care costs and no improvement in health outcomes, while vastly limiting the freedoms of Americans to make choices for themselves.
In the early nineteenth century, Johann Peter Frank published a 6,262-page book titled, System einer Vollständigen Medicinischen Polizey or “System of Complete Medical Police.” He argued that in order to maximize productivity and advance the best interests of the state, the government must optimize the health of workers. Therefore, he continued, the state will mandate how people conduct their lives. In other words, the central government will dictate to the people what they can and cannot do. For example, pregnant women were forbidden to wear corsets: Frank believed tight corsets would prevent the growth of the fetus. All citizens were required to carry an umbrella every day to keep off the rain. Washing oneself more than once a week was forbidden as it was considered bad for skin health.
For Johann Peter Frank, welfare of the state superseded an individual’s right to choose. In this country, freedom comes first. If Americans make unhealthy choices, that is their prerogative.
When health statistics decline, such as longevity, that is an opportunity to educate the public on the choices they make and explain the consequences. But ultimately, the decision to live longer, healthier lives resides with the people. No amount of tinkering with the system or limiting our freedoms will change that.
As a physician, I understand the urge to believe that more medicine will solve all our problems, but good health and long life start with us. We the people are responsible.