Healthcare: Assumptions Kill

When I talk to people from different parts of the US, they tend to assume that healthcare across the country is “all the same” or that healthcare in their area is excellent.

In fact, neither assertion is necessarily correct.

Among the 35 countries in the OECD, the US ranks 26th in overall life expectancy and 29th in infant mortality.(1) In 1960, the US had the highest life expectancy on the planet. Now that’s far from true, and life expectancy in the US in the last year has actually regressed.(4)

However, we spend more on healthcare per capita than any other country.

Data shown for males; red and blue are below average, yellow and purple are above average
https://www.worldlifeexpectancy.com/usa/life-expectancy-by-county

Analysts and the Federal government tend to blame declining life expectancy on the opioid epidemic, liver disease and rising suicide rates. However, those factors don’t necessarily explain the huge disparities in life expectancies between different areas of the US, as shown in the map above.

There are disparities in the quality of healthcare that do align with shorter life expectancies.(2) Arkansas, Georgia, Louisiana, Nevada, Oklahoma, Tennessee and Texas are in the bottom 10 states on quality of care and have below average life expectancies for their residents.

Top 10Middle 31Bottom 10
Delaware
Iowa
Maine
Massachusetts
Minnesota
New Hampshire
North Dakota
Rhode Island
Vermont
Wisconsin
 
Alabama
Alaska
Arizona
Colorado
Connecticut
District of Columbia
Hawaii
Idaho
Illinois
Indiana
Kansas
Kentucky
Maryland
Michigan
Mississippi
Missouri
Montana
Nebraska
New Jersey
New York
North Carolina
Ohio
Oregon
Pennsylvania
South Carolina
South Dakota
Utah
Virginia
Washington
West Virginia
Wyoming  
Arkansas
California
Florida
Georgia
Louisiana
Nevada
New Mexico
Oklahoma
Tennessee
Texas
 

In many states, there are acute differences in access to quality healthcare between affluent metropolitan areas and rural communities. In California, for example coastal areas fare much better than do interior counties. In Florida, the Miami-Ft. Lauderdale area fares better than the rest of the state.

Rural areas have suffered disproportionately from hospital closings over the last 15 years. More than 113 rural hospitals closed between 2010 and 2019, with as many as 430 now on the brink of collapse. Typically, these closings are accompanied by closing of doctors’ offices and pharmacies. Further, it is now common for patients discharged from rural hospitals to be placed in rehab facilities that are more than four hours from their home.(5, 6) In areas of Mississippi, it is more than 100 miles to the nearest hospital.

If you have a heart attack or stroke, being one hour or more from a hospital may be a virtual death warrant.

Even the best hospital facilities in the US can have problems. The MD Anderson cancer center at the University of Texas has been rated as the number 1 cancer facility in the US for 15 of the last 17 years. However, a review this year by the Centers for Medicare and Medicaid Services (CMS) found serious deficiencies at the hospital that may be linked to two patient deaths. (3)

If the best facilities can have significant problems, just how good is your local care?

Don’t assume.

Arguably, every patient who enters a hospital needs to have a friend or family member who is willing to aggressively advocate for the patient’s care and ask and demand answers to questions. My wife has a severe iodine allergy, and that’s been a major problem at a local hospital, with nurses disregarding wrist bands. If you can’t scream under sedation, someone else has to be there to do it for you.

When I advise clients on creating living wills, having an advocate is one of the points that I stress. You cannot assume your wishes will be followed just because they are stated on paper.

Sources:

  1. https://borgenproject.org/life-expectancy-in-the-united-states/
  2. https://www.ahrq.gov/data/infographics/state-compare-text.html
  3. https://www.medscape.com/viewarticle/920973?nlid=132593_5322&src=WNL_mdplsnews_191115_mscpedit_wir&uac=153634BV&spon=17&impID=2168194&faf=1
  4. https://www.cnbc.com/2019/07/09/us-life-expectancy-has-been-declining-heres-why.html
  5. https://www.healthline.com/health-news/rural-hospitals-closing
  6. https://heavy.com/news/2019/09/rural-hospital-closings-crisis/

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