We hear a lot of wailing about the sorry state of the US health system, but a review of the twenty years from 1990 to 2010 suggests substantial progress has been made, although our relative rank among developed countries fell. (JAMA Article) Total life expectancy increased from 65.8 years to 78.2 years. Life in good health expectancy increased from 65.8 to 68.1 years. But our place among 34 other similar countries fell from 20th to 27th for life expectancy and 14th to 26th for years of healthy life. However, these numbers are not adjusted for socio-economic, demographic or other relevant factors. Major health problems accounting for much of the years of life lost to disease are arteriosclerosis , stroke, lung cancer, COPD and car accident injuries. The diseases which are growing fastest in contributing to the years of life lost are Alzheimer’s, drug use issues, chronic kidney disease, kidney cancer and falls. For years lived with disability, major causes were low back pain, depression, neck pain and anxiety disorders. Factors relating to disability and significant morbidity were dietary, tobacco use, obesity, high blood pressure, high blood sugar, alcohol use and lack of exercise. No surprise in any of this. It is intuitive that as we keep people alive longer with significant disease, there will be more years lived with disability. It is also striking that many of the sources of both early death and high morbidity or disability are within the control of individuals. Perhaps the greatest failing of our system is not putting incentives in place to encourage individual responsibility for health and not forcing individuals to accept the consequences of poor health behaviors.
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MedPAC 2019 Report to Congress
June 18, 2019
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