Why this graph is wrong:
Since I was an MPH student in 2005, this graph has always haunted me. How is it that in a country where over the past century we have done incredible things we cannot make a dent in life expectancy at birth? On the face of things, the United States looks worse than any other ‘developed’ countries. However, dig a little deeper and you will find a completely different story.
The main assumption in any graph is that there is a relationship between the dependent and independent variables. You may recall from algebra that y= mx+ b. The dependent variable y is affected by the slope of the curve for the independent variable x. The steeper the curve, the stronger the relationship. As you can see for the United States, the slope is flat. What this really tells us is that in the United States, there is NO relationship between healthcare expenditures and life expectancy at birth. I am emphasizing this obvious point because we will need different approaches to fix healthcare expenditures and life expectancy at birth.
Let us begin with life expectancy at birth. What does this really mean? For example, let us calculate the life expectancy at birth for a cohort of 4 people: 3 live until 90 and 1 lives until the age of 20. The life expectancy for this cohort (90*3+20)/4) is 72.5 years. It does not mean that on average you will live to 72.5 years old. As you can see, if we are to improve life expectancy, we need to figure out why so many of our people die early in life.
From 1900 to 1980, worldwide life expectancy had nearly doubled from 35 to around 70. Many attribute this climb in life expectancy to better sanitation, containment of communicable disease and improvements in child mortality rates. Rapid technological advances in agriculture probably had the largest effect on life expectancy through eradicating worldwide poverty. We saw this in India in the 1960s where millions of people were saved from destitute lives with the agricultural revolution.
From the 1980s onward, improvements in life expectancy have been murkier. Nowadays, the main reasons people die in and before early adulthood are infant mortality, car accidents, drug overdoses, violent crimes, and emerging communicable diseases. Life expectancy has become a political issue where we have needed to balance our individual freedoms for the health of our society. As a country that was founded on individual liberties, it is no wonder that we are struggling to keep up with the rest of the ‘developed’ world.
Runaway healthcare expenditures are uniquely far more complicated issues. As a proportion of the Gross Domestic Product has increased from 5% in 1970 to nearly 20% today. To put this into perspective, we have gone from spending 1 in every 20 dollars on health care to 1 in every 6. These expenditures have profound effects on our government spending and the cost of manufacturing where health insurance is a 15% ‘tax’ on all goods and services.
The people that are doing the most to change this are at the Value Institute for Health and Care at Dell Medical School. The concept is simple: how do we get more value from our healthcare dollars? Value is defined as outcomes that matter most to patients/ total healthcare costs. For this model to succeed, we need honest discussions between patients and their doctors. For every medical procedure we should be asking ourselves what we expect in terms of cost (time rehabilitating, pain, and suffering) versus benefit (will my shortness of breath really go away once I undergo a bypass surgery? Will my shoulder range of motion be that much better after my surgery?) These conversations take time and are built on truthful doctor-patient relationships. Unfortunately, with higher demands for physicians to see more visit encounters over building patient relationships, it is no wonder that it is becoming harder to do so nowadays.