Health Care Reform – A Reasonable Risk: Building On 75 Years Of Progress

Posted on | March 14, 2012 | No Comments

Mike Magee

With the Presidential Election just around the corner in the U.S., jobs and the economy are the #1 issue on most voters lists – but healthcare is right behind because healthcare is a huge job creator and has a huge impact on national and individual economies.

Of course the big debate in healthcare isn’t so much a disagreement about reform – nearly everyone agrees that we need to pursue quality and safety on the one hand, and efficiency and cost savings on the other. It’s about how exactly we go about it.

One question worth asking is “How well have we done in the past and why?” To this, some query, “Compared to what?” But putting that aside for a moment, and excluding the escalading and unsustainable expense of our current bias toward over-consumption, how have we done in the past 75 years on one broad measure – mortality?

Well, the simple answer is “Pretty darn good!” The CDC analyzed our performance(1) from 1935 to 2010 and here’s what they found:

1. Although single year improvements in mortality were often small, the age-adjusted risk of dying dropped 60 percent from 1935 to 2010.
2. The risk of dying decreased for all age groups but the progress  for younger age groups was astounding with a 94 percent reduction in death rates at 1–4 years compared with a 38 percent decline at 85 years or more.

A few details on female/male and race disparities. First the good news – everyone’s improving. And the bad news – we still have a ways to go. Specifically:

1. Age-adjusted death rates were consistently greater for males than females. For example, 65 percent higher than those for females between 1975 and 1981 compared with 40 percent higher in 2010.

2. The risk of dying decreased for all race subgroups of the U.S. population from 1935 to 2010; however, differences persisted between groups (the gap was the widest between 1988 and 1996).

What are we dying from, and retrospecively, what has influenced our performance? Well, as for the dying part, heart disease, cancer, and stroke were among the five leading causes every year between 1935 and 2010.

As for the living part, and more specifically the influencers that allowed us to survive, here’s the CDC’s viewpoint:

“While the overall risk of mortality decreased 60 percent over this 75-year period, there were fluctuations in the rate of decline most likely associated with changes in the broader environment. For example, the 29 percent decline in age-adjusted mortality in the earlier period from 1935 to 1954 was probably influenced by the introduction of various drugs such as antibiotics (2). In contrast, in the period 1955 to 1968, age-adjusted death rates decreased by only 2 percent, influenced in part by increases in diseases linked to tobacco use such as cancer and chronic lower respiratory diseases (3,4). In the most recent period from 1969 to 2010, significant progress in the prevention, diagnosis, and treatment of cardiovascular diseases (5) likely contributed to the 41 percent decline in age-adjusted mortality despite cancer continuing to increase from 1969 to 1990 and chronic lower respiratory diseases continuing to increase from 1969 to 1998.”

Finally, why do we sometimes feel like we’re standing still? Says the CDC, “Because year-to-year changes in death rates are often small, one might not appreciate the full extent of progress in reducing mortality in the United States over the past ¾ of a century. For example, the 2010 age-adjusted death rate of 746.2 deaths per 100,000 population was just 0.5 percent lower than in 2009. However, the 2010 rate represented a 60 percent decrease from the 1935 age-adjusted death rate of 1,860.1 deaths per 100,000 population signaling significant progress in reducing the overall risk of death in the United States across all groups.”

Does this mean we don’t need reform? Hardly! The way we made progress was by forging ahead – discovering the causes of disease, fighting big tobacco and pollution and unsafe labor and manufacturing, improving fetal and maternal health through targeted services, protecting vulnerable seniors and providing insurance coverage, and supporting innovative groundbreaking research. In all of this, our government proudly led – and in all cases it partnered with private enterprise.

We have this track record because we cared, we tried hard, and we fought the status quo. What has been proposed and is being enacted falls clearly under the heading of “reasonable risk”, and deserves our support.

For Health Commentary, I’m Mike Magee

References:

1. NCHS Data Breifs: 75 Years of Mortality In The United States, 1935-2010.http://www.cdc.gov/nchs/data/databriefs/db88.htm

2.Moriyama IM. The change in mortality trend in the United States. National Center for Health Statistics. Vital and Health Stat 3(1). 1964.

3.Shopland DR. Tobacco use and its contribution to early cancer mortality with a special emphasis on cigarette smoking. Environ health Perspect 103(Suppl 8): 131–42. 1995

4.  Akinbami LJ. Chronic obstructive pulmonary disease among adults aged 18 and over in the United States, 1998–2009. NCHS data brief, no 63. Hyattsville, MD: National Center for Health Statistics. 2011.

5. Ford ES, Capewell S. Proportion of the decline in cardiovascular mortality disease due to prevention versus treatment: Public health versus clinical care. Annu Rev Public Health 32: 5–22. 2011.

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