What’s Good About U.S. Healthcare
We hear a lot lately about the problems with healthcare in the United States. While the need to improve quality and decrease costs is real, let’s not forget to celebrate what is good about the US healthcare system.
In today’s commentary, I’d like to share a bit of history to emphasize one point: our healthcare is the best the world has ever seen!
Consider these simple examples:
- From 1900 to 2010, average life expectancy at birth increased from only 49 years to almost 79 years.
- Since 1960, age-adjusted mortality from heart disease (the #1 cause of death) has decreased by 56 percent.
- Since 1950, age-adjusted mortality from stroke has decreased by 70 percent.
Why so much progress over the last 100 years? Let’s explore a few historical trends together.
The Emergence of Modern Medicine
For much of history, if you were ill or injured and saw a physician, your chances of survival actually went down. Hospitals were where people went to die. Actually, hospitals were where the poor went to die. If you had any resources at all, you invited a physician into your home … and you died at home.
Just prior to 1900, this all changed profoundly. I credit the change to four impactful advances in the medical profession:
- New high standards of clinical education
- Strict requirements for professional licensing
- Clinical practice founded on scientific research
- New internal organization for hospitals
Since that time, we in the medical profession routinely achieve miracles.
A Century of Strides in Public Health and Patient Care
Let’s return to the change in life expectancy in the U.S. since 1900. The graph below shows that a child born in 1900 had a life expectancy of just shy of 50 years. For a child born 110 years later, the life expectancy is 78 years—an increase of over 28 years! This is an amazing accomplishment and, frankly, something unseen in the prior 6000 years of recorded human history (where life expectancy remained relatively flat).
A lot of this increase can be attributed to improvements in public health. That’s why the first half of the 20th century could be called the Public Health Era. Because of public health advances, there was a gain of about 3.5 years in life expectancy with each passing decade. The increase was largely due to avoiding epidemics of infectious disease like cholera, typhus and smallpox.
Then, sometime between 1950 and 1960, two things happened:
- We largely tapped out (though not completely) public health as a major source of increase in life expectancy.
- For the first time, we begin to document gains in life expectancy in the population as a whole from treatment provided in hospitals and clinics. You’ll notice that the curve on the graph flattens out a bit at this point—a gain of about 1.3 years of life expectancy per decade. Though less than the public health increase, against the sweep of human history, the gain driven by clinical care is phenomenal.
We stand on the foundation of 100 years of science that have massively improved our understanding of the human organism in health and disease and given us thousands of ways to improve the wellbeing and life expectancy of patients.
Only in the last 60 years have we been able to show that clinical care can make a difference. This is in the lifetime of many people involved in healthcare today. We can do more than just predict whether a patient will live or die. We can actually change the outcome. We are the first generation of clinicians that can make that claim. That’s something that I’m proud and excited to be a part of.
Why the History Lesson?
All of this history is important, because it changes how we think about the present and future. No doubt, we face many challenges. As healthcare increasingly contributes to the national debate, let’s debate in the context of the phenomenal progress we’ve made and the progress we’re capable of making. And let’s remember that at least 95 percent of our peer clinicians get up every day seeking to be the best they can be for the patients they serve. They hold deep-seated professional expertise and a passion for quality that can be tapped as we seek to address the challenges and transform the system.
What is good about the U.S. healthcare system from your perspective?