Blog on the Run: Reloaded

Friday, July 12, 2013 7:51 pm

“Best [health care] in the world, my ass.”

Aaron Carroll at the Incidental Economist brings the pain:

There’s a ridiculously fantastic manuscript over at JAMA that you should go read right now. “The State of US Health, 1990-2010: Burden of Diseases, Injuries, and Risk Factors“: …

I’m a health services researcher, and I’m obsessed with outcomes. One of the first major projects of this blog was a two-week series on quality in the US health care system. I’ve written numerous times about what kills us. This study specifically looked at the burden of disease, injuries, and risk factors in the US versus other countries. The methods are amazingly detailed.

So how did we do compared to other countries? Not well. Between 1990 and 2010, among the 34 countries in the OECD, the US dropped from 18th to 27th in age-standardized death rate. The US dropped from 23rd to 28th for age-standardized years of life lost. It dropped from 20th to 27th in life expectancy at birth. It dropped from 14th to 26th for healthy life expectancy. The only bit of good news was that the US only dropped from 5th to 6th in years lived with disability.

There’s a chart I’d like to highlight. This is the rank of age-standardized years of life lost rates among the 34 OECD countries in 2010.  The numbers in each cell show the rank of the country in years of life lost for each cause (1 is best). The countries are sorted overall on age-standardized all-cause years of life lost.  The colors show if the age-standardized years of life lost for a country is significantly lower than the mean (green), indistinguishable from the mean (yellow), or higher than the mean (red) for all OECD countries. …

Things don’t look so good for the US. There’s an awful lot of red there. A little bit of yellow. One green. Best in the world, my ass. …

What we have here is a prioritization issue. We spend a lot of time worrying about colon cancer. It’s ranked 11th in 2010. We spend a lot of time worrying about breast cancer. We have walks, and ribbons, and whole months dedicated to it. It’s ranked 13th. Prostate cancer? Men are obsessed with it. It’s ranked 27th. But more years of life are lost to lung cancer than to prostate cancer, colon cancer, and breast cancer combined. Ischemic heart disease causes four times as many years of life to be lost each year as prostate cancer, colon cancer, and breast cancer combined. Stroke is 3rd. COPD is 4th. Traffic accidents are 5th. Suicide is 6th. None of these things get the national attention, or resources, that they deserve. [emphasis added]

In short, we have a lousy health-care system, and the reason we have a lousy health-care system is because we choose to have a lousy health-care system. This isn’t about Obamacare, or health insurance in general, or even how much money we have available to spend on health care. It’s about where we put our research and treatment dollars, and the study shows we’re not putting them anywhere near where they would do the most good. That’s a problem we can fix, but we have to choose to fix it.




  1. I am totally agreed with your point lex, our governments should emphasize more to reform the health care system of their countries. I have read somewhere that US government spend 2.5 trillion dollars a year on health care system which is great but after reading your blog i think there are many loop holes left to be taken care of. I am an Irishmen and i have to tell you that we spent 8.2 % of our GDP on health care and health related problems which is very less as compared to yours but the health care structure and policies here are so great that many developed countries take a lesson from these.

    Comment by Ross Gallor — Monday, July 15, 2013 2:31 am @ 2:31 am | Reply

  2. Ross, I’m not familiar specifically with the relative advantages and disadvantages of U.S. v. Irish health care, but I do know that we pay far more per capita than other OECD countries for care and get, on the whole, mediocre results or worse. If there are any lessons we can take from the Irish system, we should do so, if we can get our bought-and-paid-for Congress to actually focus on the problem rather than on the demands of large contributors in the drug, device and insurance industries.

    Comment by Lex — Monday, July 15, 2013 10:44 am @ 10:44 am | Reply

  3. I think it’s great. Keep up the good work. I will help spread the word. Good articles, I think you care a lot about what you are doing.

    Comment by pedro pliester — Thursday, August 22, 2013 12:54 pm @ 12:54 pm | Reply

RSS feed for comments on this post. TrackBack URI

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Create a free website or blog at

%d bloggers like this: