The message that the healthcare industry in the United States is broken is a popular refrain from just about every corner these days. It is true that we need to bring greater clarity, transparency and rationalization to healthcare costs while improving access, and we need to empower consumers and align incentives in ways we have yet to sort out. However, while all of this is true, there is a great deal to celebrate about the US healthcare industry and all the good it does. In the last 60 years the evolution of clinical care has made dramatic strides in increasing average life expectancy and decreasing mortality from many diseases all while improving healthcare quality in the United States for patients. That is something to be proud of.
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. (1)
U.S. firms conduct the majority of the world’s research and development in pharmaceuticals and hold the intellectual property rights on most new medicines. The biopharmaceutical pipeline also has over 5,000 new medicines currently in development around the world with approximately 3,400 compounds currently being studied in the United States - more than in any other region around the world. (2)
At the beginning of the 20th century, for every 1000 live births, 6-9 women in the US died of pregnancy-related complications, and 100 infants died before age 1 year. By 1997, the infant mortality rate declined greater than 90% to 7.2 per 1000 live births, and the maternal mortality rate declined almost 99% to less than 0.1 reported death per 1000 live births. (3)
Tuberculosis was the second-leading killer in 1900. There's actually a fierce debate in the medical community over whether it was drugs that licked tuberculosis or changes in lifestyle but in 2012, there were no deaths from tuberculosis reported in the US which is down from 20,000 in 1953 (although there is much work yet to be done as too many people throughout the developing world still suffer and die from this disease) (4)
In 1900, more than 800 people per 100,000 in population died annually from an infectious disease, today that number is less than 20 (4)
The advent of laparoscopy has vastly improved the patient experience for surgical procedures such as cholecystectomy (gallbladder removal). Laparoscopic cholecystectomy decreases postoperative pain, decreases need for postoperative analgesia, shortens hospital stay from 1 week to less than 24 hours, and returns the patient to full activity within 1 week compared to 1 month after open cholecystectomy. In 1990, 10% of cholecystectomies were being performed laparoscopically. By 1995, 10 years after the introduction of LC, close to 80% of cholecystectomies were being performed laparoscopically.(5)
So there is much to feel good about when we talk about the state of the US healthcare system and what it has accomplished in improving people’s health. Yes, we have a lot of work to do to perfect the payment models and increase access but if the next 100 years have been like the last in terms of improving health status, there is much to look forward to.